Journal Detail Information

1

Cite

Share

Colin YEO ; Jeremy CHOW ; Gerard LEONG ; Kah Leng HO

Singapore medical journal.2015;56(1):e10-3.

A patient with non-ischaemic cardiomyopathy, and pre-existing atypical atrial flutter and left bundle branch block, developed broad complex tachycardia. In this unique and uncommon case of double tachycardia, we discuss the diagnostic approach of ventricular tachycardia in patients with broad complex tachycardia, and the use of different contemporary algorithms to help diagnose ventricular tachycardia and differentiate it from supraventricular tachycardia with aberrant conduction.
Algorithms ; Atrial Flutter ; complications ; diagnosis ; Bundle-Branch Block ; physiopathology ; Cardiomyopathies ; complications ; diagnosis ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Humans ; Male ; Middle Aged ; Tachycardia, Supraventricular ; diagnosis ; physiopathology ; Tachycardia, Ventricular ; diagnosis ; physiopathology

2

Cite

Share

Electrocardiographic changes in acute perimyocarditis.

Phong Teck LEE ; Chai Keat SEE ; Paul Toon Lim CHIAM ; Soo Teik LIM

Singapore medical journal.2015;56(1):e1-3.

Pericarditis and myocarditis are characterised by electrocardiographic changes and elevated cardiac enzymes, respectively, and patients with perimyocarditis often complain of chest discomfort. These findings are nonspecific and often lead to diagnostic difficulties, as ST-elevation myocardial infarction commonly presents in a similar fashion. Clinical differentiation between perimyocarditis and myocardial infarction are especially important because adverse side effects can occur if reperfusion therapy is administered for a patient with acute pericarditis or if a diagnosis of acute myocardial infarction is missed. We herein describe a case of perimyocarditis with ST elevation and raised cardiac markers, which led to two emergency coronary angiographies that were subsequently found to be normal. We include the three serial electrocardiographies (ECGs) performed to show the characteristic features of perimyocarditis and further discuss the importance of identifying typical and atypical ECG features of pericarditis.
Acute Disease ; Aged ; Biopsy ; Blood Pressure ; Coronary Angiography ; Electrocardiography ; Female ; Humans ; Myocardial Infarction ; pathology ; Myocarditis ; diagnosis ; physiopathology

3

Cite

Share

Authors' reply. Comment on: Cosmetic procedures among youths: a survey of junior college and medical students in Singapore: part 2.

Jia Hui NG ; Seth YEAK ; Natalie PHOON ; Stephen LO

Singapore medical journal.2015;56(1):65-65.

Attitude to Health ; Beauty ; Body Image ; Female ; Humans ; Reconstructive Surgical Procedures ; psychology ; Self Concept

4

Cite

Share

Comment on: Cosmetic procedures among youths: a survey of junior college and medical students in Singapore: part 2.

Shunjie CHUA ; Jing LI

Singapore medical journal.2015;56(1):65-65.

Attitude to Health ; Beauty ; Body Image ; Female ; Humans ; Reconstructive Surgical Procedures ; psychology ; Self Concept

5

Cite

Share

Comparison of total hip and knee joint replacement in patients with rheumatoid arthritis and osteoarthritis: a nationwide, population-based study.

Chi-Yang LIAO ; Hui-Ting CHAN ; En CHAO ; Che-Ming YANG ; Tzu-Chuan LU

Singapore medical journal.2015;56(1):58-64.

INTRODUCTIONPatients with rheumatoid arthritis (RA) and osteoarthritis (OA) may require total hip replacement (THR) or total knee replacement (TKR). The present study aimed to compare the demographic characteristics and medical costs of RA and OA patients from Taiwan who underwent either THR or TKR.

METHODSThe medical records of patients who had undergone THR or TKR from 1 January 1996 to 31 December 2010 were obtained from the Taiwan National Health Insurance Research Database (NHIRD). In all, we found 49 and 146 RA patients who received THR and TKR, respectively, and 1,191 and 6,574 OA patients who received THR and TKR, respectively. The gender, age, Charlson comorbidity index (CCI), hospital grade, age at registration in the catastrophic illness dataset, and medical utilisation costs of the different groups were compared.

RESULTSThere were statistically significant differences in age, CCI score, drug costs and surgery costs between RA and OA patients. Joint replacement incidence was lower in RA patients than in OA patients, and among patients who underwent THR, total medical costs incurred were higher for RA patients than OA patients. RA patients who underwent THR incurred a significantly greater total medical utilisation cost in the outpatient department (3 months before surgery and 12 months after surgery) than OA patients who underwent THR.

CONCLUSIONAnalysis of Taiwan NHIRD with regard to patients who had undergone either THR or TKR indicated that RA patients were younger than OA patients, and that significantly more medical resources were used for RA patients before, during and after hospitalisation for these procedures.

Adult ; Age Factors ; Aged ; Arthritis, Rheumatoid ; surgery ; Arthroplasty, Replacement, Hip ; economics ; methods ; Arthroplasty, Replacement, Knee ; economics ; methods ; Databases, Factual ; Female ; Health Care Costs ; Hospitalization ; Humans ; Length of Stay ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Sex Factors ; Taiwan ; Treatment Outcome

6

Cite

Share

Prevalence of oral lesions and measurement of salivary pH in the different trimesters of pregnancy.

Kanu JAIN ; Harshaminder KAUR

Singapore medical journal.2015;56(1):53-57.

INTRODUCTIONOral changes observed during pregnancy have been studied for many years, but their magnitude and frequency have not been stressed upon. This study was undertaken to assess the prevalence of oral lesions during different trimesters of pregnancy and their correlation with salivary pH change.

METHODSThe gingival, simplified oral hygiene, community periodontal and decayed-missing-filled teeth indices were used to assess a total of 120 pregnant women (40 in each trimester group) and 40 nonpregnant women (control group). Salivary pH was measured using a digital pH meter. Presence of any oral lesions was determined via oral examination.

RESULTSScores for all indices increased while salivary pH decreased from the control group to the first trimester group, through to the third. Oral lesions were seen in 44.2% of pregnant women. Lesions were seen in 27.5%, 52.5% and 52.5% of women in the first, second and third trimesters, respectively. The percentage of pregnant women with one oral lesion was highest in the second trimester (47.5%), whereas the third trimester had the highest prevalence (17.5%) of two concurrent oral lesions. The incidence of fissured tongue was highest in the first trimester group, and that of gingival enlargement was highest in the third trimester group. In the second trimester group, there was an almost equal incidence of fissured tongue and gingival/mucosal enlargement.

CONCLUSIONMost changes in oral tissues during pregnancy can be avoided with good oral hygiene. Salivary pH could be used to assess the prevalence of oral lesions in the different trimesters of pregnancy.

Adolescent ; Adult ; Dental Caries ; complications ; diagnosis ; Female ; Gingiva ; pathology ; Humans ; Hydrogen-Ion Concentration ; Mouth Diseases ; complications ; diagnosis ; Oral Hygiene ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimesters ; Prevalence ; Saliva ; chemistry ; Tongue ; pathology ; Young Adult

7

Cite

Share

The assessment of combined first trimester screening in women of advanced maternal age in an Asian cohort.

Sarah Weiling LI ; Angela Natalie BARRETT ; Leena GOLE ; Wei Ching TAN ; Arijit BISWAS ; Hak Koon TAN ; Mahesh CHOOLANI

Singapore medical journal.2015;56(1):47-52.

INTRODUCTIONFirst trimester screening (FTS) is a validated screening tool that has been shown to achieve detection rates of 84%-90% for trisomies 21, 18 and 13. However, its effectiveness for different maternal ages has not been assessed. The present study aimed to assess the performance of FTS in an Asian population, and to compare its effectiveness in older (≥ 35 years) and younger (< 35 years) women. The potential use of noninvasive prenatal test (NIPT) as a contingent screening test is also examined.

METHODSData on cases of FTS performed on singleton pregnancies over a six-year period was collated from two Singapore maternal centres, National University Hospital and Singapore General Hospital. Cases that had a 1:250 risk of trisomy were considered to be screen-positive. Pregnancy outcomes were obtained from birth records or karyotype test results.

RESULTSFrom 10,289 FTS cases, we obtained a sensitivity of 87.8%, a specificity of 97.6%, a false positive rate of 2.4% and a false negative rate of 0.06% for the detection of aneuploidy. The overall detection rate for trisomy 21 was 86.5%-85.7% for older women and 87.5% for younger women. The mean number of invasive tests required per case of trisomy 21 was 9.3 in younger women, 8.6 in older women and 13.5 in women with intermediate risk (1:250-1,000).

CONCLUSIONWhile the performance of FTS was similar in younger and older women, more invasive procedures were required to diagnose trisomy 21 in women with intermediate risk. It may be advantageous to offer contingent NIPT to this group of women to reduce the risk of iatrogenic fetal loss.

Adolescent ; Adult ; Aneuploidy ; Asia ; Cohort Studies ; DNA ; analysis ; Down Syndrome ; diagnosis ; Female ; Humans ; Karyotyping ; Maternal Age ; Maternal Serum Screening Tests ; methods ; Middle Aged ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, First ; Prenatal Diagnosis ; methods ; Risk Factors ; Singapore ; Trisomy ; diagnosis

8

Cite

Share

How patients fare after anaesthesia for elective surgery: a survey of postoperative nausea and vomiting, pain and confusion.

Yun Zhi LEE ; Ruth Qianyi LEE ; Kyu Kyu THINN ; Keah How POON ; Eugene Hern LIU

Singapore medical journal.2015;56(1):40-46.

INTRODUCTIONPostoperative nausea and vomiting (PONV), and postoperative pain are common during the early postoperative period. In addition to these problems, elderly patients risk developing postoperative confusion. This study aimed to identify the risk factors associated with these problems, and the extent of these problems, in a Singapore inpatient surgical population.

METHODSOver a period of six weeks, we surveyed 707 elective surgical inpatients aged ≥ 18 years who received general anaesthesia and/or regional anaesthesia.

RESULTSThe incidence of PONV was 31.8% (95% confidence interval [CI] 34.8-41.9). The incidence increased with increasing Apfel score (p < 0.001) and were higher in female patients (odds ratio [OR] 1.74, 95% CI 1.28-2.36), non-smokers (OR 1.72, 95% CI 1.04-2.88), patients with a history of PONV and/or motion sickness (OR 3.45, 95% CI 2.38-5.24), patients who received opioids (OR 1.39, 95% CI 1.03-1.88), and patients who received general anaesthesia (OR 1.76, 95% CI 1.11-2.79). Moderate to severe pain at rest and with movement were reported in 19.9% and 52.5% of patients, respectively. Among the patients who were predicted to experience mild pain, 29.5% reported moderate pain and 8.1% reported severe pain. The prevalence of postoperative confusion was 3.9% in the geriatric population.

CONCLUSIONHigher Apfel scores were associated with a higher risk of PONV and multimodal treatment for postoperative pain management was found to be insufficient. The incidence of postoperative confusion was low in this study.

Adult ; Aged ; Aged, 80 and over ; Anesthesia, General ; adverse effects ; Confusion ; chemically induced ; Female ; Humans ; Incidence ; Inpatients ; Male ; Middle Aged ; Pain, Postoperative ; drug therapy ; Postoperative Complications ; chemically induced ; Postoperative Nausea and Vomiting ; chemically induced ; Postoperative Period ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Singapore ; Surveys and Questionnaires ; Young Adult

9

Cite

Share

Struma ovarii: management and follow-up of a rare ovarian tumour.

Jonathan Yeow Sherng WEE ; Xinyi LI ; Bernard Su Min CHERN ; Irene Sze Yuen CHUA

Singapore medical journal.2015;56(1):35-39.

INTRODUCTIONStruma ovarii represents about 1.0% of all ovarian tumours. While management involves surgery, there is a paucity of data regarding the extent and approach of surgery, and postoperative management. This study aimed to delineate the management of struma ovarii, its associated complications, and postoperative follow-up and investigations.

METHODSWe retrospectively reviewed cases of benign struma ovarii treated at KK Women's and Children's Hospital, Singapore, between January 2000 and May 2011.

RESULTSA total of 68 patients underwent surgical removal of ovarian cyst or mass (24 cystectomy, 20 salpingo-oopherectomy and 24 total hysterectomy and bilateral salpingo-oopherectomy). Of the 68 surgeries, 39 (57.4%) included intraoperative frozen section sampling or procedures for staging of ovarian malignancy. The majority (73.5%) of surgeries were laparotomies. Histology revealed benign struma ovarii in all (98.5%) but one patient. Only 7 (10.3%) patients had postoperative complications - 3 wound-related, 2 thyroid-related, 1 incisional hernia and 1 nonspecific. The mean length of hospital stay was 4.2 days. During follow-up, 45 (66.2%) patients required no additional investigations. The most common investigation done was ultrasonography (n = 18, 26.5%). While no recurrences were diagnosed histologically, two patients were subsequently found to have complex/dermoid ovarian cysts on the ipsilateral side of the previous struma ovarii on ultrasonography.

CONCLUSIONSimple surgery is recommended for patients with struma ovarii, especially if they have fertility potential. Laparoscopic surgery is the recommended approach due to its shorter recovery time and lower morbidity. Most patients do not require extended periods of follow-up or postoperative investigations.

Cystectomy ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Laparoscopy ; Length of Stay ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Ovarian Neoplasms ; diagnosis ; surgery ; Ovariectomy ; Ovary ; pathology ; Postoperative Period ; Retrospective Studies ; Salpingectomy ; Singapore ; Struma Ovarii ; diagnosis ; surgery

10

Cite

Share

Magnetic resonance imaging of diabetic foot complications.

Keynes T A LOW ; Wilfred C G PEH

Singapore medical journal.2015;56(1):23-quiz 34.

This pictorial review aims to illustrate the various manifestations of the diabetic foot on magnetic resonance (MR) imaging. The utility of MR imaging and its imaging features in the diagnosis of pedal osteomyelitis are illustrated. There is often difficulty encountered in distinguishing osteomyelitis from neuroarthropathy, both clinically and on imaging. By providing an accurate diagnosis based on imaging, the radiologist plays a significant role in the management of patients with complications of diabetic foot.
Aged ; Aged, 80 and over ; Cellulitis ; diagnosis ; Diabetic Foot ; complications ; diagnosis ; Female ; Gangrene ; diagnosis ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteomyelitis ; diagnosis ; physiopathology ; Risk Factors ; Skin Diseases ; diagnosis ; Ulcer ; diagnosis

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share