Understanding cannabis use in Singapore: profile of users and drug progression

INTRODUCTION@#Cannabis has consistently been the third most commonly abused drug among drug arrestees in Singapore over the past few years. Accordingly, this study aimed to understand the profile of cannabis users in Singapore and explore the effects of cannabis use on drug progression.@*METHODS@#A total of 450 participants who had used cannabis at least once in their lifetime were recruited from the National Addictions Management Service, prisons, the Community Rehabilitation Centre and halfway houses from August 2017 to May 2018. A face-to-face questionnaire was administered and descriptive analyses were conducted.@*RESULTS@#The mean participant age was 40.9 ± 14.51 years, and 93.1% of them were male. The participants generally initiated cannabis use during adolescence, at a mean onset age of 16.5 ± 4.46 years. Most (89.6%) were introduced to cannabis by peers. Approximately half of them (46.9%) had used cannabis before other illicit drugs and 42.1% of them had used heroin as the succeeding drug.@*CONCLUSION@#In Singapore, cannabis use is often initiated during adolescence, largely under peer influence. Cannabis users may progress to other illicit drugs, particularly heroin, later in life.

Utilisation patterns of helpline and Web chat services among gamblers in Singapore

We evaluated the utilisation of a helpline and Web chat system by the public for gambling-related services in Singapore over a period of 12 months. The profile of callers, call characteristics and actions taken were descriptively analysed using aggregate data. The majority of helpline calls and Web chats were from gamblers aged 40-49 years (23.3%, n = 644). Gamblers made 85.4% (n = 8,010) of the calls to the helpline and 73.3% (n = 546) of the Web chats. About four-fifths of the gamblers were Chinese (79.5%, n = 6,381) and employed full time (79.9%, n = 4,125). Table games (67.6%, n = 2,605) were the most popular gambling activity reported by callers, 55.8% of which involved local casinos. Enquiries were mostly casino related (92.4%, n = 5,739). Approximately 1,827 calls were received per month during the study period and 185 referrals were made to the clinic, 80.5% of whom sought treatment.

Academy of Medicine-Ministry of Health clinical practice guidelines: attention deficit hyperactivity disorder

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Occurrence of a lymphocele following renal transplantation

<p><b>INTRODUCTION</b>The incidence of lymphoceles - lymphatic collections around a transplanted kidney - can be as high as 20%. We aimed to review the presentation, treatment and outcome of patients with lymphoceles.</p><p><b>METHODS</b>We reviewed a prospective database of 154 patients who underwent renal transplantation at our hospital from January 2005 to November 2008.</p><p><b>RESULTS</b>The mean age of the patients in our cohort was 46 (range 34-58) years. The incidence of lymphoceles in our series was 5.8% (n = 9). The median onset was 19 (range 6-28) days post-transplantation, while the median size of the lymphoceles was 5 (range 1.5-8) cm. Lymphoceles were most commonly found at the lower pole of the transplanted kidney. Eight patients with lymphoceles had received cadaveric transplants. While a majority of these patients did not have hydronephrosis on presentation, four had markedly elevated creatinine. Of the nine patients with lymphoceles, six were on macrolides (tacrolimus, sirolimus or everolimus), two were successfully managed conservatively, three were managed percutaneously and four required surgical drainage via either laparoscopic marsupialisation (n = 1) or open drainage (n = 3). There was no graft loss.</p><p><b>CONCLUSION</b>It remains unknown whether the choice of immunosuppressants increases the risk of lymphocele formation. Intervention is necessary in the case of impaired drainage of the pelvicalyceal system in these patients. Minimally invasive intervention, while effective in treating lymphoceles, does not provide definitive treatment. Surgical intervention should be considered early for the treatment of post-transplantation patients with lymphoceles, so as to shorten hospital stay and prevent further complications.</p>

Vascularisation of Urethral Repairs with the Gracilis Muscle Flap

BACKGROUND: The ability to achieve a long-term, stricture-free urethral repair is one of the ongoing challenges of reconstructive urologic surgery. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps. METHODS: We describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair site to provide a well-vascularised soft tissue reinforcement for urethral repair. This technique promotes vascular induction, whereby a new blood supply is introduced to the repair site to improve the outcome of urethral repair or anastomotic urethroplasty. The surface contact between the muscle flap and the repair site is enhanced by the use of fibrin glue to improve adherence and promote inosculation and healing. We employed this technique in 4 patients with different urethral defects. RESULTS: After a follow-up period of 32 to 108 months, all of the urethral repairs were successful without complications. CONCLUSIONS: Our results suggest that the use of a gracilis muscle flap to vascularise urethral repairs can improve the outcome of challenging urethral repairs.