Objective: This case report highlights folie a duex of a caregiver that complicate the management of a case of childhood onset schizophrenia. Methods: We report a case of a young Malay girl with symptoms of schizophrenia and her caregiver who share her delusion. Result: Folie a duex in the caregiver caused difficulty in the initiation and maintenance of treatment of a child with schizophrenia. Conclusion: Treating children with schizophrenia is not easy and could be complicated by the folie a duex in caregiver. Although Child Act 2001 can be applied in order to deliver appropriate treatment to this group of patients, one must be cautious about the implication in therapeutic alliance.

Due to the nature and demands of their work, healthcare professionals, including primary care physicians, are at risk of experiencing burnout. They might feel exhausted or lack enthusiasm and motivation toward their work and other aspects of life, despite experiencing no obvious difficulties or major problems. Positive psychology is the scientific study of positive emotions, positive traits and strengths, and the processes that promote well-being and optimal functioning (or what is termed as flourishing). This article introduces readers to positive psychology and discusses the concepts and techniques in the context of burnout in primary care physicians. Suggestions are provided on how to use strategies from positive psychology to achieve happiness and fulfilment in one’s life

Aim: To study the epidemiology, clinical characteristics, vascular access, and the short term survival of ESRD patients initiated on dialysis from Hospital Queen Elizabeth (HQE). Background: The number of patients with ESRD is increasing in Sabah, Malaysia. Most patients present late and some live in remote areas with difficult access to healthcare services. Many therefore present with potentially fatal complications. Methods: All the newly confirmed ESRD patients who were initiated on renal replacement therapy (RRT) from 1 January to 31 December 2014 were included. The basic epidemiological and clinical data were collected. They were divided into three groups: Group 1 - those known to the medical service and had been prepared properly for the initiation of RRT; Group 2 - those known to the medical service, but were not prepared for the RRT; Group 3 - those with undiagnosed CKD. Outcome is mainly survival at 3rd, 6th, 9th and 12th month. Results: There were 249 ESRD patients. 153 (61.4%) were male. The average age was 53.3 (range 12 - 83). The main cause of ESRD was diabetic nephropathy (128 patients, 51.4%). Most patients were started on RRT with a catheter (74.3%), 47 patients (18.9%) with a fistula, and 17 patients (6.8%) with a Tenckhoff catheter. 185 (74.3%) patients were not prepared properly (Group 2 – 66.3%, and Group 3 – 8.0%). The survival for 249 patients were 86.3% at 6 months, 77.9% at 12 months. Group 2 has the worst survival (81.9% at 6 months, 71.1% at 12 months). Conclusions: Our data showed that most patients (74.3%) were started on dialysis in an unplanned manner with poor survival. A comprehensive and well-supported predialysis programme is needed.

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

Background: Eosinophilic gastroenteritis (EG) can mimic symptoms of common gastrointestinal (GI) disorders but responds well to appropriate treatment. Accurate diagnosis is central to effective management. Data on EG in Southeast Asia is lacking. We aim to describe the clinical profiles and treatment outcomes of adult patients with EG in a Singapore Tertiary Hospital. Materials and Methods: This retrospective study involved archival search of patients with GI biopsies that showed eosinophilic infiltration from January 2004 to December 2012. Patients’ clinical data from computerised hospital records and clinical notes was reviewed. Diagnostic criteria for EG included presence of GI symptoms with more than 30 eosinophils/high power field on GI biopsies. Patients with secondary causes for eosinophilia were excluded. Results: Eighteen patients with EG were identified (mean age 52 years; male/female: 11/7). Fifteen patients (83%) had peripheral blood eosinophilia. Seven patients (39%) had atopic conditions. Most common symptoms were diarrhoea and abdominal pain. Small intestine was the most common site involved. Endoscopic finding was non-specific. Ten patients were treated with corticosteroids (nine prednisolone, one budesonide): eight patients (89%) responded clinically to prednisolone but four patients (50%) relapsed following tapering-off of prednisolone and required maintenance dose. One patient each responded to diet elimination and montelukast respectively. Half of the remaining six patients who were treated with proton-pump inhibitors, antispasmodic or antidiarrheal agents still remained symptomatic. Conclusion: Prednisolone is an effective treatment though relapses are common. Small intestine is most commonly involved. EG should be considered in the evaluation of unexplained chronic recurrent GI symptoms.
Enteritis ; Gastroenteritis

Background: Unstable distal clavicles experience high non-union rates, prompting surgeons to recommend surgery for more predictable outcomes. There is a lack of consensus on the optimal method of surgical fixation, with an array of techniques described in the literature. We describe an alternative method of fixation involving the use of a distal clavicular anatomical locking plate with Fibertape cerclage augmentation in our series of patients. Methods: Nine patients (8 males and 1 female), with a mean age of 36 years, who sustained unstable fracture of the distal clavicle in our institution were treated with our described technique. Postoperative range of motion, functional and pain scores, and time to radiographic union were measured over a mean follow-up period of 10 months. Incidences of postoperative complications were also recorded. Results: At the last patient consult, the mean visual analog scale score was 0.88±0.35, with a mean Disabilities of the Arm, Shoulder, and Hand (DASH) score of 1.46±0.87 and American Shoulder and Elbow Surgeons (ASES) score of 94.1±3.57. The mean range of motion achieved was forward flexion at 173°±10.6°, abduction at 173°±10.6°, and external rotation at 74.4°±10.5°. All patients achieved internal rotation at a vertebral height of at least L2 with radiographical union at a mean of 10 weeks. No removal of implants was required. Conclusions Our described technique of augmented fixation of the distal clavicle is effective, produces good clinical outcomes, and has minimal complications.

Adolescent ; Antibiotic Prophylaxis ; Child ; Dermatitis, Atopic/prevention & control* ; Eczema/drug therapy* ; Humans

COVID-19/prevention & control* ; COVID-19 Vaccines ; Health Personnel ; Humans ; Singapore ; Vaccination

INTRODUCTIONWe aimed to evaluate the local incidences of hydronephrosis and renal impairment in the presence of severe uterovaginal or vault prolapse, and determine whether treatment by surgery or ring pessary resulted in the resolution of hydronephrosis in these patients.

METHODSThis was a retrospective case study of 121 patients who presented with severe uterovaginal or vault prolapse. All patients who had fourth degree uterovaginal or vault prolapse, and underwent renal ultrasonography and renal function blood tests were included in the study. Follow-up imaging for hydronephrosis was performed to determine the outcome after patients received treatment.

RESULTSThe mean age of the study population was 66.1 years. The overall incidence of hydronephrosis was 20.6%. The incidence of hydronephrosis in patients with severe vault prolapse was 7.1%, while that in patients with severe uterovaginal prolapse was 22.4%. Of the 25 patients with hydronephrosis, 16 (64.0%) had complete resolution of hydronephrosis after treatment, 5 (20.0%) had residual but smaller degrees of hydronephrosis, and 4 (16.0%) were lost to follow-up. The incidence of renal impairment was 3.3%.

CONCLUSIONThe local incidence of hydronephrosis in patients with severe uterovaginal or vault prolapse was 20.6% in our study. We established that 3.3% of women with severe uterovaginal or vault prolapse had mild renal impairment. Treatment by vaginal surgery for severe uterovaginal or vault prolapse appears to result in either complete resolution or improvement of hydronephrosis in the majority of patients.

Aged ; Female ; Humans ; Hydronephrosis ; epidemiology ; pathology ; therapy ; Incidence ; Kidney ; diagnostic imaging ; Kidney Diseases ; complications ; Kidney Function Tests ; Middle Aged ; Pessaries ; Retrospective Studies ; Treatment Outcome ; Ultrasonography ; Uterine Prolapse ; complications ; epidemiology ; therapy ; Uterus ; surgery ; Vagina ; surgery

INTRODUCTIONWe assessed the pedagogical value of a student-led community-based experiential learning project called the Public Health Screening (PHS) run by medical and nursing students of the National University of Singapore's Yong Loo Lin School of Medicine (NUS YLLSoM).

MATERIALS AND METHODSWe conducted a cross-sectional study using a self-administered anonymised questionnaire on medical and nursing students who participated in PHS using the Fund for the Improvement of Postsecondary Education (FIPSE) Survey Instrument. Participants also gave an overall score for their learning experience at the PHS.

RESULTSThe participation rate was 93.1% (576/619) for medical students and 100% (37/37) for nursing students. All participants gave the PHS learning experience a high rating (median = 8 out of maximum of 10, inter-quartile range, 7 to 9). A majority of participants felt that PHS had helped them to improve across all domains surveyed. For medical students, those in preclinical years and females were independently more likely to feel that PHS had helped them to improve in communication skills, teamwork, ability to identify social issues, taking action, and gaining and applying their knowledge than those in clinical years and males. Improved ability to interact with patients (β=1.64, 95%CI, 1.01-2.27), appreciation of challenges to healthcare faced by Singaporeans from lower income groups (β=0.93, 95%CI, 0.49-1.37), thinking of others (β=0.70, 95%CI, 0.04-1.37) and tolerance of different people (β =0.63, 95%CI, 0.17-1.10) were strongly associated with the overall rating score.

CONCLUSIONPHS was a positive learning experience in a wide range of domains for all students involved. This suggests that student-organised community-based experiential learning projects have potential educational value for both medical and nursing students.

Attitude of Health Personnel ; Community Health Services ; organization & administration ; Confidence Intervals ; Cross-Sectional Studies ; Data Collection ; Education, Medical ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Learning ; Logistic Models ; Male ; Mass Screening ; Models, Educational ; Odds Ratio ; Program Development ; Program Evaluation ; Public Health Practice ; Schools, Medical ; Singapore ; Students, Medical ; Students, Nursing ; Surveys and Questionnaires ; Teaching ; Volunteers