Pub Date : 2023-04-19DOI: 10.1177/20101058231172233
Abdul Azim Al-Abrar Ahmad Kailani, Muhammad Ariff Sobani, Noor Shairah Mat Barhan, Norazila Abdul Rahim, M. Mansor, N. Lazim
Elongated styloid process or Eagle syndrome is a rare condition presenting with a wide range of symptoms including throat pain, foreign body sensation, neck pain, and ear pain. Establishing a diagnosis requires a high index of suspicion and understanding of this entity by the physician. Computed tomography (CT) is the gold standard to diagnose Eagle syndrome. Conservative medical treatment with analgesics, oral steroids, and anticonvulsants are offered in patients who refused surgery. The mainstay of treatment is surgical resection through transoral or transcervical approaches. We describe a rare case of bilateral Eagle syndrome which presented with chronic foreign body sensation in the throat but aggravated by fish bone ingestion. Flexible nasopharyngolaryngoscopy (FNPLS) and cervical x-ray did not reveal any foreign body but showed an incidental finding of elongated styloid process bilaterally. Contrast-enhanced CT scan of the neck confirmed the finding of the elongated styloid process bilaterally. The patient underwent transoral endoscopic assisted bilateral styloidectomy following tonsillectomy. There was complete resolution of the symptoms during postoperative follow-up. This approach is recommended to avoid external scarring, minimize postoperative pain, and shorter hospital stay.
{"title":"Bilateral eagle syndrome: A rare entity","authors":"Abdul Azim Al-Abrar Ahmad Kailani, Muhammad Ariff Sobani, Noor Shairah Mat Barhan, Norazila Abdul Rahim, M. Mansor, N. Lazim","doi":"10.1177/20101058231172233","DOIUrl":"https://doi.org/10.1177/20101058231172233","url":null,"abstract":"Elongated styloid process or Eagle syndrome is a rare condition presenting with a wide range of symptoms including throat pain, foreign body sensation, neck pain, and ear pain. Establishing a diagnosis requires a high index of suspicion and understanding of this entity by the physician. Computed tomography (CT) is the gold standard to diagnose Eagle syndrome. Conservative medical treatment with analgesics, oral steroids, and anticonvulsants are offered in patients who refused surgery. The mainstay of treatment is surgical resection through transoral or transcervical approaches. We describe a rare case of bilateral Eagle syndrome which presented with chronic foreign body sensation in the throat but aggravated by fish bone ingestion. Flexible nasopharyngolaryngoscopy (FNPLS) and cervical x-ray did not reveal any foreign body but showed an incidental finding of elongated styloid process bilaterally. Contrast-enhanced CT scan of the neck confirmed the finding of the elongated styloid process bilaterally. The patient underwent transoral endoscopic assisted bilateral styloidectomy following tonsillectomy. There was complete resolution of the symptoms during postoperative follow-up. This approach is recommended to avoid external scarring, minimize postoperative pain, and shorter hospital stay.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44304430","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}
Pub Date : 2023-03-31DOI: 10.1177/20101058231167252
Dennis Seow, Amanda Pang, S. Ho, Chetna Malhotra
Currently, there is little understanding of how patients with dementia and their caregivers view end-of-life (EOL) care. We thus aimed to study and understand the perception of EOL care by patients with mild dementia and their family caregivers. We conducted qualitative in-depth interviews with 25 patients with mild dementia and their family caregivers belonging to Chinese ethnicity in Singapore. Patients’ and family caregivers’ understanding of illness, patients’ preferences for EOL care and caregiver concerns for the patients were discussed. Thematic analysis was conducted on the transcribed results of the interviews. We identified three main themes of person-centred EOL care: planning for cognitive decline and death, supporting patients to die peacefully at home, and supporting family caregivers to cope with patient’s condition. Most patients wanted to die peacefully and be cared for at their home. However, they were reluctant to initiate discussions regarding their future health care and seemed to be in denial that they may decline cognitively in future. Caregiver burden was noticeable for all family caregivers interviewed. . Results highlight three important components that would enhance the delivery of patient-centred EOL care in patients with mild dementia. Strategies based on these components can enable family caregivers and health care providers to plan for and provide patient-centred EOL care concordant with patients’ wishes.
{"title":"Perspectives of Singaporean Chinese patients with mild dementia and their family caregivers towards end-of-life care: Results from a qualitative study","authors":"Dennis Seow, Amanda Pang, S. Ho, Chetna Malhotra","doi":"10.1177/20101058231167252","DOIUrl":"https://doi.org/10.1177/20101058231167252","url":null,"abstract":"Currently, there is little understanding of how patients with dementia and their caregivers view end-of-life (EOL) care. We thus aimed to study and understand the perception of EOL care by patients with mild dementia and their family caregivers. We conducted qualitative in-depth interviews with 25 patients with mild dementia and their family caregivers belonging to Chinese ethnicity in Singapore. Patients’ and family caregivers’ understanding of illness, patients’ preferences for EOL care and caregiver concerns for the patients were discussed. Thematic analysis was conducted on the transcribed results of the interviews. We identified three main themes of person-centred EOL care: planning for cognitive decline and death, supporting patients to die peacefully at home, and supporting family caregivers to cope with patient’s condition. Most patients wanted to die peacefully and be cared for at their home. However, they were reluctant to initiate discussions regarding their future health care and seemed to be in denial that they may decline cognitively in future. Caregiver burden was noticeable for all family caregivers interviewed. . Results highlight three important components that would enhance the delivery of patient-centred EOL care in patients with mild dementia. Strategies based on these components can enable family caregivers and health care providers to plan for and provide patient-centred EOL care concordant with patients’ wishes.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47863377","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}
Pub Date : 2023-03-30DOI: 10.1177/20101058231167245
Jia Rui Kwan, Shiun-Hwa Chantal Lim, Wei Lin Lester Ong, Yong Hui Alvin Tan, J. Kam, J. Pek
Recreational cycling is gaining popularity in Singapore but there is a lack of literature regarding the spectrum and severity of these injuries and their impact on the utilisation of healthcare resources. We aim to characterise these injuries, as well as to review the healthcare resources required by injured cyclists. A retrospective review of patients with recreational cycling-related injuries presenting to the Emergency Department (ED) between August 2018 and December 2020 was performed. Information about demographics, circumstances of injury, injuries sustained, clinical progress, and outcomes were collected and analysed. There were 214 patients, with an increase in monthly attendance towards the end of the study period. The median age was 48 years old (interquartile range (IQR) 31 to 60) and 165 (77.1%) patients were male. In the ED, 35 (16.4%), 142 (66.4%), and 37 (17.3%) patients were triaged as P1 (emergent), P2 (urgent), and P3 (ambulatory) respectively. Blunt injuries occurred in 210 (98.1%) patients. Soft tissue injuries involving the upper and lower limbs were most common. One hundred and eighty-one (84.6%) patients had a minor to moderate injury classified by an Injury Severity Score of 0 to 8. One hundred twenty-four (57.9%) patients were admitted to the hospital with 40 (18.7%) requiring surgery. Recreational cycling-related injuries are increasingly encountered in the ED. These injuries are associated with morbidities which require utilisation of healthcare resources. Legislation and education efforts to promote safety in recreational cycling are required to reduce accidents and minimise the impact of the injuries sustained.
{"title":"Recreational cycling related injuries at the emergency department","authors":"Jia Rui Kwan, Shiun-Hwa Chantal Lim, Wei Lin Lester Ong, Yong Hui Alvin Tan, J. Kam, J. Pek","doi":"10.1177/20101058231167245","DOIUrl":"https://doi.org/10.1177/20101058231167245","url":null,"abstract":"Recreational cycling is gaining popularity in Singapore but there is a lack of literature regarding the spectrum and severity of these injuries and their impact on the utilisation of healthcare resources. We aim to characterise these injuries, as well as to review the healthcare resources required by injured cyclists. A retrospective review of patients with recreational cycling-related injuries presenting to the Emergency Department (ED) between August 2018 and December 2020 was performed. Information about demographics, circumstances of injury, injuries sustained, clinical progress, and outcomes were collected and analysed. There were 214 patients, with an increase in monthly attendance towards the end of the study period. The median age was 48 years old (interquartile range (IQR) 31 to 60) and 165 (77.1%) patients were male. In the ED, 35 (16.4%), 142 (66.4%), and 37 (17.3%) patients were triaged as P1 (emergent), P2 (urgent), and P3 (ambulatory) respectively. Blunt injuries occurred in 210 (98.1%) patients. Soft tissue injuries involving the upper and lower limbs were most common. One hundred and eighty-one (84.6%) patients had a minor to moderate injury classified by an Injury Severity Score of 0 to 8. One hundred twenty-four (57.9%) patients were admitted to the hospital with 40 (18.7%) requiring surgery. Recreational cycling-related injuries are increasingly encountered in the ED. These injuries are associated with morbidities which require utilisation of healthcare resources. Legislation and education efforts to promote safety in recreational cycling are required to reduce accidents and minimise the impact of the injuries sustained.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46449312","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}
Pub Date : 2023-03-29DOI: 10.1177/20101058231167250
Mohamed Faisal Abdul Hamid, Asyraf Ahmad, Mas Fazlin Mohamad Jailaini, Shahrul Aiman Soelar, Nik Nuratiqah Nik Abeed, Ng Boon Hau, Azat Azrai Azmel, Andrea Ban
Background Bronchial asthma is characterised by chronic inflammation of both large and small airways. Extra-fine formulation of inhaled corticosteroid (ICS) can achieve a higher peripheral lung deposition leading to improved asthma control. We investigated the effect of extra-fine and fine particle size inhaled ICS with airway resistance and severity of symptoms in asthmatic patients. Methods Prospective interventional study of outpatient asthmatics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Subjects were grouped based on pre-existing inhalers; extra-fine and fine inhaled corticosteroid (ICS)/long acting beta agonist (LABA). Crossover was at week 7 and treatment regime continued for 7 weeks. Subjects were assessed at week 0, 6 and 13 using asthma control test (ACT) score, forced expiratory volume in 1 s (FEV 1 ) and impulse oscillometry (IOS) Inhaler technique was assessed periodically. Results Thirty-four subjects were recruited. Median asthma duration was 20 years. Twenty subjects (58%) in fine ICS/LABA and 14 (42%) in extra-fine ICS/LABA group. Thirty-one subjects were analysed before crossver. There was a significant improvement of FEV 1 in the extra-fine ICS/LABA group (1.7 ± 0.47 to 1.88 ± 0.5; p = 0.01). ACT score reduced significantly in extra-fine ICS/LABA group (23 ± 5 to 21 ± 4; p = 0.04) at week 0–6. Week 7–13 showed a significant improvement of ACT score (16.5 ± 3 to 20 ± 3; p = 0.01) and FEV1 (1.71 ± 0.96 to 1.81 ± 1.02: p = 0.01) in extra-fine ICS/LABA. There was no significant difference in (IOS) parameters between the groups. Conclusion There was an improvement of FEV 1 and ACT score with extra-fine ICS/LABA with no benefit in airway resistance.
{"title":"The effect of fine-particle size and extrafine particle size inhaled corticosteroid in reducing airway resistance in asthmatic patients","authors":"Mohamed Faisal Abdul Hamid, Asyraf Ahmad, Mas Fazlin Mohamad Jailaini, Shahrul Aiman Soelar, Nik Nuratiqah Nik Abeed, Ng Boon Hau, Azat Azrai Azmel, Andrea Ban","doi":"10.1177/20101058231167250","DOIUrl":"https://doi.org/10.1177/20101058231167250","url":null,"abstract":"Background Bronchial asthma is characterised by chronic inflammation of both large and small airways. Extra-fine formulation of inhaled corticosteroid (ICS) can achieve a higher peripheral lung deposition leading to improved asthma control. We investigated the effect of extra-fine and fine particle size inhaled ICS with airway resistance and severity of symptoms in asthmatic patients. Methods Prospective interventional study of outpatient asthmatics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Subjects were grouped based on pre-existing inhalers; extra-fine and fine inhaled corticosteroid (ICS)/long acting beta agonist (LABA). Crossover was at week 7 and treatment regime continued for 7 weeks. Subjects were assessed at week 0, 6 and 13 using asthma control test (ACT) score, forced expiratory volume in 1 s (FEV 1 ) and impulse oscillometry (IOS) Inhaler technique was assessed periodically. Results Thirty-four subjects were recruited. Median asthma duration was 20 years. Twenty subjects (58%) in fine ICS/LABA and 14 (42%) in extra-fine ICS/LABA group. Thirty-one subjects were analysed before crossver. There was a significant improvement of FEV 1 in the extra-fine ICS/LABA group (1.7 ± 0.47 to 1.88 ± 0.5; p = 0.01). ACT score reduced significantly in extra-fine ICS/LABA group (23 ± 5 to 21 ± 4; p = 0.04) at week 0–6. Week 7–13 showed a significant improvement of ACT score (16.5 ± 3 to 20 ± 3; p = 0.01) and FEV1 (1.71 ± 0.96 to 1.81 ± 1.02: p = 0.01) in extra-fine ICS/LABA. There was no significant difference in (IOS) parameters between the groups. Conclusion There was an improvement of FEV 1 and ACT score with extra-fine ICS/LABA with no benefit in airway resistance.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135526466","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}
Pub Date : 2023-03-27DOI: 10.1177/20101058231167258
Zhi Yang Neo, E. Foo, Li Xian Ng, Yao Hui Poh
Background Singapore General Hospital (SGH) Pharmacy department set up a novel 24-h medication locker service in November 2019 to serve hospital staff on work shifts who were unable to collect medication within the pharmacy operating hours. However, the initial uptake rate was modest. Objectives Primary objective was to increase the daily locker service uptake by staff from five lockers to 42 lockers (100%) in 6 months, starting from June 2020. Secondary objectives include exploring the cost savings and impact of the locker service on the pharmacy’s operational efficiency, as well as compare the medication collection experience of hospital staff using the locker service and in the pharmacy. Methods FOCUS-PDSA was the adopted QI methodology. Two Plan-Do-Study-Act (PDSA) cycles were used to implement the final identified solutions. PDSA cycle one focused on improving publicity and educational efforts. PDSA cycle two then focused on expanding the service to include the entire hospital campus staff and setting up a self-registration booth at the pharmacy entrance. Results The primary objective of achieving 100% locker utilization was attained in October 2020, with daily average service uptake rate increasing from 12.6 at baseline to 49.8 by the end of PDSA cycle 2. Annual pharmacist manpower savings of 0.88 Full Time Equivalent (FTE) was also achieved. Locker service users gave a higher average satisfaction score compared to those who collected from the pharmacy. Conclusion Project SAPPORO successfully increased the daily locker service, providing hospital campus staff with increased convenience and positive medication collection experience during the COVID-19 pandemic.
{"title":"Project SAPPORO (StAff prescription – bluPORt optimization): Quality improvement report on the expanded use of secured medication lockers for hospital staff during COVID-19 pandemic","authors":"Zhi Yang Neo, E. Foo, Li Xian Ng, Yao Hui Poh","doi":"10.1177/20101058231167258","DOIUrl":"https://doi.org/10.1177/20101058231167258","url":null,"abstract":"Background Singapore General Hospital (SGH) Pharmacy department set up a novel 24-h medication locker service in November 2019 to serve hospital staff on work shifts who were unable to collect medication within the pharmacy operating hours. However, the initial uptake rate was modest. Objectives Primary objective was to increase the daily locker service uptake by staff from five lockers to 42 lockers (100%) in 6 months, starting from June 2020. Secondary objectives include exploring the cost savings and impact of the locker service on the pharmacy’s operational efficiency, as well as compare the medication collection experience of hospital staff using the locker service and in the pharmacy. Methods FOCUS-PDSA was the adopted QI methodology. Two Plan-Do-Study-Act (PDSA) cycles were used to implement the final identified solutions. PDSA cycle one focused on improving publicity and educational efforts. PDSA cycle two then focused on expanding the service to include the entire hospital campus staff and setting up a self-registration booth at the pharmacy entrance. Results The primary objective of achieving 100% locker utilization was attained in October 2020, with daily average service uptake rate increasing from 12.6 at baseline to 49.8 by the end of PDSA cycle 2. Annual pharmacist manpower savings of 0.88 Full Time Equivalent (FTE) was also achieved. Locker service users gave a higher average satisfaction score compared to those who collected from the pharmacy. Conclusion Project SAPPORO successfully increased the daily locker service, providing hospital campus staff with increased convenience and positive medication collection experience during the COVID-19 pandemic.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"32 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42147266","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}
Pub Date : 2023-03-15DOI: 10.1177/20101058231163406
Ji Xing, Samuel Kent Neng Loh
Among the different types of perioperative organ injury, acute kidney injury (AKI) occurs frequently and is consistently associated with increased rates of mortality and mortality. Despite development of many clinical trials to assess perioperative interventions, reliable means to prevent or reverse AKI are still lacking. This narrative review discusses recent literature on modifiable risk factors, current approaches to prevention and potential directions for future research. A Pubmed search with the relevant keywords was done for articles published in the last 10 years. New insights into preoperative identification and optimisation, intraoperative strategies, including the choice of anaesthetic, haemodynamic and fluid management, have been made, with the aim of preventing perioperative AKI. A patient-centric multidisciplinary approach is essential to protect kidney function of patients going for surgery. Much can be done by anaesthesiologists perioperatively, to reduce the risk of development of AKI, especially in susceptible patients. There is a need for further multicentred trials to enhance the currently generic perioperative recommendations.
{"title":"Perioperative acute kidney injury: Current knowledge and the role of anaesthesiologists","authors":"Ji Xing, Samuel Kent Neng Loh","doi":"10.1177/20101058231163406","DOIUrl":"https://doi.org/10.1177/20101058231163406","url":null,"abstract":"Among the different types of perioperative organ injury, acute kidney injury (AKI) occurs frequently and is consistently associated with increased rates of mortality and mortality. Despite development of many clinical trials to assess perioperative interventions, reliable means to prevent or reverse AKI are still lacking. This narrative review discusses recent literature on modifiable risk factors, current approaches to prevention and potential directions for future research. A Pubmed search with the relevant keywords was done for articles published in the last 10 years. New insights into preoperative identification and optimisation, intraoperative strategies, including the choice of anaesthetic, haemodynamic and fluid management, have been made, with the aim of preventing perioperative AKI. A patient-centric multidisciplinary approach is essential to protect kidney function of patients going for surgery. Much can be done by anaesthesiologists perioperatively, to reduce the risk of development of AKI, especially in susceptible patients. There is a need for further multicentred trials to enhance the currently generic perioperative recommendations.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46907061","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}
Pub Date : 2023-03-14DOI: 10.1177/20101058231160606
T. K. Tong, I. Ismail, Nik M Yunus Mohammad, S. Yusoff, Afifulhadi M Sahri
Over the decades, rhinosporidiosis has remained an enigma. It is a recalcitrant disease caused by Rhinosporidium seeberi, primarily affecting the nasal cavity, conjunctiva, and less frequently involved sites, including skin, urethra, and others. We report a case of a local from Sabah who has presented with recurring symptoms of nasal obstruction and epistaxis for two decades. He had previously undergone multiple endoscopic excisional surgeries before receiving treatment at our centre. Otorhinolaryngeal examination revealed polypoidal masses occupying bilateral nasal cavities with a perforation of the nasal septum. He underwent surgical resection of the lesions, and the histopathological examination confirmed recurrent rhinosporidiosis. Due to its sporistatic effects, dapsone was chosen as the pharmacological treatment in this case. However, after a year of follow-up, he developed similar symptoms and the endoscopic findings, indicated a recurrence of the disease. The histopathological samples obtained during the repeated surgery for recurrent polypoidal masses, confirmed the diagnosis of rhinosporiodiosis. As the disease poses diagnostic and therapeutic challenges, clinicians should be prudent in establishing the diagnosis in non-endemic areas, such as Malaysia, and evaluating the possibility of recurrence.
{"title":"Recurrent rhinosporidiosis: A case report from Malaysia and review of literature","authors":"T. K. Tong, I. Ismail, Nik M Yunus Mohammad, S. Yusoff, Afifulhadi M Sahri","doi":"10.1177/20101058231160606","DOIUrl":"https://doi.org/10.1177/20101058231160606","url":null,"abstract":"Over the decades, rhinosporidiosis has remained an enigma. It is a recalcitrant disease caused by Rhinosporidium seeberi, primarily affecting the nasal cavity, conjunctiva, and less frequently involved sites, including skin, urethra, and others. We report a case of a local from Sabah who has presented with recurring symptoms of nasal obstruction and epistaxis for two decades. He had previously undergone multiple endoscopic excisional surgeries before receiving treatment at our centre. Otorhinolaryngeal examination revealed polypoidal masses occupying bilateral nasal cavities with a perforation of the nasal septum. He underwent surgical resection of the lesions, and the histopathological examination confirmed recurrent rhinosporidiosis. Due to its sporistatic effects, dapsone was chosen as the pharmacological treatment in this case. However, after a year of follow-up, he developed similar symptoms and the endoscopic findings, indicated a recurrence of the disease. The histopathological samples obtained during the repeated surgery for recurrent polypoidal masses, confirmed the diagnosis of rhinosporiodiosis. As the disease poses diagnostic and therapeutic challenges, clinicians should be prudent in establishing the diagnosis in non-endemic areas, such as Malaysia, and evaluating the possibility of recurrence.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42258854","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}
Pub Date : 2023-03-08DOI: 10.1177/20101058231163408
M. A. Ibrahim, Nuruliman Dashuki, Nor Qhairul Izzreen Mohd Noor, S. M. Rusli
Multiple primary malignant tumors of lung and colorectal incidence were extremely rare and in most cases, diagnosed incidentally. Due to its rarity, most physicians consider pulmonary lesions found in patients with a history of colorectal cancer as lung metastasis. To avoid misdiagnosis and treatment delays, it is critical to properly screen and explore for possible metastasis or the occurrence of a second primary tumor after a primary cancer has been diagnosed. We describe a 72-year-old woman who presented with rectal bleeding associated with altered bowel movement. Rectal biopsy revealed colon adenocarcinoma and subsequent CT scan showed sigmoid colon mass and right lower lobe lung mass with multiple mediastinal lymphadenopathies. Biopsies of the mediastinal lymph nodes also showed adenocarcinoma. PET/CT scans showed different SUVmax of lesions in the sigmoid colon and right lower lobe, which raised the possibility of separate colonic and lung primary tumors as opposed to colonic primary with lung metastasis. Further immunohistology studies confirmed separate primary lung tumor. These diagnoses facilitate the clinical approach and define treatment options for the patient.
{"title":"Multiple primary malignant tumours of lung and colorectal adenocarcinoma: A case report","authors":"M. A. Ibrahim, Nuruliman Dashuki, Nor Qhairul Izzreen Mohd Noor, S. M. Rusli","doi":"10.1177/20101058231163408","DOIUrl":"https://doi.org/10.1177/20101058231163408","url":null,"abstract":"Multiple primary malignant tumors of lung and colorectal incidence were extremely rare and in most cases, diagnosed incidentally. Due to its rarity, most physicians consider pulmonary lesions found in patients with a history of colorectal cancer as lung metastasis. To avoid misdiagnosis and treatment delays, it is critical to properly screen and explore for possible metastasis or the occurrence of a second primary tumor after a primary cancer has been diagnosed. We describe a 72-year-old woman who presented with rectal bleeding associated with altered bowel movement. Rectal biopsy revealed colon adenocarcinoma and subsequent CT scan showed sigmoid colon mass and right lower lobe lung mass with multiple mediastinal lymphadenopathies. Biopsies of the mediastinal lymph nodes also showed adenocarcinoma. PET/CT scans showed different SUVmax of lesions in the sigmoid colon and right lower lobe, which raised the possibility of separate colonic and lung primary tumors as opposed to colonic primary with lung metastasis. Further immunohistology studies confirmed separate primary lung tumor. These diagnoses facilitate the clinical approach and define treatment options for the patient.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43470781","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}
Pub Date : 2023-02-27DOI: 10.1177/20101058231160603
W. L. Neo, B. Tan, Adam Ping Meng Tan, Olivia May Ling Wee, J. Thong
Sensorineural hearing loss resulting from microtia and aural atresia is rare due to different embryologic origins of the external and inner ear. Consequently, cochlear implants are seldom performed in patients with microtia and/or aural atresia. Herein we discuss an 8 year-old boy with congenital aural atresia and microtia who underwent cochlear implant surgery for profound hearing loss with good results. A literature review was performed and discussed. Pre-operative planning with high resolution computed tomography and facial nerve monitoring are crucial in identification and preservation of the facial nerve due to the high rate of aberrant anatomy. Careful incision placement is required particularly if pinna reconstruction is considered. Literature review highlighted various surgical approaches as well as different modalities used for intra-operative facial nerve monitoring. Only one patient had intra-operative complications. Cochlear implant is a viable solution in patients with external ear malformations and severe-profound sensorineural hearing loss. Adequate planning and counselling are essential due to the challenges that may occur in microtia and aural atresia.
{"title":"The role for cochlear implants in microtia and congenital aural atresia: A case report and a review of literature","authors":"W. L. Neo, B. Tan, Adam Ping Meng Tan, Olivia May Ling Wee, J. Thong","doi":"10.1177/20101058231160603","DOIUrl":"https://doi.org/10.1177/20101058231160603","url":null,"abstract":"Sensorineural hearing loss resulting from microtia and aural atresia is rare due to different embryologic origins of the external and inner ear. Consequently, cochlear implants are seldom performed in patients with microtia and/or aural atresia. Herein we discuss an 8 year-old boy with congenital aural atresia and microtia who underwent cochlear implant surgery for profound hearing loss with good results. A literature review was performed and discussed. Pre-operative planning with high resolution computed tomography and facial nerve monitoring are crucial in identification and preservation of the facial nerve due to the high rate of aberrant anatomy. Careful incision placement is required particularly if pinna reconstruction is considered. Literature review highlighted various surgical approaches as well as different modalities used for intra-operative facial nerve monitoring. Only one patient had intra-operative complications. Cochlear implant is a viable solution in patients with external ear malformations and severe-profound sensorineural hearing loss. Adequate planning and counselling are essential due to the challenges that may occur in microtia and aural atresia.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":"50 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66104723","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}
Pub Date : 2023-02-27DOI: 10.1177/20101058231160604
Sin Wai Lee, H. Yuen, D. Low, S. Kamath, K. Chua
Single-sided deafness (SSD) is associated with significant functional impairment such as listening speech in noise and localizing sound. To date, studies on the efficacy of CI and BCI for single-sided deafness are conflicting. Thus, the objective of our study was to describe and compare the functional outcomes between these devices. Thirteen subjects with SSD were prospectively recruited for our study. Six underwent CI and seven received BCI. Word recognition scores (WRS) and disease specific outcome measures were obtained pre-implantation, at 6, and 12 months. WRS improved both in quiet and in noise for CI and BCI recipients. On the contrary, CI recipients displayed improvement in Speech Spatial Quality (SSQ) scores. A decreasing trend of improvement in APHAB scores were observed for the BCI group. BCI recipients showed a significant improvement in WRS (in noise). Conversely, CI recipients showed a great improvement in SSQ scores. These preliminary findings suggest that true binaural hearing can only be restored with CI for better SSQ performance. However, BCIs could be recommended to a sub-group of patients, if listening to speech in noise is a priority.
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