Paracetamol overdose is the most common cause of drug-related poisoning and death worldwide. Although N-acetylcysteine is the widely accepted antidote for paracetamol poisoning, much debate persist regarding the appropriate route and duration of early N-acetylcysteine therapy. There is a paucity of studies comparing the effectiveness of oral and intravenous (IV) acetylcysteine for paracetamol poisoning. Methods: A literature search was performed using the keywords [paracetamol OR acetaminophen] AND [acetylcysteine OR n-acetylcysteine] on the PubMed and Ovid database. The literature search was limited to human exposure studies published in English between 1-Jan-1966 and 1-May-2015. The proportion of patients who developed hepatotoxicity (defined as serum transaminase greater than 1000 IU/L) for each route of administration was determined using multiple regression and the studies were further stratified by early (less than 10 hours from ingestion) and late treatment (longer than 10 hours from ingestion). Results: 3,981 full studies were reviewed for data. Studies with fewer than 20 subjects were excluded. Metaanalysis revealed that the overall proportion of patients who developed hepatotoxicity was 12.3% (95% confidence interval [CI]: 9.6% to 17.2%). The percentages were similar when studies were stratified by route of administration; the proportion for IV treated patients was 12.6% (95% CI: 8.7% to 19.4%) while the proportion for oral treated patients was 12.0% (95% CI: 8.2% to 18.8%). However, there was a marked difference in the percentage of patients who developed hepatotoxicity with early as compared to late N-acetylcysteine treatment. There was a statistically significant effect due to time (p < 0.001) but no significant effect due to route of administration (p = 0.716). Conclusion: Pooled analysis of studies did not find any significant difference in outcome between oral and IV N-acetylcysteine therapy, but these findings require confirmation by randomized controlled trials. However, overall hepatotoxicity was significantly worse if treatment was delayed beyond 8 to 10 hours. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment.
Cholangiopancreatography, Endoscopic Retrograde ; adverse effects ; Cholangiopancreatography, Magnetic Resonance ; Endoscopy ; Humans ; Male ; Middle Aged ; Pancreatic Ducts ; physiopathology ; Pancreatic Fistula ; diagnosis ; epidemiology ; therapy ; Pleural Diseases ; diagnosis ; epidemiology ; therapy ; Treatment Outcome

Given the consensus that there is a causal relationship between Zika virus (ZIKV) infection in pregnancy and congenital Zika syndrome (CZS), clinicians must be prepared to manage affected patients despite the numerous gaps in current knowledge. The clinical course in pregnancy appears similar to that in non-pregnant women, although viraemia may be prolonged. ZIKV infection can be diagnosed by serum and urine reverse transcription-polymerase chain reaction, but commercially available serological tests are currently unreliable in dengue-endemic regions. Although vertical transmission can occur at any time during gestation, first- and second-trimester infections have the highest risk of developing central nervous system anomalies. Aberrant fetal growth and pregnancy loss may also occur. Serial ultrasonography should be conducted for infected cases. Without a vaccine, pregnant women should be advised to minimise mosquito bites and reduce sexual transmission risk. Overall, the absolute risk of CZS arising amid a ZIKV outbreak appears relatively low.

Aerospace Medicine ; Aviation ; Emergencies ; Ethicists ; Humans

Anatomy ; history ; Animals ; Education, Medical ; history ; History, 20th Century ; Humans ; Singapore

Biomedical Research ; history ; trends ; Cardiology ; education ; history ; trends ; Cardiology Service, Hospital ; history ; Coronary Care Units ; history ; Coronary Disease ; diagnosis ; therapy ; Education, Medical, Graduate ; history ; trends ; Forecasting ; History, 20th Century ; History, 21st Century ; Humans ; Singapore

Nasal polyposis (NP) is a common chronic inflammatory disease of the rhinosinus mucosa and a complex disease with strong genetic and environmental components. During the past 10 to 20 yr, many studies have been performed to determine differential gene expression profiles between NP and normal nasal tissues, in order to identify susceptible genes that are associated with NP-related traits. Despite achievement in the identification of candidate genes and their associated pathogenic pathways, the large challenges remain as the genetic and molecular alterations required for its development and progression are still unclear. Therefore, the development of novel, powerful tools for gene discovery, and a closer integration of genetics and medical biology would provide valuable insight into the pathogenesis of NP.
Achievement ; Biology ; Gene Expression ; Genetic Association Studies ; Mucous Membrane ; Transcriptome

The mitogen-activated protein kinases (MAPKs) are key regulators of cell growth and survival in physiological and pathological processes. Aberrant MAPK signaling plays a critical role in the development and progression of human cancer, as well as in determining responses to cancer treatment. The MAPK phosphatases (MKPs), also known as dual-specificity phosphatases (DUSPs), are a family of proteins that function as major negative regulators of MAPK activities in mammalian cells. Studies using mice deficient in specific MKPs including MKP1/DUSP1, PAC-1/DUSP2, MKP2/DUSP4, MKP5/DUSP10 and MKP7/DUSP16 demonstrated that these molecules are important not only for both innate and adaptive immune responses, but also for metabolic homeostasis. In addition, the consequences of the gain or loss of function of the MKPs in normal and malignant tissues have highlighted the importance of these phosphatases in the pathogenesis of cancers. The involvement of the MKPs in resistance to cancer therapy has also gained prominence, making the MKPs a potential target for anti-cancer therapy. This review will summarize the current knowledge of the MKPs in cancer development, progression and treatment outcomes.
Animals ; Dual-Specificity Phosphatases ; Homeostasis ; Humans ; Mice ; Mitogen-Activated Protein Kinase Phosphatases* ; Mitogen-Activated Protein Kinases ; Pathologic Processes ; Phosphoric Monoester Hydrolases

This review presents studies that support an inflammation-immunological model for the pathogenesis of post-infectious irritable bowel syndrome (IBS), and highlights recent studies that support a similar disease model in non-post-infectious IBS, in particular, diarrhoea-predominant IBS, as well as in post-infectious functional dyspepsia. These recent studies are highlighted to demonstrate that one line of research in functional gastrointestinal disorders has moved away from the old psychosomatic concepts. It is hoped that this will encourage future students of this field to explore the role of immunological events.
Dyspepsia ; Gastrointestinal Diseases ; Humans ; Inflammation ; Irritable Bowel Syndrome