Mr Q is a 59-year old single male, pre-morbid independent in activities of daily living, community ambulant with a history of uncontrolled diabetes mellitus (DM) along with complications of osteomyelitis and chronic kidney disease (CKD). I was part of the family medicine team providing inpatient medical care for Mr Q, where he was transferred for rehabilitation following his below knee amputation (BKA). SITUATION AND BACKGROUND
{"title":"A New Lease of Life - Living With Disability and Renal Dialysis","authors":"Rose Fok Wai Yee, Lowon Luke, F. Vasanwala","doi":"10.33591/SFP.45.6.UP1","DOIUrl":"https://doi.org/10.33591/SFP.45.6.UP1","url":null,"abstract":"Mr Q is a 59-year old single male, pre-morbid independent in activities of daily living, community ambulant with a history of uncontrolled diabetes mellitus (DM) along with complications of osteomyelitis and chronic kidney disease (CKD). I was part of the family medicine team providing inpatient medical care for Mr Q, where he was transferred for rehabilitation following his below knee amputation (BKA). SITUATION AND BACKGROUND","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"151 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131921088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Uncontrolled airway inflammation contributes to persistent asthma symptoms and risks of exacerbations and airway remodelling. many asthma patients are non-adherent to inhaled corticosteroid (ICS) treatment and have a discordance between subjective symptom perception versus actual control of asthma, i.e. airway inflammation. Objective measurements of airway inflammation, e.g. fENO and sputum cell count quantification can aid clinical management. Nonetheless, there are many limitations in the tests’ availability and interpretation. Hence, these tests are used mainly for difficultto-treat or severe airway diseases. In the 2019 Global Initiative for Asthma (GINA) strategy report, short-acting beta-agonist (SABA) monotherapy is no longer recommended in Step 1 and ICS is recommended across all asthma severity to emphasize the importance of controlling airway inflammation. Doctors should discuss and recommend the most appropriate ICS therapy (dosing regimen and inhaler device) that is acceptable to the patient, to promote adherence. Appropriate use of ICS is crucial in achieving the management targets of asthma: maintenance symptom control and prevention of asthma risks.
{"title":"The Role of Airway Inflammation in Asthma","authors":"Liman Fang","doi":"10.33591/SFP.45.6.U2","DOIUrl":"https://doi.org/10.33591/SFP.45.6.U2","url":null,"abstract":"Uncontrolled airway inflammation contributes to persistent asthma symptoms and risks of exacerbations and airway remodelling. many asthma patients are non-adherent to inhaled corticosteroid (ICS) treatment and have a discordance between subjective symptom perception versus actual control of asthma, i.e. airway inflammation. Objective measurements of airway inflammation, e.g. fENO and sputum cell count quantification can aid clinical management. Nonetheless, there are many limitations in the tests’ availability and interpretation. Hence, these tests are used mainly for difficultto-treat or severe airway diseases. In the 2019 Global Initiative for Asthma (GINA) strategy report, short-acting beta-agonist (SABA) monotherapy is no longer recommended in Step 1 and ICS is recommended across all asthma severity to emphasize the importance of controlling airway inflammation. Doctors should discuss and recommend the most appropriate ICS therapy (dosing regimen and inhaler device) that is acceptable to the patient, to promote adherence. Appropriate use of ICS is crucial in achieving the management targets of asthma: maintenance symptom control and prevention of asthma risks.","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114636637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Spirometry in Asthma","authors":"Quek Li Ling, Pang Pee Hwee","doi":"10.33591/SFP.45.6.U3","DOIUrl":"https://doi.org/10.33591/SFP.45.6.U3","url":null,"abstract":"","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126172841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asthma is a chronic inflammatory airway disease, for which the cornerstone of asthma therapy is inhaled corticosteroids. however, long term clinical outcomes are variable, and not all patients respond optimally to corticosteroids. Underpinning this observation is that asthma is a heterogeneous disease consisting of phenotypes that are driven by different inflammatory pathways. In this article, we will discuss the different inflammatory mechanisms of asthma to better define patient characteristics and help improve patient outcomes with newer specific-targeted asthma therapies.
{"title":"Asthma and Inflammation","authors":"A. Chan","doi":"10.33591/SFP.45.6.U1","DOIUrl":"https://doi.org/10.33591/SFP.45.6.U1","url":null,"abstract":"Asthma is a chronic inflammatory airway disease, for which the cornerstone of asthma therapy is inhaled corticosteroids. however, long term clinical outcomes are variable, and not all patients respond optimally to corticosteroids. Underpinning this observation is that asthma is a heterogeneous disease consisting of phenotypes that are driven by different inflammatory pathways. In this article, we will discuss the different inflammatory mechanisms of asthma to better define patient characteristics and help improve patient outcomes with newer specific-targeted asthma therapies.","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"119 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124610563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ten readings on ASThmA AND INfLAmmATION – NEw UpDATES","authors":"L. Goh","doi":"10.33591/sfp.45.6.ur","DOIUrl":"https://doi.org/10.33591/sfp.45.6.ur","url":null,"abstract":"","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131763556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adolescent Eating Disorder in Primary Care - A Case Study","authors":"A. Han, R. Ramachandran, L. Goh","doi":"10.33591/sfp.45.6.up2","DOIUrl":"https://doi.org/10.33591/sfp.45.6.up2","url":null,"abstract":"","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127286138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Seronegative Spondyloarthropathies","authors":"L. W. Koh","doi":"10.33591/sfp.43.2.u3","DOIUrl":"https://doi.org/10.33591/sfp.43.2.u3","url":null,"abstract":"","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122601991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiovascular disease (CVD) is a leading global cause of mortality and morbidity. Risk assessment of asymptomatic individuals plays an important role in the primary prevention of CVD and its complications by guiding management decisions, in particular the decision to use statins or antiplatelet agents, as well as more controversially, the target level for risk factors such as hypertension and cholesterol. Timely and regular risk assessments also identify the development of physiological disturbances such as pre-hypertension, pre-diabetes, dyslipidaemias, clinical obesity and metabolic syndrome, which can be asymptomatic in the early stages, but may lead to increased risk for many ageing-related degenerative diseases, including CVD. These physiological mal-adaptations are remarkably responsive to behavioural lifestyle interventions at an early stage, and may be stabilised or even reversed without medications. This article describes the why and how of assessing CVD risk and a suggested framework for management, including the appropriate use of behavioural lifestyle interventions as first-line treatment. It also describes the various risk scores available, their differences and limitations and how to best use them in clinical practice. More research is required regarding the use of non-traditional and emerging markers of CVD risk such as carotid intima-media thickness, coronary artery calcium scoring, hsCRP, ankle brachial index, Apo-B, albuminuria, and how they may be incorporated into existing risk models.
{"title":"Cardiovascular Risk Calculators: Back to Basics","authors":"P. Ting","doi":"10.33591/sfp.43.1.u2","DOIUrl":"https://doi.org/10.33591/sfp.43.1.u2","url":null,"abstract":"Cardiovascular disease (CVD) is a leading global cause of mortality and morbidity. Risk assessment of asymptomatic individuals plays an important role in the primary prevention of CVD and its complications by guiding management decisions, in particular the decision to use statins or antiplatelet agents, as well as more controversially, the target level for risk factors such as hypertension and cholesterol. Timely and regular risk assessments also identify the development of physiological disturbances such as pre-hypertension, pre-diabetes, dyslipidaemias, clinical obesity and metabolic syndrome, which can be asymptomatic in the early stages, but may lead to increased risk for many ageing-related degenerative diseases, including CVD. These physiological mal-adaptations are remarkably responsive to behavioural lifestyle interventions at an early stage, and may be stabilised or even reversed without medications. This article describes the why and how of assessing CVD risk and a suggested framework for management, including the appropriate use of behavioural lifestyle interventions as first-line treatment. It also describes the various risk scores available, their differences and limitations and how to best use them in clinical practice. More research is required regarding the use of non-traditional and emerging markers of CVD risk such as carotid intima-media thickness, coronary artery calcium scoring, hsCRP, ankle brachial index, Apo-B, albuminuria, and how they may be incorporated into existing risk models.","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126846642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Management of hypertension will continue to evolve as new studies provide us more evidence on many relevant aspects of care for this very common condition. To define hypertension, we need to be able to measure blood pressure (BP) accurately and make it easily reproducible. The mercury sphygmomanometer has been a standard tool to measure BP, but it is evident that it will be phased out soon and replaced by electronic BP devices — both for clinic and home use. There is increasingly more awareness of the benefits of out-of-office (clinic) BP measurement to estimate extent of BP control and also prognosis. The goal for BP treatment has also evolved and, for the first time in decades, there has been a suggestion that a lower-than-140/90 mmHg target is associated with further reduction in adverse cardiovascular outcomes. There is, however, a need for more pills and an increased risk of treatment-related side effects. The choice of which anti-hypertensive to use, as well as the goal of treatment, should be individualised and discussed with the patient.
{"title":"Updates in Hypertension Management - 2017","authors":"T. Lau","doi":"10.33591/sfp.43.1.u3","DOIUrl":"https://doi.org/10.33591/sfp.43.1.u3","url":null,"abstract":"Management of hypertension will continue to evolve as new studies provide us more evidence on many relevant aspects of care for this very common condition. To define hypertension, we need to be able to measure blood pressure (BP) accurately and make it easily reproducible. The mercury sphygmomanometer has been a standard tool to measure BP, but it is evident that it will be phased out soon and replaced by electronic BP devices — both for clinic and home use. There is increasingly more awareness of the benefits of out-of-office (clinic) BP measurement to estimate extent of BP control and also prognosis. The goal for BP treatment has also evolved and, for the first time in decades, there has been a suggestion that a lower-than-140/90 mmHg target is associated with further reduction in adverse cardiovascular outcomes. There is, however, a need for more pills and an increased risk of treatment-related side effects. The choice of which anti-hypertensive to use, as well as the goal of treatment, should be individualised and discussed with the patient.","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124186024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Complications of Diabetes Mellitus: Prevention in Type 2 Diabetes Mellitus","authors":"Chew Ek Kwang, Quek Peng Lim","doi":"10.33591/sfp.45.1.u3","DOIUrl":"https://doi.org/10.33591/sfp.45.1.u3","url":null,"abstract":"","PeriodicalId":435054,"journal":{"name":"Singapore family physicians","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126996056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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