The Winnipeg Regional Health Authority's introduction of a full-time nurse practitioner in a 116-bed non-profit nursing home provided an opportunity to explore a collaborative relationship between an NP acting as the primary care provider and a single physician serving as the consultant for complex care and after-hours care. The outcomes were measured in terms of resident and family satisfaction, quality of care indicators and cost effectiveness. Data were collected from pre-existing quality indicators, including a resident/family satisfaction survey, transfers to acute care, and medication use statistics.
View Article and Find Full Text PDFBackground And Objectives: Chloramphenicol was considered the anti-microbial gold standard for typhoid treatment but, following the increasing worldwide frequency of antibiotic resistance, ciprofloxacin has been the mainstay of therapy since 1980. Recent studies have shown a shifting of susceptibility to conventional drugs like chloramphenicol, ampicillin and cotrimoxazole. The primary objective of the study was to evaluate the in vitro activity of chloramphenicol and other first-line drugs in comparison with cephalosporins and quinolones.
View Article and Find Full Text PDFSpinal tuberculosis most commonly presents as a paradiscal lesion involving the disc space and adjacent vertebral bodies. Atypical forms of spinal tuberculosis have been described and are most often a result of posterior element involvement. The authors report a patient, who presented with complete posterior migration of an intact vertebral body, a complication of spinal tuberculosis that has not been reported till date.
View Article and Find Full Text PDFIndian J Otolaryngol Head Neck Surg
September 2009
Hearing aids are the principal means of auditory rehabilitation for patients with moderate to severe sensorineural hearing loss. Although technical improvements and modifications have improved the fidelity of conventional aids, hearing aids still have many limitations. Implantable hearing aids offer patients with hearing loss several potential advantages over conventional hearing aids.
View Article and Find Full Text PDFAims: To characterise the mechanism of glycopeptide resistance, genetic relatedness, and pathogenicity factors in isolates of vancomycin-resistant enterococci (VRE) in Singapore.
Methods: A total of 292 Enterococcus faecium and 17 Enterococcus faecalis were isolated from humans, and five E. faecium, two Enterococcus durans, two Enterococcus flavescens, one Enterococcus casseliflavus, and one Enterococcus gallinarum from chickens.
Background: Breast cancer is a major problem in the United States leading to tens of thousands of deaths each year. Although citrus auraptene suppresses cancer in numerous rodent models, its role in breast cancer prevention previously has not been reported. Thus, our goal was to determine the anticarcinogenic effects of auraptene against breast cancer.
View Article and Find Full Text PDFSingapore Med J
June 2009
Introduction: Since late March 2009, a novel influenza H1N1 strain emerged in humans in Mexico and the United States. It has rapidly spread to many countries on different continents, prompting unprecedented activation of pandemic preparedness plans. Singapore has adopted a containment strategy with active screening of febrile travellers with respiratory symptoms from affected countries since April 27, 2009.
View Article and Find Full Text PDFObjectives: The objective of this study is to analyze the clinical outcomes and treatment strategies of coronary wire perforations (WPs) in the era of heparin use compared to the era of bivalirudin use.
Background: Percutaneous coronary intervention (PCI) advances have led to progressive decrease in complications. Therefore, complex coronary lesions such as chronic total occlusions and calcified lesions are being attempted with stiff/hydrophilic wires with resultant higher incidence of coronary WP.
The use of stable and cost-effective DNA vaccines for silencing genes of White Spot Syndrome Virus (WSSV) in Penaeus monodon through RNA interference has been tested. DNA constructs that express long-hairpin RNA (lhRNA) constitutively in vivo against two WSSV envelop genes vp19 and vp28 (pCMV-VP19-LH and pCMV-VP28-LH) were used to confer protection against the pathogen. A construct expressing lhRNA directed against gfp gene (pCMV-GFP-LH) was used to estimate the non-specific protection and to show that on intramuscular administration the plasmid spreads all across the shrimp body and persists for at least 30 days.
View Article and Find Full Text PDFAnn Acad Med Singap
April 2009
Introduction: Renal transplantation is the treatment of choice for children with end-stage renal failure (ESRF). The paediatric renal transplant programme in Singapore was initiated in 1989. This study aimed to examine our outcomes over the 19-year period from 1989 to 2007.
View Article and Find Full Text PDFUnlabelled: The occurrence of contrast induced nephropathy (CIN) is associated with increased mortality after percutaneous revascularization procedures. However, the exact correlation between various levels of creatinine elevation relative to the baseline and subsequent mortality in patients with chronic renal insufficiency (CRI) is not well established. In addition, the relationship between elevated postprocedural creatinine and ensuing mortality in patients with normal baseline renal function needs to be investigated.
View Article and Find Full Text PDFThe illegal enrichment of anabolic androgenic steroids in over-the-counter dietary supplements is well documented, but the health consequences have not been widely recognized. Three recent reports document cholestatic jaundice and nephropathy due to these compounds. We present 3 additional cases of anabolic androgenic steroid-enriched dietary supplement-induced hepatotoxicity and 1 case of renal failure, and we review the literature and the relevant features of this growing health concern.
View Article and Find Full Text PDFIntroduction: Lung cancer is the leading cause of death among the cancers seen in the United States. Hypercalcemia and leukocytosis are two common paraneoplastic syndromes associated with lung cancer. Unfortunately patients presenting with Hypercalcemia- leukocytosis syndrome has a worse prognosis than patients presenting with lung cancer alone.
View Article and Find Full Text PDFHigh-density lipoprotein (HDL) cholesterol level is a strong predictor of morbidity and mortality in the general population. Conflicting data exist on the protective effects of high HDL cholesterol in patients with optimal low-density lipoprotein (LDL) cholesterol levels. To determine the association of high HDL cholesterol with mortality in patients with LDL cholesterol levels <70 mg/dl who undergo percutaneous coronary intervention, 3,616 consecutive patients with LDL cholesterol levels <70 mg/dl who underwent percutaneous coronary intervention from July 1, 1999, to June 1, 2007, were retrospectively analyzed and followed through July 1, 2007.
View Article and Find Full Text PDFBackground: Eukaryotic initiation factor 4E (eIF4E) is elevated in many cancers and is a prognostic indicator in breast cancer. Many pro-tumorigenic proteins are selectively translated via eIF4E, including c-Myc, cyclin D1, ornithine decarboxylase (ODC), vascular endothelial growth factor (VEGF) and Tousled-like kinase 1B (TLK1B). However, western blot analysis of these factors in human breast cancer has been limited by the availability of fresh frozen tissue and the labor-intensive nature of the multiple assays required.
View Article and Find Full Text PDFJ Am Acad Nurse Pract
December 2008
Purpose: To discuss the assessment, diagnosis, and management of geriatric insomnia, a challenging clinical condition of older adults frequently seen by primary care providers.
Data Sources: Extensive literature review of the published research articles and textbooks.
Conclusions: Complaints of insomnia among older adults are frequently ignored, considered a part of the normal aging process or viewed as a difficult to treat condition.
Melioidosis is an emerging infectious disease in India acquired through percutaneous inoculation or contaminated water. Known risk factors include diabetes mellitus, renal failure, cirrhosis, and malignancy. Melioidosis presents with a febrile illness, with protean manifestations ranging from septicemia to localized abscess formation.
View Article and Find Full Text PDFAnn Acad Med Singap
October 2008
Introduction: Antibiotic resistance in gram-negative bacilli is an area of increasing importance. This prospective study was performed to survey antibiotic resistance in Escherichia coli (E. coli), Klebsiella spp.
View Article and Find Full Text PDFClin Neurol Neurosurg
April 2009
Toxic leukoencephalopathy occurs as a result of exposure to wide variety of agents. Inhalation of heroin or its vapours produces a distinct syndrome with characteristic findings on MR imaging. We report a case of heroin vapour abuse (chasing the dragon) who presented with altered sensorium.
View Article and Find Full Text PDFBackground: Establishing a histological diagnosis in abdominal tuberculosis can be difficult, frequently delaying treatment. The aim of the study was to evaluate the role of laparoscopy for ascertaining the diagnosis in suspected abdominal tuberculosis.
Methods: A retrospective review was undertaken of patients who underwent diagnostic laparoscopy for suspected abdominal tuberculosis over a 6-year period, analysing its usefulness in establishing a histological diagnosis.
Background: The present study was done to analyze if glycoprotein IIb/IIIa inhibitors (GPI) bolus-only will reduce vascular/bleeding complications and cost with similar major adverse cardiac events (MACE) when compared with GPI bolus + infusion. Evidence-based therapy of GPI inhibitors during percutaneous coronary intervention (PCI) incorporates intravenous bolus followed by 12 to 18 hours of infusion. However, GPI bolus + infusion may increase vascular/bleeding complications and may not reduce MACE when compared with GPI bolus-only.
View Article and Find Full Text PDFIndian J Gastroenterol
September 2008
Circadian changes in membrane potential and spontaneous firing frequency have been observed in microbial systems, invertebrates, and mammals. Oscillators in olfactory sensory neurons (OSNs) from Drosophila are both necessary and sufficient to sustain rhythms in electroanntenogram (EAG) responses, suggesting that odorant receptors (ORs) and/or OR-dependent processes are under clock control. We measured single-unit responses in different antennal sensillae from wild-type, clock mutant, odorant-receptor mutant, and G protein-coupled receptor kinase 2 (Gprk2) mutant flies to examine the cellular and molecular mechanisms that drive rhythms in olfaction.
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