Strategies for Management of Peritoneal Dialysis Patients in Singapore during COVID-19 Pandemic

Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory.

Chlorpheniramine maleate: an effective antiallergic agent

Chlorpheniramine maleate is Hi receptor antagonist and is useful in the management of allergic and non-allergic rhinitis. It is commonly used to treat different symptoms associated with rhino conjunctivitis and urticaria. This article briefly reviews the therapeutic uses, drug-drug interactions, incompatibilities and side effects of chlorpheniramine maleate

Gynaecomastia; management and causative factors

To determine the causative factors and management of Gynaecomastia. Observational case series study. Surgical Unit-1 Bahawal Victoria Hospital Bahawalpur, from 1st January 200 till 31st December 2007. Thirty male patients having breast swelling were included in this study. Relevant history was obtained. Appropriate | physical examination was performed. Necessary investigations were done and after making a diagnosis appropriate treatment was done. A total of 30 patients were studied in the study period of 18 months. Those male patients who were having breast lesion other than benign enlargement [e.g. Ca. Breast, Breast/Abscess] were not included in the study. Necessary investigations were done. Subcutaneous I Mastectomy was performed. The most common age group developing gynaecomastia was of 20-30 years [60%]. Bilateral gynaecomastia was observed in 76.66% and unilateral gynaecomastia in 23.33%. Idiopathic gynaecomastia was observed in 73.33% cases. Medical treatment was given with tamoxifen 10mg twice a day for the period of three months in 6 case [20%] and this remained effective in 5 case [83.33%]. Subcutaneous mastectomy was performed in 17 cases [56.66%]. Post-operative complications were seen in 4 cases [23.52%], the most common complication being wound hematoma in 2 cases [11.76%]. Most of the patients [88.9%] were fully satisfied with the results of subcutaneous mastectomy. Gynaecomastia is the most common benign lesion of the male breast. As far as physiological gynaecomastia is concerned, patients should be observed for at least 2 years from the onset of their condition. In most of the cases spontaneous resolution occurs. Surgical treatment should be planned in whom spontaneous resolution does not occur. Surgery remains the mainstay of therapy and is frequently indicated for psychological and cosmetic reasons

Spontaneous per urethral expulsion of gossipibyoma - a rarity

Foreign bodies left accidentally during a surgical procedure are rare. In spite of careful intra-operative precautions and gauze counts mistake still occurs. Many of these cases present with sepsis, the foreign body may erode hollow viscera with and without signs of peritonitis and discovered on laparatomy. These foreign bodies may remain silent for years. We are reporting an interesting case of an 11 years old girl who presents with gauze piece coming out of her urethra 4 years after cystolithotomy and right ureterolithotomy. Such cases of intraluminal migration and spontaneous expulsion of foreign body are rarely reported

Frequency of hepatic hydrothorax in patients with liver cirrhosis: a tertiary care hospital experience

Objective: present study was designed to find out the frequency of hepatic hydrothorax among the patients with liver cirrhosis in a tertiary care hospital

Methods: this prospective observational study was carried out at the Hepatology Section of Department of Medicine, Isra University Hospital, Hyderabad, from December 2005 to May 2006. All the consecutive patients suffering from cirrhosis of liver were included and studied for the presence of hepatic hydrothorax. Results were summed up and test parameters were compared statistically

Results: the total number of patients was 128, and the mean age of these patients was 48.6 years. Frequency of hepatic hydrothorax in all patients with cirrhosis was 5.5% [7/128]. It was seen that highest frequency of hepatic hydrothorax was found in Hepatitis C cirrhotic patients [4/7]. The second most common occurrence was found in hepatitis B cirrhotic patients [2/7]. In other types [non "B", non "C"] it was 1/7

Conclusion: the frequency of hepatic hydrothorax at our center is similar as reported in the world literature

Factors affecting survival in patients with oesophageal atresia and tracheo-oesophageal fistula

To evaluate the various factors affecting survival in babies with oesophageal atresia and tracheo-oesophageal fistula. Descriptive study. The study was carried out at the Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from March 2004 to March 2005. All neonates with oesophageal atresia [EA] and tracheo-oesophageal fistula [TEF] during the study period were included in the study. Patients having isolated EA were excluded. A total of 80 patients were included in the study. Patients were received from the emergency department, OPD and Neonatal ICU. Diagnosis was confirmed by passing a radio opaque orogastric tube. Investigations were done to look for other associations. After stabilisation, right thoracotomy was performed, fistula was ligated and divided. An attempt was made to do a primary oesophago-oesopahgostomy. Nasogastric feeding was started on 2nd post-operative day. A contrast oesophagogram was performed on the 7th postoperative day and having ruled out leak, oral feeding was started. Out of the total, 33 [41%] survived and 47 [58%] patients died. Out of 47 deaths 20 [25%] died before surgery and 27 [34%] died after surgery. Mean follow up period was 6 months. Sixteen [20%] patients had anastomotic leak, 24 [30%] had anastomotic stricture, and 64 [80%] patients had postoperative pneumonia. We conclude that proper antenatal check ups will detect the problem early, avoid home deliveries and hence improve survival. Pneumonitis and septicaemia significantly affect survival. Availability of ICU is one of the main determinants of survival. The likely cause of high mortality rate in pre-operative patients in our series is non-availability of NICU due to limited space in our setup

Surgical ligation of patent ductus arteriosus in a non-cardiac surgical centre

Surgery for Patent Ductus Arteriosus [PDA] is usually performed in specialized cardiac centres with either open surgery of percutaneous embolisation using different materials and devices. This involves high cost of treatment especially for those poor patients who have grown up to several years of age without seeking any treatment for their disease. The objective of this study is to evaluate the safety of surgery for PDA in a non cardiac paediatric surgical setup. A total of 89 patients of 8 months to 12 years [mean 3 years] age were operated over a period of 13 years [from 1993 to 2006]. Fifty-five cases were females and 34 were males. Investigations included x-ray chest, ECG and echocardiography. All patients with PDA were included in the study except those who had other associated cardiac anomaly and those who had a calcified ductus. The ductus was dissected out and ligated with non-absorbable suture [Silk No. 1 or 2]. The patients were discharged by the 5[th] postoperative day. In majority of the patients the recovery was smooth and uneventful. Eight patients had minor complications which were treated conservatively. There were 3 mortalities in this series; 2 patients were over 10 years of age and had calcified ductus. They died during surgery due to primary haemorrhage and 1 died after 24 hours in the intensive care unit. All patients were reviewed at 1 week, 1 month, 3 months and 1 year after surgery. In majority, the typical machinery murmur disappeared immediately or a soft systolic murmur persisted for up to 4 weeks and then disappeared. With proper patient selection, the procedure can safely be performed in a paediatric surgical setup with facilities for cardiac monitoring. The surgeon needs to receive some additional training in the cardiac institution for safe surgery on these children. This will significantly reduce the cost with minimal complications especially for those poor patients who cannot afford the modern procedures due to monitory constraints. Children older than 10 years are not suitable for open surgery because of calcification of the duct

Liver biopsy in patients infected with chronic hepatitis C and persistently normal serum ALT levels

Introduction: Approximately 30 to 40% of patients with Chronic Hepatitis "C" [CHC] have persistently normal serum alanine aminotransferase [ALT] levels. Historically, these patients have been classified as healthy or asymptomatic and have not received any treatment for CHC infection. However, definition and clinical significance of persistently normal ALT in CHC have been recently revised as new information on liver disease which is now getting available

Aims: To evaluate the histological feature of liver of patients suffering from CHC with persistently normal ALT levels

Methods: In this prospective observational study we recruited consecutive patients infected with CHC with persistently normal ALT since last six months, visited our hepatology clinic from September 2004 to April 2005. The METAVIR scoring system was used for liver histology grading [degree of inflammation] and staging [degree of fibrosis]

Results: A total of 55 patients were recruited from outpatient clinic with normal ALT during a follow up of six months. Mean age of these patients was 36.7+/- 9.78 years; out of these 39 [70.9%] were male. All these patients were diagnosed to have hepatitis C by HCV RNA PCR method. There were 24 [43.6%] patients with stage [fibrosis] equal or greater than 2 and 33 [60%] had biopsy grade equal or greater than 2. Eighteen [32.7%] patients had steatosis on liver biopsy. Twelve patients with stage > 2 had steatosis while 6 patients with stage < 2 had steatosis [p< 0.01]

Conclusion: There was no correlation found between the transaminase level and biopsy scores. Approximately 44 % of the patients have fibrosis equal to or greater than stage 2. The extent of steatosis is directly related to the biopsy score of the patients