Prof. Cheuk-Chun Szeto, Dr. Winston W. S. Fung, 20180125045128
A 65-year-old lady with a background of type 2 diabetes, hyperlipidaemia and chronic immune thrombocytopenia presented to us with a 2-week history of generalized malaise and myalgia. Shortly after the onset of myalgia, she was noted to have reduced urine output and the urine was described as dark in colour. Her regular medications included prednisolone, danazol, simvastatin, metformin, and human insulin. Upon further questioning, the patient admitted that her compliance to simvastatin and danazol used to be poor. However, she recently started to take both medications regularly after repeated education.
A 45-year-old gentleman presented with nephrotic-range proteinuria (6 g/day) and acute renal impairment. Blood tests revealed active lupus serological markers. He had no other extra-renal lupus manifestations. Renal biopsy showed Class IV lupus nephritis (activity score, 12/24; chronicity score, 1/12; 3 out of 12 glomeruli showed cellular crescents).
Dr. Priscilla Wong, Dr. Lydia Tam, Prof. LS Tam, 20171110000000
This case report highlights that psoriatic arthritis is a heterogenous disease affecting multiple disease domains, and effective treatment requires thorough assessment of each of these different domains.
With increasing affordability and availability of international travel, many endemic infections once restricted to overseas regions are now not uncommonly seen in our locality. Three cases of important arthropod-borne infections from returned travellers are reported and discussed.
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.
Use of noninvasive ventilation (NIV), similar to invasive mechanical ventilation (IMV), appears to lessen mortality but may increase the risk for transmission of the novel coronavirus disease (COVID-19) in healthcare workers, suggest the results of a study.
Use of corticosteroid is not associated with improved outcomes in idiopathic pulmonary fibrosis (IPF) patients admitted to the hospital with acute exacerbation (AE), reveals a recent study. In addition, corticosteroids may even contribute to reduced overall survival following exacerbation.
Acne is a common skin problem seen in primary care. Dr Wong
Soon Tee of Assurance Skin Clinic at Mt Elizabeth Novena Hospital, Singapore
shares his insights with Pearl Toh on how to manage acne in the primary care