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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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Epidemiology of Haemophilus influenzae invasive disease in hospitalised Kelantanese children, 1985-1994.

N Y Nik KHAIRULDDIN ; K E CHOO ; M R JOHARI

Singapore medical journal.1999;40(2):96-100.

AIMData is lacking with regard to the epidemiology of invasive haemophilus influenzae (HI) disease in Malaysia. This study was carried out to document the epidemiology of invasive HI disease in hospitalised Kelantanese children.

METHODSWe conducted a retrospective study of 65 children who had invasive HI disease from June 1985 to December 1994. Data regarding age, sex, duration of illness, weight, diagnosis, complications, duration of hospitalisation, outcome, full blood count and sensitivity pattern of HI to various antibiotics were reviewed.

RESULTSThe age distribution varied from one day to 72 months with a mean of 13 months. Peak incidence occurred in the 7-12 months age group. Majority (89.1%) was below two years of age. The relative frequencies of the 75 clinical entities documented were as follows: meningitis 64%, pneumonia 29.3%, septicaemia 5.4%, and abscess 1.3%. In addition, 13.5% of cases had meningitis associated with pneumonia. Serotype b accounted for all strains in cases where serotyping was done. Anaemia (Hb < 10 g%) was seen in 71.4% of cases. Long term complications were noted in 41.5% of cases of meningitis. Case fatality rate was 12.3%. The percentage of HI strains sensitive to penicillin, ampicillin, chloramphenicol and co-trimoxazole were 83.7%, 87.7%, 98.2% and 89.7%, respectively.

CONCLUSIONThe data suggest that invasive HI disease causes considerable morbidity and mortality in Kelantanese children.

Age Distribution ; Child, Preschool ; Drug Resistance, Microbial ; Female ; Haemophilus Infections ; epidemiology ; Haemophilus influenzae ; drug effects ; Humans ; Infant ; Infant, Newborn ; Malaysia ; epidemiology ; Male ; Retrospective Studies ; Seasons

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The changing pattern of cytomegalovirus retinitis in human immunodeficiency virus disease.

K G Au EONG ; S BEATTY ; S J CHARLES

Singapore medical journal.2000;41(6):298-300.

There have been profound changes in the pattern of cytomegalovirus (CMV) retinitis over the last two decades. The epidemiology and behaviour of CMV retinitis has been significantly altered by Acquired Immune Deficiency Syndrome (AIDS). It was uncommon prior to the AIDS epidemic, but soon became the most common retinal infection in AIDS patients. In the past several years, highly active anti-retroviral treatment (HAART) has achieved a dramatic improvement in the prognosis for patients infected with human immunodeficiency virus (HIV). As a result, HIV patients are living longer and have a reduced risk of CMV retinitis. Some patients with CMV retinitis who respond to HAART develop a transient symptomatic vitritis while others undergo no reactivation of their retinitis despite having no specific anti-CMV therapy. This pattern is likely to undergo further change as the treatment of HIV and CMV disease continues to improve.
AIDS-Related Opportunistic Infections ; drug therapy ; epidemiology ; Antiretroviral Therapy, Highly Active ; methods ; trends ; Antiviral Agents ; therapeutic use ; Cytomegalovirus Infections ; drug therapy ; epidemiology ; Disease Progression ; Humans ; Longevity ; Prognosis ; Remission Induction ; Risk Factors ; Treatment Outcome

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Strengthen the foundation before building upwards.

Ah San PANG

Singapore medical journal.2010;51(6):527-528.

Acute Disease ; Appendectomy ; methods ; Appendicitis ; surgery ; General Surgery ; standards ; Humans ; Pathology ; methods

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