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":null,"pages":null},"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 : 2023-02-24DOI: 10.1177/20101058231160605
Rachel QM Ng, KF Yip, YE Teh
With improved survival among People Living with HIV (PLHIV), many are confronted with age associated comorbidities and geriatric syndromes. Neurocognitive impairment is one of the three most frequent conditions that affects quality of life of PLHIV despite achieving viral suppression. Healthcare providers face challenges in early identification of neurocognitive impairment, performing comprehensive assessment and managing older PLHIV. This paper aims to review available evidence regarding aetiology and management of older PLHIV who develop neurocognitive impairment, suggest improvements on current management and postulate future study direction. A PubMed search for original articles and Clinical Guidelines was conducted from September 2021 to August 2022 using a combination of keywords related to neurocognitive impairment in PLHIV. The citations from all selected articles were reviewed for additional studies. Older PLHIV tend to be frailer than their uninfected counterparts, are plagued with multi-morbidity and are at increased risk of cognitive impairment. The aetiologies for neurocognitive impairment are multifactorial, multi-dimensional and complex. The management of neurocognitive impairment in older PLHIV involves identifying and optimizing predisposing factors, physical function, social and psychological health with appropriate care navigation. Identification and management of neurocognitive impairment in older PLHIV through interdisciplinary collaboration among stakeholders is important. This exemplifies an integrated model of care for older PLHIV and promotes the notion of living well beyond viral suppression.
{"title":"An overview of neurocognitive impairment in older people living with HIV","authors":"Rachel QM Ng, KF Yip, YE Teh","doi":"10.1177/20101058231160605","DOIUrl":"https://doi.org/10.1177/20101058231160605","url":null,"abstract":"With improved survival among People Living with HIV (PLHIV), many are confronted with age associated comorbidities and geriatric syndromes. Neurocognitive impairment is one of the three most frequent conditions that affects quality of life of PLHIV despite achieving viral suppression. Healthcare providers face challenges in early identification of neurocognitive impairment, performing comprehensive assessment and managing older PLHIV. This paper aims to review available evidence regarding aetiology and management of older PLHIV who develop neurocognitive impairment, suggest improvements on current management and postulate future study direction. A PubMed search for original articles and Clinical Guidelines was conducted from September 2021 to August 2022 using a combination of keywords related to neurocognitive impairment in PLHIV. The citations from all selected articles were reviewed for additional studies. Older PLHIV tend to be frailer than their uninfected counterparts, are plagued with multi-morbidity and are at increased risk of cognitive impairment. The aetiologies for neurocognitive impairment are multifactorial, multi-dimensional and complex. The management of neurocognitive impairment in older PLHIV involves identifying and optimizing predisposing factors, physical function, social and psychological health with appropriate care navigation. Identification and management of neurocognitive impairment in older PLHIV through interdisciplinary collaboration among stakeholders is important. This exemplifies an integrated model of care for older PLHIV and promotes the notion of living well beyond viral suppression.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44346847","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 : 2023-02-11DOI: 10.1177/20101058231156628
Natalie Tan, K. Tham, Chun Keong Eric Ho, C. Ng
Prediction equations for resting metabolic rate (RMR) are valuable in managing patients’ weight; however, no accurate equation exists for Singaporeans. To develop and cross-validate a predictive regression equation for RMR in Singaporeans, using indirect calorimetry as the reference method. 104 healthy Singaporeans (34.3 ± 12.2 years) participated, comprising 34 men and 70 women. Anthropometric measurements and demographics information were obtained from participants. RMR was measured via indirect calorimetry (TrueOne 2400 system). Stepwise regression analysis was used to develop the most parsimonious predictive equation. Performance of the equation was evaluated using ordinary least products (OLP) regression and Bland–Altman analysis, whilst internal cross-validation was performed by use of the predicted residual sum of squares (PRESS) method. To compare the new equation with existing ones, the performance of the Harris-Benedict equation was also evaluated. The best predictive equation takes the form RMR(kcal) = 918 + 16.5(weight)-135.7(gender) - 1152(Waist-to-height-ratio) +0.014(International Physical Activity Questionnaire Score), where gender = 1 (female) or 0 (male). OLP regression revealed no systematic bias for the new equation. Bland–Altman analysis showed that its total (systematic and random) error was 212 kcal. Internal model validation using the PRESS method revealed minimal reduction in predictive accuracy. In contrast, OLP regression showed a significant pattern of over-prediction by the Harris-Benedict equation (y-intercept = −280 kcal; 95%CI, −100 to −461 kcal). Our new equation outperformed the Harris-Benedict equation in accurately predicting RMR in Singaporeans. Comprising easily obtained anthropometric and self-reported measures, we envisage its potential relevance in clinical and epidemiological settings.
{"title":"Resting metabolic rate in healthy Singaporeans: Performance of the Harris-Benedict equation and a new predictive model","authors":"Natalie Tan, K. Tham, Chun Keong Eric Ho, C. Ng","doi":"10.1177/20101058231156628","DOIUrl":"https://doi.org/10.1177/20101058231156628","url":null,"abstract":"Prediction equations for resting metabolic rate (RMR) are valuable in managing patients’ weight; however, no accurate equation exists for Singaporeans. To develop and cross-validate a predictive regression equation for RMR in Singaporeans, using indirect calorimetry as the reference method. 104 healthy Singaporeans (34.3 ± 12.2 years) participated, comprising 34 men and 70 women. Anthropometric measurements and demographics information were obtained from participants. RMR was measured via indirect calorimetry (TrueOne 2400 system). Stepwise regression analysis was used to develop the most parsimonious predictive equation. Performance of the equation was evaluated using ordinary least products (OLP) regression and Bland–Altman analysis, whilst internal cross-validation was performed by use of the predicted residual sum of squares (PRESS) method. To compare the new equation with existing ones, the performance of the Harris-Benedict equation was also evaluated. The best predictive equation takes the form RMR(kcal) = 918 + 16.5(weight)-135.7(gender) - 1152(Waist-to-height-ratio) +0.014(International Physical Activity Questionnaire Score), where gender = 1 (female) or 0 (male). OLP regression revealed no systematic bias for the new equation. Bland–Altman analysis showed that its total (systematic and random) error was 212 kcal. Internal model validation using the PRESS method revealed minimal reduction in predictive accuracy. In contrast, OLP regression showed a significant pattern of over-prediction by the Harris-Benedict equation (y-intercept = −280 kcal; 95%CI, −100 to −461 kcal). Our new equation outperformed the Harris-Benedict equation in accurately predicting RMR in Singaporeans. Comprising easily obtained anthropometric and self-reported measures, we envisage its potential relevance in clinical and epidemiological settings.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43561353","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 : 2023-02-04DOI: 10.1177/20101058231154667
Hazel Yeo Kai Hui, Kenneth Chua Wei De, S. Kamath, Steven Lock Hey Lee
The prevalence of age-related hearing loss is expected to increase with the ageing population in Singapore resulting in increased demand for pure tone audiometry (PTA). One way of meeting the increased demand for PTA is the Automated Method of Testing Auditory Sensitivity (AMTAS). Nonetheless, before AMTAS may be implemented, it is important to validate its results by comparing them against those of conventional PTA for the diverse Singaporean population. 100 participants were recruited from the Otorhinolaryngology clinic at a public hospital. PTA was conducted for participants via the conventional method and AMTAS. The hearing thresholds obtained via the two methods were then compared. A feedback questionnaire on the use of AMTAS was also completed by all participants. Air and bone conduction threshold results from 80 participants were analysed. The absolute mean difference in air conduction thresholds obtained via the two methods ranged from 3.30 to 9.62 dB. The absolute mean difference in bone conduction thresholds obtained via the two methods ranged from 8.16 to 9.38 dB. Most participants indicated that the machine was easy to use. Other feedback collected indicated that the AMTAS testing environment was noisy and that testing was fast. This study finds that despite differences in hearing thresholds obtained via AMTAS and manual PTA, these differences are within the acceptable 10 dB test-retest variation. Nonetheless, existing issues related to the AMTAS software and noise levels in the testing environment will need to be addressed before it can be used in the clinic.
{"title":"A pilot study to validate AMTAS in a specialist outpatient clinic at a public restructured hospital in Singapore","authors":"Hazel Yeo Kai Hui, Kenneth Chua Wei De, S. Kamath, Steven Lock Hey Lee","doi":"10.1177/20101058231154667","DOIUrl":"https://doi.org/10.1177/20101058231154667","url":null,"abstract":"The prevalence of age-related hearing loss is expected to increase with the ageing population in Singapore resulting in increased demand for pure tone audiometry (PTA). One way of meeting the increased demand for PTA is the Automated Method of Testing Auditory Sensitivity (AMTAS). Nonetheless, before AMTAS may be implemented, it is important to validate its results by comparing them against those of conventional PTA for the diverse Singaporean population. 100 participants were recruited from the Otorhinolaryngology clinic at a public hospital. PTA was conducted for participants via the conventional method and AMTAS. The hearing thresholds obtained via the two methods were then compared. A feedback questionnaire on the use of AMTAS was also completed by all participants. Air and bone conduction threshold results from 80 participants were analysed. The absolute mean difference in air conduction thresholds obtained via the two methods ranged from 3.30 to 9.62 dB. The absolute mean difference in bone conduction thresholds obtained via the two methods ranged from 8.16 to 9.38 dB. Most participants indicated that the machine was easy to use. Other feedback collected indicated that the AMTAS testing environment was noisy and that testing was fast. This study finds that despite differences in hearing thresholds obtained via AMTAS and manual PTA, these differences are within the acceptable 10 dB test-retest variation. Nonetheless, existing issues related to the AMTAS software and noise levels in the testing environment will need to be addressed before it can be used in the clinic.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46955386","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 : 2023-01-28DOI: 10.1177/20101058231154666
Shiqi Chung, A. Gogna, S. Chandramohan, R. Lo, F. Irani, N. Venkatanarasimha
A systematic review of the outcomes of combination therapy using Yttrium 90 radioembolization (Y90) and sorafenib/nivolumab for patients with hepatocellular carcinoma (HCC), with hepatic vein (HV) or inferior vena cava (IVC) invasion. The aim of this study is to summarise the results of different studies that used the combination therapy for HCC patients with tumor thrombosis involving the HV or IVC. A literature search was performed using keywords in Medline and Google Scholar limited to publications from 2010 to 2021. There were 173 articles identified during the initial literature search. During abstract screening, 81 articles were excluded. Another 83 did not contain information on hepatic vein or IVC invasion. Therefore, 9 articles met the eligibility criteria and were included in the synthesis. In total, 37 patients with hepatic vein or IVC invasion were identified. There were 31 patients who were given sorafenib, 7 were given nivolumab and 1 was given both sorafenib and nivolumab. Among the 37 patients, 21 had hepatic vein invasion, 22 had IVC invasion and 6 had both HV and IVC invasion. The median OS was 20.55 months and median PFS was 8.18 months. For the results, 23 patients were evaluated via modified RECIST (mRECIST) criteria and 14 were evaluated via RECIST 1.1. The combination of local and systemic therapies demonstrated potential results for increased response rates, OS and PFS benefits. Further studies are required to determine the long-term outcomes of the combination therapy for this group of patients.
{"title":"Review of outcomes of combination therapy using yttrium 90 radioembolization and sorafenib/nivolumab for HCC with hepatic vein or IVC invasion","authors":"Shiqi Chung, A. Gogna, S. Chandramohan, R. Lo, F. Irani, N. Venkatanarasimha","doi":"10.1177/20101058231154666","DOIUrl":"https://doi.org/10.1177/20101058231154666","url":null,"abstract":"A systematic review of the outcomes of combination therapy using Yttrium 90 radioembolization (Y90) and sorafenib/nivolumab for patients with hepatocellular carcinoma (HCC), with hepatic vein (HV) or inferior vena cava (IVC) invasion. The aim of this study is to summarise the results of different studies that used the combination therapy for HCC patients with tumor thrombosis involving the HV or IVC. A literature search was performed using keywords in Medline and Google Scholar limited to publications from 2010 to 2021. There were 173 articles identified during the initial literature search. During abstract screening, 81 articles were excluded. Another 83 did not contain information on hepatic vein or IVC invasion. Therefore, 9 articles met the eligibility criteria and were included in the synthesis. In total, 37 patients with hepatic vein or IVC invasion were identified. There were 31 patients who were given sorafenib, 7 were given nivolumab and 1 was given both sorafenib and nivolumab. Among the 37 patients, 21 had hepatic vein invasion, 22 had IVC invasion and 6 had both HV and IVC invasion. The median OS was 20.55 months and median PFS was 8.18 months. For the results, 23 patients were evaluated via modified RECIST (mRECIST) criteria and 14 were evaluated via RECIST 1.1. The combination of local and systemic therapies demonstrated potential results for increased response rates, OS and PFS benefits. Further studies are required to determine the long-term outcomes of the combination therapy for this group of patients.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47382112","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 : 2023-01-19DOI: 10.1177/20101058231152048
Kah Mun Cheong, M. Sriranganathan, E. Lee
The concept of a pharmacist-led collaborative gout clinic is relatively new in Singapore. This study examined the impact of this pilot shared care model on providing dose titration of urate lowering therapy, gout education and patient support to achieve target serum uric acid (sUA) levels. A retrospective pre-post study was undertaken to compare outcomes in patients who were started on either allopurinol or febuxostat in the 24 months prior to (Group A: Pre implementation) or 33 months following launch of the collaborative gout clinic (Group B: Post implementation). The collaborative gout clinic comprises of a clinical pharmacist under the supervision of a rheumatologist. Of 98 eligible subjects enrolled in our study, there were 50 patients (all prescribed allopurinol) for Group A and 48 patients for Group B (allopurinol n = 29, febuxostat n = 19). Among patients who achieved target sUA level of 360 μmol/L or less at 1 year of drug initiation with use of allopurinol, the median [interquartile range, IQR] time taken to attain target sUA was shorter in Group B than Group A (111 [82–308] days vs. 293 [265–414] days, p = 0.016). As compared to Group A, Group B had lesser patients experiencing gout flare (41.3% vs. 70.0%, p = 0.018) and more patients achieving target sUA (75.9% vs. 22.0%, p < 0.001). Mean ± [standard deviation, SD] daily allopurinol dose to achieve target sUA levels was 276 mg ± [138 mg]. Our results demonstrate the use of a pharmacist-led collaborative gout clinic may help to achieve better clinical outcomes in gout management.
{"title":"Impact of pharmacist-led collaborative gout clinic on timely achievement of serum uric acid goals","authors":"Kah Mun Cheong, M. Sriranganathan, E. Lee","doi":"10.1177/20101058231152048","DOIUrl":"https://doi.org/10.1177/20101058231152048","url":null,"abstract":"The concept of a pharmacist-led collaborative gout clinic is relatively new in Singapore. This study examined the impact of this pilot shared care model on providing dose titration of urate lowering therapy, gout education and patient support to achieve target serum uric acid (sUA) levels. A retrospective pre-post study was undertaken to compare outcomes in patients who were started on either allopurinol or febuxostat in the 24 months prior to (Group A: Pre implementation) or 33 months following launch of the collaborative gout clinic (Group B: Post implementation). The collaborative gout clinic comprises of a clinical pharmacist under the supervision of a rheumatologist. Of 98 eligible subjects enrolled in our study, there were 50 patients (all prescribed allopurinol) for Group A and 48 patients for Group B (allopurinol n = 29, febuxostat n = 19). Among patients who achieved target sUA level of 360 μmol/L or less at 1 year of drug initiation with use of allopurinol, the median [interquartile range, IQR] time taken to attain target sUA was shorter in Group B than Group A (111 [82–308] days vs. 293 [265–414] days, p = 0.016). As compared to Group A, Group B had lesser patients experiencing gout flare (41.3% vs. 70.0%, p = 0.018) and more patients achieving target sUA (75.9% vs. 22.0%, p < 0.001). Mean ± [standard deviation, SD] daily allopurinol dose to achieve target sUA levels was 276 mg ± [138 mg]. Our results demonstrate the use of a pharmacist-led collaborative gout clinic may help to achieve better clinical outcomes in gout management.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41351943","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 : 2023-01-18DOI: 10.1177/20101058231152047
Logaswari M, M. Koh, K. Sittampalam
Atypical fibrous histiocytomas are an uncommon but benign variant of dermatofibroma where the neoplastic cells can feature cytological atypia constituted by prominent nuclear enlargement, pleomorphism and multinucleated giant cells. Though these can have a degree of atypia, they have a benign course and a failure to recognize these tumors as benign can lead to misdiagnosis and overtreatment, particularly in patients with Li-Fraumeni syndrome who are known to be predisposed to various malignancies. Here, we report a patient with atypical fibrous histiocytomas and multiple pleomorphic fibroma-type lesions in the setting of Li-Fraumeni syndrome.
{"title":"Atypical fibrous histiocytomas and pleomorphic fibroma-type lesions in a patient with li-fraumeni syndrome","authors":"Logaswari M, M. Koh, K. Sittampalam","doi":"10.1177/20101058231152047","DOIUrl":"https://doi.org/10.1177/20101058231152047","url":null,"abstract":"Atypical fibrous histiocytomas are an uncommon but benign variant of dermatofibroma where the neoplastic cells can feature cytological atypia constituted by prominent nuclear enlargement, pleomorphism and multinucleated giant cells. Though these can have a degree of atypia, they have a benign course and a failure to recognize these tumors as benign can lead to misdiagnosis and overtreatment, particularly in patients with Li-Fraumeni syndrome who are known to be predisposed to various malignancies. Here, we report a patient with atypical fibrous histiocytomas and multiple pleomorphic fibroma-type lesions in the setting of Li-Fraumeni syndrome.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46779622","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 : 2023-01-17DOI: 10.1177/20101058231152046
Udayan Joseph, J. R. Thangayah
A Morel-Lavallée lesion is a rare internal degloving injury that patients present with to the Emergency Department (ED) typically following high impact trauma. The diagnosis is often missed due to its uncommon presentation and emphasis on other concomitant injuries that may have occurred as a result of polytrauma. Potential long-term complications from these closed soft-tissue injuries highlight the need for early recognition. We present one such case encountered in our ED and aim to familiarize readers with the presentation, diagnostic and treatment modalities, and challenges emergency physicians might face when encountering patients with such lesions.
{"title":"What lies beneath: A case report of Morel-Lavallée lesion","authors":"Udayan Joseph, J. R. Thangayah","doi":"10.1177/20101058231152046","DOIUrl":"https://doi.org/10.1177/20101058231152046","url":null,"abstract":"A Morel-Lavallée lesion is a rare internal degloving injury that patients present with to the Emergency Department (ED) typically following high impact trauma. The diagnosis is often missed due to its uncommon presentation and emphasis on other concomitant injuries that may have occurred as a result of polytrauma. Potential long-term complications from these closed soft-tissue injuries highlight the need for early recognition. We present one such case encountered in our ED and aim to familiarize readers with the presentation, diagnostic and treatment modalities, and challenges emergency physicians might face when encountering patients with such lesions.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42679403","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 : 2023-01-15DOI: 10.1177/20101058231152049
M. Tan, Mary Grace Aller Arciga, Juweita Binte Arba’in, Rachel Marie Towle, S. Lim, Woon Hoe Tang, L. Low
Background The Singapore General Hospital COVID-19 Virtual Ward is a “hospital at home” (HaH) programme for the supervised home recovery of higher-acuity COVID-19 patients from the hospital and the community. Objective To describe how an existing HaH programme was redesigned so that COVID-19 patients could be remotely monitored at home and report the outcomes of the first 100 patients in this Virtual Ward. Methods Patients received an admission package comprising instructions and equipment for home monitoring, and uploaded their parameters into a clinical dashboard via a secure messaging app. Medical staff conducted video or telephone consultations daily. Patients were discharged according to time-based criteria, although some required SARS-CoV-2 PCR testing, which were conducted at home by a third-party medical provider. De-identified data of the first 100 patients were analysed by demographic details, indication for enrolment into the Virtual Ward, and the need for subsequent inpatient readmission. Results Of the first 100 patients admitted into the Virtual Ward, 58 were female, mean age was 63.1 years old (23–95 years), and 76 were fully vaccinated. There were 77 hospital referrals and 23 community referrals. The number of days of inpatient hospitalisation avoided was 717 days (average of 7.9 days per patient). Three hospital referrals (3.9%) were readmitted, while seven community referrals (30.4%) required subsequent hospitalisation. Conclusion The Virtual Ward programme demonstrates that selected COVID-19 patient can safely recover at home with remote medical support and monitoring, thereby expanding hospital capacity.
{"title":"Outcomes of a “hospital at home” programme for the supervised home recovery of COVID-19 patients in Singapore","authors":"M. Tan, Mary Grace Aller Arciga, Juweita Binte Arba’in, Rachel Marie Towle, S. Lim, Woon Hoe Tang, L. Low","doi":"10.1177/20101058231152049","DOIUrl":"https://doi.org/10.1177/20101058231152049","url":null,"abstract":"Background The Singapore General Hospital COVID-19 Virtual Ward is a “hospital at home” (HaH) programme for the supervised home recovery of higher-acuity COVID-19 patients from the hospital and the community. Objective To describe how an existing HaH programme was redesigned so that COVID-19 patients could be remotely monitored at home and report the outcomes of the first 100 patients in this Virtual Ward. Methods Patients received an admission package comprising instructions and equipment for home monitoring, and uploaded their parameters into a clinical dashboard via a secure messaging app. Medical staff conducted video or telephone consultations daily. Patients were discharged according to time-based criteria, although some required SARS-CoV-2 PCR testing, which were conducted at home by a third-party medical provider. De-identified data of the first 100 patients were analysed by demographic details, indication for enrolment into the Virtual Ward, and the need for subsequent inpatient readmission. Results Of the first 100 patients admitted into the Virtual Ward, 58 were female, mean age was 63.1 years old (23–95 years), and 76 were fully vaccinated. There were 77 hospital referrals and 23 community referrals. The number of days of inpatient hospitalisation avoided was 717 days (average of 7.9 days per patient). Three hospital referrals (3.9%) were readmitted, while seven community referrals (30.4%) required subsequent hospitalisation. Conclusion The Virtual Ward programme demonstrates that selected COVID-19 patient can safely recover at home with remote medical support and monitoring, thereby expanding hospital capacity.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43056182","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 : 2023-01-03DOI: 10.1177/20101058221149575
A. Masnammany, Wendy Lau, P. Wong, N. Manolios
Voriconazole is a fluoride-containing anti-fungal. Prolonged exposure can result in fluoride deposition within the bone extracellular matrix, resulting in periostitis and arthritis. We report a patient who developed widespread bony pain and polyarthralgia while on voriconazole therapy for COVID-19-associated pulmonary aspergillosis. No associated autoimmune rheumatic disease or alternative cause was noted. Blood investigations showed elevated total serum alkaline phosphatase, bone-specific ALP and fluoride levels, with normal serum voriconazole levels. A whole body nuclear bone scan showed multifocal periostitis. A diagnosis of voriconazole-induced periostitis and arthritis was made. Complete resolution of clinical symptoms with normalisation of the serum ALP occurred within four weeks of voriconazole cessation. While voriconazole-induced periostitis/arthritis is a recognised phenomenon in solid organ and haematopoietic stem cell transplant patients on long-term voriconazole, this case highlights the importance of having a high index of suspicion in other settings including CAPA. Clinical presentation can be mistaken for bony metastatic disease or other inflammatory arthritis.
{"title":"Voriconazole-induced arthritis, enthesitis and periostitis","authors":"A. Masnammany, Wendy Lau, P. Wong, N. Manolios","doi":"10.1177/20101058221149575","DOIUrl":"https://doi.org/10.1177/20101058221149575","url":null,"abstract":"Voriconazole is a fluoride-containing anti-fungal. Prolonged exposure can result in fluoride deposition within the bone extracellular matrix, resulting in periostitis and arthritis. We report a patient who developed widespread bony pain and polyarthralgia while on voriconazole therapy for COVID-19-associated pulmonary aspergillosis. No associated autoimmune rheumatic disease or alternative cause was noted. Blood investigations showed elevated total serum alkaline phosphatase, bone-specific ALP and fluoride levels, with normal serum voriconazole levels. A whole body nuclear bone scan showed multifocal periostitis. A diagnosis of voriconazole-induced periostitis and arthritis was made. Complete resolution of clinical symptoms with normalisation of the serum ALP occurred within four weeks of voriconazole cessation. While voriconazole-induced periostitis/arthritis is a recognised phenomenon in solid organ and haematopoietic stem cell transplant patients on long-term voriconazole, this case highlights the importance of having a high index of suspicion in other settings including CAPA. Clinical presentation can be mistaken for bony metastatic disease or other inflammatory arthritis.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47189440","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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