COVID-19 ; Child ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Liver ; Liver Transplantation ; Living Donors ; SARS-CoV-2

COVID-19/psychology* ; Child ; Child Health ; Health Care Rationing ; Health Policy ; Health Services Accessibility ; Humans ; Pandemics ; Parents/psychology* ; Patient Acceptance of Health Care ; Singapore/epidemiology*

Therapeutic temperature management (TTM) was strongly recommended by the 2015 International Liaison Committee on Resuscitation as a component of post-resuscitation care. It has been known to be effective in improving the survival rate and neurologic functional outcome of patients after cardiac arrest. In an effort to increase local adoption of TTM as a standard of post-resuscitation care, this paper discusses and makes recommendations on the treatment for local providers.

The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Lipids to provide doctors and patients in Singapore with evidence-based treatment for lipids. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on Lipids, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.
Adult ; Cardiovascular Diseases ; complications ; therapy ; Child ; Coronary Artery Disease ; complications ; therapy ; Decision Support Systems, Clinical ; Dyslipidemias ; blood ; complications ; therapy ; Evidence-Based Medicine ; Female ; Humans ; Kidney Failure, Chronic ; complications ; therapy ; Life Style ; Lipids ; blood ; Lipoproteins, LDL ; blood ; Male ; Practice Guidelines as Topic ; Pregnancy ; Pregnancy Complications ; Risk Assessment ; Risk Factors ; Singapore

Roux-en-y gastric bypass (RYGB) is currently used to treat obesity and metabolic syndrome. It is however technically challenging with a steep learning curve and long operating times. Laparoscopitc mini-gastric bypass (LMGB) is another surgical method that is acclaimed to achieve similar efficacy and yet safe with acceptable complication rates. We reviewedcurrent literature on LMGB on its efficacy and safety profile. Comprehensive search of available literature using a combination of key words was performed, looking out for efficacy and safety end points. Efficacy end points include excess weight loss, change in body mass index (BMI), resolution of metabolic syndrome or T2DM remission. Safety end points include mortality and morbidity rates, short and long term complications. 18 studies were selected with a total of 9392 patients. Follow up range was from 1 year to 6 years with majority of studies achieving 57%-92% excess weight loss (%EWL) within 1 year. Remission of T2DM rates were mostly more than 84%. Several studies reported better %EWL and T2DM remission when compared to SG and RYGB. Overall mortality rate was 0.152%. Morbidity rates vary from 2.7%-12.5%. Some studies reported lower mortality and complication rates in LMGB when compared to SG and RYGB. In summary, MGB is a safe and effective metabolic-bariatric procedure in treating morbid obesity and T2DM. It should be considered an alternative to standard RYGB. Risk of bile reflux, marginal ulcer and anemia needs to be explained to the patient when counselling for such procedure.
Anemia ; Bile Reflux ; Body Mass Index ; Follow-Up Studies ; Gastric Bypass* ; Humans ; Learning Curve ; Methods ; Mortality ; Obesity ; Obesity, Morbid* ; Peptic Ulcer ; Weight Loss

INTRODUCTIONThe use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time.

METHODSWe prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSiteTM NavXTM or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported.

RESULTSA total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups.

CONCLUSIONThe use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Catheter Ablation ; methods ; Child ; Female ; Fluoroscopy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radiation Dosage ; Radiation, Ionizing ; Tachycardia, Atrioventricular Nodal Reentry ; therapy ; Tachycardia, Supraventricular ; therapy ; Treatment Outcome ; Young Adult