Dr. Michael Sze, Dr. Tammy Ma, Dr. Yui-Ming Lam, 20180409000000
A 47-year-old gentleman with a known history of mitral valve prolapse (MVP) and mild-to-moderate mitral regurgitation since his 30s presented to Queen Mary Hospital with sudden onset of chest pain and palpitations for 1 day.
Adjunct Assistant Prof Tang Tjun Yip, Consultant Vascular & Endovascular Surgeon, Department of Vascular Surgery, Singapore General Hospital, shares clinical pearls on how GPs can manage varicose veins and chronic venous insufficiency in the primary care setting.
Dr. Michael Kwan-Lung Ko, Dr. Siu-Yin Wong, 20170710000000
Case 1: A 79-year-old male patient presented initially with acute coronary syndrome and newly diagnosed myeloproliferative neoplasm with high white blood cell and platelet counts. He was stabilized and subsequently discharged with dual antiplatelet therapy (DAPT) (aspirin plus clopidogrel) and hydroxyurea.
Case 2: A 62-year-old female patient with a history of decompensated cryptogenic cirrhosis presented with acute variceal haemorrhage with haematemesis. Emergency OGD revealed three columns of grade 3 oesophageal varices with fibrin clot noted on one of them.
Case 3: A 51-year-old female patient with a history of systemic lupus erythematosus and hyperlipidaemia was referred to our hepatology clinic for evaluation of deranged liver function.
An 82-year-old lady with hypertension and hyperlipidaemia presented with 2 weeks’ history of increasing breathing difficulty. She had flu-like illness 2 weeks ago with some residual dry cough. Physical examination showed low-grade fever of 37.8°C with mildly elevated jugular venous pressure and mild pedal oedema. There was no obvious murmur, and chest auscultation revealed bilateral basal crepitations. Her blood pressure was 130/80 mm Hg. She required oxygen 1 L/min to maintain blood oxygen saturation level (SpO2) of 94 percent.
Dr. Yiting Fan, Yiqun Zhang, Dr. Xingwei Zhang, Dr. Alex Pui-Wai Lee, 20160812000000
A 74-year-old man with a history of paroxysmal non-valvular atrial fibrillation (AF) and transient ischaemic attack (TIA) despite oral anticoagulation was referred for catheter-based left atrial appendage (LAA) occlusion.
Implantable cardioverter defibrillators (ICDs) have become the mainstay of therapy for patients at risk of sudden cardiac death from ventricular arrhythmias. ICDs have been shown to reduce mortality in real-world settings. However, insertion of transvenous leads in the cardiac chambers can cause perforation with serious sequelae, a devastating manifestation of which is cardiac tamponade. Other lead-related complications are thrombosis, pneumothorax, and in some cases, lead failure. Subcutaneous ICD (S-ICDTM, Boston Scientific), a new type of ICD that does not require intracardiac leads, has been approved in Hong Kong and in Singapore. Adjunct Associate Professor Ching Chi Keong, senior consultant, Department of Cardiology and director, Electrophysiology and Pacing at the National Heart Centre Singapore (NHCS), discussed the advantages of using the novel defibrillator over traditional defibrillators, which patients would benefit from it, and shared his experience using the device with Elvira Manzano.
Diabetes causes blindness. We have heard or seen this many times. It seems like everyone (doctors, nurses, pharmacists and patients) knows that diabetes causes blindness. Then why is it that there are so many diabetics still going blind? Knowing and not doing anything to prevent blindness is akin to not knowing at all. Pharmacists need to play their role in preventing their diabetic patients from going blind.
The use of statins, and their potential over-prescription, has been a hot topic in media worldwide, with arguments for and against the cholesterol-lowering drug. Pharmacy Today New Zealand investigates whether the preventative prescription is appropriate for the very elderly or if the risks outweigh the benefits
Type 2 diabetes mellitus (T2DM) is a common chronic metabolic disorder in Malaysia and is characterized by a lack of secretion of insulin and/or insulin resistance. The classic symptoms of diabetes are polyuria, polydipsia, tiredness and unintentional weight loss.
Taking 10 resting blood pressure (BP) readings daily for 2 days provides a reliable, stable representation of patients’ resting systolic (S)BP and diastolic (D)BP, according to a study. This approach shows that the current home BP monitoring protocol of twice-daily readings for 4–7 days may be trimmed down to just 48 hours.
Impaired endothelial-dependent microvascular reactivity appears to be predictive of albuminuria progression in Asian patients with type 2 diabetes (T2D) who have normal urine albumin levels at baseline, but not in those with microalbuminuria, a prospective longitudinal cohort study suggests.