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The use of midazolam and haloperidol in cancer patients at the end of life.

Singapore medical journal.2012;53(1):62-66.

INTRODUCTIONThis study aimed to describe the patterns of sedative use among terminally ill cancer patients who were referred to a hospital-based specialist palliative care service for symptom management. It also aimed to examine whether sedative use among terminally ill cancer patients during the last two days of life had any impact on their survival.

METHODSA retrospective review of case notes was carried out for patients with a diagnosis of terminal cancer, who died in a 95-bedded oncology ward between September 2006 and September 2007. Data was collected on patient characteristics, duration of palliative care, indications and doses of sedatives used at 48 hours and 24 hours before death.

RESULTSA total of 238 patients died while receiving specialist palliative care, 132 of whom (55.5%) were female. At 48 hours and 24 hours before death, 22.6% and 24.8% of patients, respectively, were on sedatives like midazolam, haloperidol or both. The median dose of midazolam was 5 mg/day while the haloperidol dose at 48 hours and 24 hours before death was 3 mg/day and 4 mg/day, respectively. The indications for midazolam were anxiety, breathlessness and stiffness, while those for haloperidol were confusion agitation and nausea. Survival analysis showed no significant difference in survival between patients who were on sedatives and those who were not. The p-value for log-rank test was 0.78.

CONCLUSIONThe results showed that the doses and overall frequency of sedative use in this patient population tended to be low and that usage of sedatives had no deleterious influence on survival.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid ; therapeutic use ; Female ; Haloperidol ; therapeutic use ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Male ; Midazolam ; therapeutic use ; Middle Aged ; Neoplasms ; drug therapy ; mortality ; Palliative Care ; methods ; Retrospective Studies ; Terminal Care ; methods ; Terminally Ill ; Time Factors ; Treatment Outcome

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Urolithiasis on non-absorbable suture material: a rare case of bladder stone on polypropylene suture material.

Yigit AKIN ; Isil BASARA

Singapore medical journal.2011;52(11):851-852.

Endoscopy ; methods ; Female ; Foreign Bodies ; Humans ; Male ; Urinary Bladder ; pathology

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Effect of 11β-HSD1 dehydrogenase activity on bone histomorphometry of glucocorticoid-induced osteoporotic male Sprague-Dawley rats.

M R Elvy SUHANA ; H S FARIHAH ; O FAIZAH ; A S NAZRUN ; M NORAZLINA ; M NORLIZA ; S IMA-NIRWANA

Singapore medical journal.2011;52(11):786-793.

INTRODUCTIONGlucocorticoids cause osteoporosis by decreasing bone formation and increasing bone resorption activity. Glucocorticoid action in bones depends on the activity of 11-beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1) enzyme, which plays an important role in regulating corticosteroids. 11β-HSD1 is expressed by human and rat osteoblasts. We aimed to investigate the relationship between 11β-HSD1 dehydrogenase activity and bone histomorphometric changes in glucocorticoid-induced osteoporotic bone in rats.

METHODSA total of 30 male Sprague-Dawley rats (aged three months, weighing 200-250 g) were divided into three groups of ten each. Group 1 rats were the baseline control, which were sacrificed untreated at the beginning of the study. Group 2 rats underwent sham operation and were administered with vehicle olive oil intramuscularly at 0.05 ml/kg. Group 3 rats were adrenalectomised and administered with an intramuscular injection of dexamethasone 120 μg/kg body weight/day. The treatment was started two weeks after the operation, for a duration of two months. Plasma osteocalcin, plasma pyrodinoline, plasma corticosterone and 11β-HSD1 were measured, and bone histomorphometry analysis was performed.

RESULTSDexamethasone treatment caused an increase in plasma corticosterone level, together with a significant reduction in 11β-HSD1 dehydrogenase activity of the bone, along with a higher plasma level of the bone resorption marker, pyridinoline. Dexamethasone treatment also caused a reduction in trabecular volume, number and thickness, and an increase in trabecular separation.

CONCLUSIONLong-term glucocorticoid treatment reduces the 11β-HSD1 dehydrogenase activity in the bone, which can otherwise lead to bone loss due to the increased level of active glucocorticoids.

11-beta-Hydroxysteroid Dehydrogenase Type 1 ; metabolism ; Adrenal Cortex Hormones ; metabolism ; Amino Acids ; pharmacology ; Animals ; Body Weight ; Bone and Bones ; metabolism ; Corticosterone ; blood ; Dexamethasone ; pharmacology ; Enzyme-Linked Immunosorbent Assay ; methods ; Gene Expression Regulation, Enzymologic ; Glucocorticoids ; metabolism ; Humans ; Male ; Osteoporosis ; metabolism ; Rats ; Rats, Sprague-Dawley

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Comment on: Aviation medicine: global historical perspectives and the development of aviation medicine alongside the growth of Singapore's aviation landscape.

Chin-Hin CHEW

Singapore medical journal.2011;52(12):924-author reply 925.

Aerospace Medicine ; history ; trends ; Humans

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Effect of pre-emptive gabapentin on postoperative pain following lower extremity orthopaedic surgery under spinal anaesthesia.

M Panah KHAHI ; A A YAGHOOTI ; S H MARASHI ; A NADJAFI

Singapore medical journal.2011;52(12):879-882.

INTRODUCTIONGabapentin has demonstrated efficacy in clinical trials as a pre-emptive analgesic and in acute postoperative pain management. However, our experience with the drug is still limited. The present study was conducted in order to evaluate the effect of gabapentin on reduction of postoperative pain in the first 24 hours after internal fixation of the tibia under spinal anaesthesia.

METHODSIn a double-blind, randomised controlled clinical trial, 64 American Society of Anesthesiologists Class I or II patients, who underwent internal fixation of the tibia, were administered 300 mg of gabapentin or a placebo two hours before surgery. The postoperative pain was assessed using Visual Analogue Scale two, 12 and 24 hours after surgery. The time from the end of surgery until the first bolus dose of morphine on demand (pain score > 4) and the total morphine requirement were recorded. Patients were also asked about the possible side effects of gabapentin.

RESULTSThe pain score was significantly lower in the gabapentin group at two hours post surgery (p-value is 0.004), while the scores at 12 and 24 hours post surgery were not significantly different between the two groups. No side effect of gabapentin was observed.

CONCLUSIONPre-emptive use of gabapentin 300 mg orally significantly decreases postoperative pain two hours after surgery.

Adult ; Amines ; pharmacology ; therapeutic use ; Anesthesia, Spinal ; methods ; Anesthesiology ; methods ; Cyclohexanecarboxylic Acids ; pharmacology ; therapeutic use ; Double-Blind Method ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Morphine ; therapeutic use ; Orthopedics ; methods ; Pain ; drug therapy ; Pain, Postoperative ; Placebos ; Tibia ; surgery ; Time Factors ; Treatment Outcome ; gamma-Aminobutyric Acid ; pharmacology ; therapeutic use

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Comment on: Lung hypoplasia and patellar agenesis in Ehlers-Danlos syndrome.

Aidan THOMAS

Singapore medical journal.2011;52(10):768-author reply 769.

Ehlers-Danlos Syndrome ; pathology ; Humans ; Lung ; abnormalities ; pathology ; Male ; Patella ; abnormalities

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Bipolar versus monopolar transurethral resection of prostate.

Christopher Ho Chee KONG

Singapore medical journal.2011;52(10):767-767.

Humans ; Male ; Prostate ; surgery ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; instrumentation ; methods

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Teratogenic effects of the anticonvulsant gabapentin in mice.

Prakash ; L V PRABHU ; R RAI ; M M PAI ; S K YADAV ; S MADHYASTHA ; R K GOEL ; G SINGH ; M A NASAR

Singapore medical journal.2008;49(1):47-53.

INTRODUCTIONWe aim to study and elucidate the safety profile of the antiepileptic doses of gabapentin during pregnancy, and to evaluate gabapentin-induced murine fetotoxicity at different dose levels.

METHODSA total of 60 pregnant mice, divided into 12 groups of five mice each, were exposed to gabapentin in four different doses of 0 (control), 113, 226, or 452 mg/kg body weight per day, at three different gestational stages including early gestation (1-6 days), mid-gestation (7-12 days), and late gestation (13-17 days). The pregnant mice were euthanized on day 18 of gestation, and foetuses were examined for teratogenic manifestations. Their brains were dissected and examined for gross changes, malformations, histological changes, and quantitative protein estimation.

RESULTSFoetal resorptions were observed in all treated groups with gabapentin administration at early gestation (1-6 days), and mid-gestation (7-12 days). On the other hand, growth retardation along with stunting in size of live foetuses were observed in all the mid-gestation (7-12 days), and late gestation (13-17 days) treated groups. Various gross malformations were observed with all the three doses (113, 226, and 452 mg/kg body weight per day) when gabapentin was administered at mid-gestation (7-12 days). The same trends were confirmed by gross and microscopic examination of brains along with quantitative protein estimation.

CONCLUSIONGabapentin should not be prescribed during pregnancy, as no therapeutic dose of gabapentin is safe during this period as far as the foetal well-being is concerned.

Abnormalities, Drug-Induced ; Amines ; adverse effects ; Animals ; Anticonvulsants ; adverse effects ; Body Weight ; Congenital Abnormalities ; prevention & control ; Cyclohexanecarboxylic Acids ; adverse effects ; Dose-Response Relationship, Drug ; Female ; Mice ; Mice, Inbred ICR ; Models, Chemical ; Pregnancy ; Pregnancy, Animal ; drug effects ; Teratogens ; gamma-Aminobutyric Acid ; adverse effects

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A variation of the phrenic nerve: case report and review.

Prakash ; L V PRABHU ; S MADHYASTHA ; G SINGH

Singapore medical journal.2007;48(12):1156-1157.

During routine dissection in the department of anatomy, the following anatomical variations of the phrenic nerve were observed on the right side of the neck of a 30-year-old male cadaver. The phrenic nerve, in its early course close to its origin, gave a communicating branch to the C5 root of the brachial plexus. At the level of the root of neck just before entering the thorax, the phrenic nerve was located anterior to the subclavian vein. This unique case of phrenic nerve variation gains tremendous importance in the context of subclavian vein cannulation, implanted venous access portals, and supraclavicular nerve block for regional anaesthesia.
Adult ; Brachial Plexus ; abnormalities ; Cadaver ; Dissection ; Humans ; Male ; Phrenic Nerve ; abnormalities ; Singapore

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Twin reverse arterial perfusion sequence.

N A Z Nik LAH ; C A Che YAAKOB ; M S OTHMAN ; N M Z Nik MAHMOOD

Singapore medical journal.2007;48(12):e335-7.

Twin reverse arterial perfusion sequence occurs in approximately one percent of monochorionic twins. This condition is always fatal for the recipient twin and carries a high mortality rate for the pump twin. Various treatment options are described, but management is continually evolving with the publication of new data. We report an acardiac acephalic monochorionic twin who was diagnosed at 31 weeks gestation. Serial ultrasonographical examinations of the normal pump twin showed intrauterine growth restriction but with no evidence of heart failure. A healthy pump twin was delivered by caesarean section at 34 weeks.
Abnormalities, Multiple ; diagnostic imaging ; Cesarean Section ; Female ; Fetofetal Transfusion ; diagnostic imaging ; Follow-Up Studies ; Gestational Age ; Heart Defects, Congenital ; diagnostic imaging ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal ; methods ; Pregnancy, Multiple ; Twins, Monozygotic ; Ultrasonography, Prenatal

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