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Safe time interval for screening estimated glomerular filtration rate prior to gadolinium-enhanced MRI scan

Dear Editor, Magnetic resonance imaging (MRI) contrast media are commonly used in medical imaging and are usually gadolinium-based contrast agents (GBCAs). They can be divided into 3 groups. Group I consists of compounds with linear molecular structures. Group II consists of compounds with macrocyclic molecular structures. Group III currently includes...

Functional improvement after inpatient rehabilitation in community hospitals following acute hospital care

Early inpatient rehabilitation therapy has been known to have beneficial impact on physical function and mobility, psychological status and cognitive function of patients following an acute medical event requiring hospitalisation.1 Following an acute hospital care, those who have been identified to have potential for functional improvements are often transferred...

Continuous Renal Replacement Therapy: Continuous Blood Purification in the Intensive Care Unit

The last decade has seen a progressive change in the style of management of severe acute renal failure (acute renal failure which requires the use of renal replacement therapy) as well as in the epidemiology of this condition. Severe acute renal failure (SARF) is now most commonly seen in...

Urinary 2/16α-hydroxyestrone Ratio: Correlation with Serum Insulin-like Growth Factor Binding Protein-3 and a Potential Biomarker of Breast Cancer Risk

Breast cancer is the most common cancer among women in Singapore with age-standardised incidence rates increasing markedly from 26.8 to 38.7 per 100 000 per year over the last decade. While many recognised risk factors exist for the development of breast cancer such as demographic factors (personal and family...

The Role for Preoperative Localisation Techniques in Surgery for Hyperparathyroidism

Hyperparathyroidism is well recognised as a clinical problem that has a myriad of presentation. The classical presenting symptoms of hypercalcaemia have been well documented but there is an even greater awareness that many non-specific symptoms like fatigue, depression and constipation are related to hypercalcaemia. This article is available only as...

Clinical Predictors of Nephritis in Systemic Lupus Erythematosus

Lupus nephritis is a common manifestation of lupus associated with significant morbidity and mortality. The use of cytotoxic agents has resulted in improved renal outcomes but is associated with considerable morbidity, and their role in the management of lupus nephritis is not universally accepted. This article is available only as...

Outcome of Tunnelled Central Venous Haemodialysis Catheters Inserted by Radiologists

In end-stage renal failure patients, maintaining adequate vascular access continues to be an ongoing challenge. Native arteriovenous fistulas or synthetic arteriovenous grafts are satisfactory long-term options. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Case Series of Falciparum Malaria-induced Acute Renal Failure

Predominantly a disease of hot and humid climates, malaria affects 270 million people worldwide annually, and has a mortality rate of 1%. The increasing morbidity and mortality attributable to malaria in recent years follows the loss, in the early 1970s, of the impetus and impact of the initial WHO...

Renal Cell Carcinoma in Patients with Chronic Renal Failure

Dunnil and associates first described the association of renal cell carcinoma (RCC) with acquired cystic kidney disease (ACKD) and end stage renal disease. The incidence of ACKD in dialysis patients ranges from 10% to 90% depending on the duration of dialysis. This article is available only as a PDF. Please...

Inferior Vena Cava Thrombectomy for Renal Cell Carcinoma with Thrombus

A characteristic feature of renal cell carcinoma is the development of tumour thrombus extending into the inferior vena cava (IVC). This takes place in 4% to 10% of cases. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Current Therapeutic Strategies in Glomerulonephritis

Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients with minimal change nephrotic syndrome and lupus nephritis. For those patients who failed to respond, they were treated with oral cyclophosphamide. This article is available only...

Preliminary Results of Heart-beating and Non-heart-beating Donor Kidney Transplants—The Singapore Experience

End stage renal failure (ESRF) is the most common end stage organ disease treated with transplantation in Singapore. Though renal transplantation is the preferred treatment for ESRF, organ shortage is a major obstacle. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship between the risk of this disease with birth weight and gestational age had been well-documented, in particular, in infants with birth weight ≤1500 g (very...

The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report

A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral functional endoscopic sinus surgery for mild obstructive sleep apnoea and chronic sinusitis respectively. He weighed 109 kg, all his four upper incisors were missing and...

Deep Vein Thrombosis after Total Knee Replacement

Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis, its incidence is quoted between 46% and 84% in various studies. This article is available only as a PDF. Please click on “Download PDF” on top...

The Role of Cytokines and Cytokine Gene Polymorphism in T-cell Activation and Allograft Rejection

Cytokines are peptide molecules that are responsible for intercellular signalling during immune activation events. Cytokines are responsible, in large part, for the regulation of all local and systemic immune inflammatory and immunoregulatory events. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Proteinuria and Angiotensin Converting Enzyme (ACE) Gene Polymorphism

Proteinuria is considered a marker of renal disease. Traditionally it has been thought that proteinuria is the result of diseased glomeruli. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Genetics of Immunoglobulin A Nephropathy

Immunoglobulin (Ig) A nephropathy is the most common primary glomerulonephritis in various parts of the world, and it was detected in 25% of biopsy specimens taken from children in Kobe University Hospital. IgA nephropathy was initially considered to be a benign disease with a favourable prognosis, but as data...

Urinary Retention in Hospitalised Older Women

Voiding dysfunction is a relatively common problem in hospitalised older patients. Up to one-third of hospitalised elderly were reported to have post-void residual urine volume (PRUV) of more than 50 mL. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Case Reports of Low Dose Cyclosporine A Therapy in Adult Minimal Change Nephrotic Syndrome

There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic syndrome (MCNS), including those who fail steroids and cyclophosphamide therapy or who are steroid dependent and frequent relapsers. We report 3 cases which demonstrate the...

Abdominal Complications after Cardiac Surgery

Despite intensive therapeutic efforts, both the incidence and mortality of gastrointestinal complications after cardiac surgery employing cardiopulmonary bypass (CPB) have not decreased during the last two decades. Gastric bleeding, ischaemic bowel disease, gallbladder disease, and pancreatitis are reportedly the most common complications. This article is available only as a PDF....

A Twelve-year Review of Radical Cystectomies in Singapore General Hospital

Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of 6.9 per 100,000 per year for men and 1.7 per 100,000 per year for women in Singapore. This article is available only as a PDF. Please...

The Course of Pregnancy in a Patient with Nail-Patella Syndrome

The nail-patella syndrome (NPS) is a rare autosomal dominant disorder defined by the association of nail dysplasia, bone abnormalities and, frequently, renal disease. We report the course of pregnancy in a patient with such a condition. This article is available only as a PDF. Please click on “Download PDF” on...

Outcome of Pregnancy in Asian Women with Systemic Lupus Erythematosus: Experience of a Single Perinatal Centre in Singapore

Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more commonly than men (ratio 9:1), particularly those in the child-bearing age (15:1). This article is available only as a PDF. Please click on “Download PDF” on...

Pregnancy after Renal Transplantation: Experience in Singapore General Hospital

Successful renal transplantation significantly improves the sexual and reproductive functions of women with end-stage renal disease and offers the best hope for those who wish to have children. Conception rate has been reported to improve dramatically from 1 in 200 dialysis patients to 1 in 50 women with a...

Clinical Update on Deep Vein Thrombosis in Singapore

Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It also contributes to significant morbidity in terms of post-phleblitic syndrome and chronic venous ulcers. This article is available only as a PDF. Please click on “Download...

Challenges in Perinatal Medicine

One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This signaled the beginning of increased collaboration between the obstetricians and neonatologists in the management of high-risk pregnancies through multidisciplinary birth defect clinics and high-risk perinatal...

Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent and future adult health and well being. Adolescent substance use and abuse is an example of this. This article is available only as a PDF. Please...

Seasonal Variations of Clinical and Biochemical Parameters in Chronic Haemodialysis

Seasonal variations in the general population in some body functions and diseases incidences have been well-established (e.g., vitamin D levels, allergic rhinitis, blood pressure, levels of physical activity and energy expenditure, mental depression, peptic ulcer disease, and death from chronic heart failure). Similar patterns of seasonal variations in some...

Molecular Adsorbent Recirculating System (MARS)

Liver failure is clinically heterogeneous in aetiology, pathophysiology, clinical severity and prognoses. It can be divided into the following categories: acute liver failure (ALF), of which the most severe form is fulminant hepatic failure (FHF); acute-on-chronic liver failure (AoCLF), such as acute viral hepatitis flare in those with chronic...

Hand-assisted Laparoscopic Living Donor Nephrectomy

Minimally invasive donor nephrectomy using laparoscopic techniques has become a very attractive method of procuring kidneys from live donors, compared to the traditional standard open surgical approach. The laparoscopic approach to live donor nephrectomy has advantages of decreased postoperative pain with lesser analgesic requirement, less surgical trauma, shorter hospitalisation...

3rd College of Physicians’ Lecture – Translational Research: From Bench to Bedside and From Bedside to Bench; Incorporating a Clinical Research Journey in IgA Nephritis (1976 to 2006)

In our quest to pursue knowledge regarding a patient’s illness or seek a cure for the disease, as doctors we have to derive the necessary answers through physical examination of the patient and investigations either at the bedside or the laboratory. We engage in research activities into the patient’s...

Guidelines on Cardiac CT in Singapore (2006)

The heart is difficult to image because of its complex wall motion and variability of the cardiac cycle. Recent advances in 16 and 64-slice computed tomography (CT) technology such as thin detector collimation and fast gantry rotation allow the heart to be scanned in a single breath-hold. This article is...

Commercial Renal Transplantation – Body Parts for Sale

A 45-year-old Singaporean was seen for review by a nephrologist at a restructured hospital. She had been on follow up by a private nephrologist for management of chronic renal failure (CRF) due to diabetes mellitus. This article is available only as a PDF. Please click on “Download PDF” on top...

Factors Associated With Functional Decline of Hospitalised Older Persons Following Discharge From an Acute Geriatric Unit

Hospitalisation is a stressful event for the older person. The physiological changes associated with ageing, such as decreased muscle strength and aerobic activity, reduced bone density, altered appetite and tendency towards urinary incontinence, predispose older patients to complications during hospitalisation. Studies have shown that about one-third of older persons...

Measurable Predictive Factors for Progression to AIDS among HIV-infected Patients in Singapore

The first case of human immunodeficiency virus (HIV) infection was detected in Singapore on 16May 1985. The number of newly diagnosed HIV/acquired immuno-deficiency virus syndrome (AIDS) infections has been increasing since 1985, and a total of 1599 cases were detected as of December 2001. In a known cohort of...

Multimodal Antiemetic Therapy and Emetic Risk Profiling

In the last few years, hundreds of papers exploring the issue of postoperative nausea and vomiting (PONV) have been published. It has been estimated that the overall incidence of PONV for all surgeries and patient populations is between 25% and 30%, with severe, intractable PONV estimated to occur in...

Factors Associated with Decompression and Strabismus Surgery in Thyroid Eye Disease

Thyroid eye disease (TED) is a visually and socially disabling condition. Newly diagnosed patients are often fearful of sight-threatening complications that include optic nerve compression or restrictive strabismus. Although the current literature has pointed to age (>60 years), gender (male), abnormal thyroid function (both hyper- and hypo-thyroidism), smoking and...

Concomitant Coronary Artery Disease Among Asian Ischaemic Stroke Patients

Coronary artery disease (CAD) is the leading cause of mortality following ischaemic stroke. The annual risk for myocardial infarction following ischaemic stroke is approximately 2.2%. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Angiotensin-Converting Enzyme Inhibitor versus Angiotensin 2 Receptor Antagonist Therapy and the Influence of Angiotensin-Converting Enzyme Gene Polymorphism in IgA Nephritis

Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ATRA) are both well established drugs utilised to help retard the progression of chronic kidney diseases to end-stage renal failure (ESRF), either by reducing proteinuria or even reversing mild renal impairment and restoring normal renal function in some cases....

The Association Between Parental Socioeconomic Status (SES) and Medical Students’ Personal and Professional Development

In order to commit to their mission and placement requirement efficiently and effectively, policy-makers need to decide which types of students their training units should recruit, what type of curriculum they should design and what kinds of support mechanisms they should implement. This article is available only as a PDF....

Risk Factors for Conversion to Open Surgery in Patients With Acute Cholecystitis Undergoing Interval Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy has become a routine surgical procedure in general surgical units all over the world. Its implementation has expanded dramatically and is considered a feasible and safe approach even for acute cholecystitis.1,2 Laparoscopic management of acute cholecystitis may still be associated with increased risks of complications such as...

Cerebral Microangiopathy in Patients with Non-insulin-dependent Diabetes Mellitus

Cardiovascular complications account for the highest rate of morbidity and mortality in patients with diabetes mellitus (DM), type 1 and type 2, respectively. The Copenhagen City Heart Study, carried out in 13,105 subjects followed up prospectively for 20 years, reported that in patients with type 2 DM, the risk...

Drug Use and Dosing in Chronic Kidney Disease

Chronic kidney disease (CKD) is an important therapeutic problem. There is an increasing realisation that renal impairment is under-diagnosed, and this has led to attempts to improve both the detection and management of patients with impaired renal function.1 The Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney...

ANCA-negative Pauci-immune Crescentic Glomerulonephritis with Thrombotic Microangiopathy

Pauci-immune crescentic glomerulonephritis (Pauci-immune CGN) is the most common cause of CGN. Thrombotic microangiopathy (TMA) defines a clinicopathological syndrome consisting of intraluminal platelet thrombosis in the microvasculature and the presence of fragmented red blood cells and thrombocytopaenia in the peripheral blood, and may be seen in haemolytic uraemic syndrome...

Urotensin 2 and Retinoic Acid Receptor Alpha (RARA) Gene Expression in IgA Nephropathy

IgA nephropathy (IgAN) is the most common primary glomerulonephritis in Singapore1 and in many parts of the world, contributing significantly to the pool of end-stage renal failure patients annually. Despite more than 3 decades of research, the pathogenesis of the disease is still poorly understood. This article is available only...

Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure

Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have more severe infections, a different spectrum of bacteriology and a worse outcome. In our experience, of all patients with upper limb infections, those with end-stage...

Peripheral Arterial Disease in Community-based Patients with Diabetes in Singapore: Results from a Primary Healthcare Study

Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In addition, PAD is a manifestation of systemic atherosclerosis and is associated with increased risk of death and ischaemic events. This article is available only as a...

Novel Trends in Haemodialysis: Where Are We Heading?

Despite advances in haemodialysis technology over the past 40 years and rapid proliferation of clinical guidelines over the last decade promoting evidence-based practices, the mortality of end-stage renal failure patients on conventional thrice-weekly in-centre haemodialysis remains remarkably high. This article is available only as a PDF. Please click on “Download...

Evaluation of Intensive Care Unit-acquired Urinary Tract Infections in Singapore

Urinary tract infection (UTI) is one of the most common types of nosocomial infections encountered in the inpatient settings including intensive care unit (ICU). Amongst patients admitted to ICU, studies have revealed the incidence of nosocomial UTIs to range from 9% to 29%. This article is available only as a...

Triplicate Ureter with Contralateral Duplicate Ureter

What do you see in this intravenous urogram? 1. Left lower ureteric calculus with proximal hydroureteronephrosis 2. Left duplicated ureter with lower ureteric calculus 3. Right triplicate ureter with left duplicated ureter 4. Right triplicate ureter with left duplicate ureter with left lower ureteric calculus with proximal hydroureteronephrosis This article is available only as a PDF....

Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009

The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas in the United States in late April 2009. This was linked to outbreaks of influenza in Mexico, which included reports of large numbers of cases...

Rationale for Redefining Obesity in Asians

Obesity is a condition characterised by an excess of body fats. According to the World Health Organization (WHO), there were about 1.6 billion overweight adults aged 15 years and above and at least 400 million adults worldwide in 2005. Obesity poses a serious health burden as it is associated...

The Risk Factors for Ultrasound-diagnosed Non-alcoholic Fatty Liver Disease Among Adolescents

Non-alcoholic fatty liver disease (NAFLD) is increasing recognised as one of the most important causes of chronic liver disease in Western countries. It encompasses a spectrum of diseases ranging from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH). Hepatic steatosis is a common clinical and histological finding and it is...

Profile of Hospitalisation and Death in the First Year after Diagnosis of End-stage Renal Disease in a Multi-ethnic Asian Population

End-stage renal disease (ESRD) is reaching epidemic proportions and is increasingly a public health issue due to the cost of providing care to these patients. There are many kidney disease databases and registries tracking and studying trends in the epidemiology and care of ESRD patients. This article is available only...

Primary Hyperoxaluria

An 18-year-old male presented with complaints of abdominal pain. He had history of previous episodes of renal colic and passage of stones in urine. Renal function tests were deranged (blood urea levels of 72 mg/dL and serum creatinine levels of 3.2mg/dL). Abdominal X-ray (Fig.1) and non-contrast computed tomography (NCCT)...

Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan

Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000 man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...

Dietary Protein Intake in a Multi-ethnic Asian Population of Healthy Participants and Chronic Kidney Disease Patients

Clinical practice guidelines recommend different amounts of dietary protein intake for chronic kidney disease (CKD) patients. The recommended daily protein intake varies according to the level of kidney function (glomerular filtration rate (GFR) in mL/min per 1.73 m2 body surface area). It is unknown how effectively these recommendations perform...

Avulsed Tip of a Systemic Iceberg

An 18-year-old male presented to the emergency department of Khoo Teck Puat Hospital with knee pain and swelling while playing basketball. He was unable to bear weight. He had a surgical history of combined liver and kidney transplant 3 years ago. This article is available only as a PDF. Please click on “Download PDF”...