Emergency department service utilisation of older patients with urgent conditions: a cross-sectional observational study.

Background: As with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growing group of patients utilising public healthcare emergency services and puts a strain on current ED resources. The medical conditions vary, and resources used has been poorly characterized.

Penetrating cardiac trauma caused by a nail-gun: A case report and narrative review.

Introduction: Penetrating cardiac injuries are emergencies that require prompt surgical management. Most of these injuries are caused by gunshots or stab wounds however the incidence of nail-gun injuries is rising due to their availability and widespread use. Cardiac injuries caused by nail-guns are often self-inflicted.

Traumatic tricuspid valve regurgitation: A two case series.

Traumatic tricuspid valve injury is rare, accounting for 0.02% of traumatic injuries. The majority of cases result from blunt force trauma to the chest, however penetrating injuries have been documented in literature.

Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report.

Introduction: Left ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement.

Case Presentation: A 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus.

Risk Stratification of Paediatric Sports Injuries Seen at a Tertiary Hospital.

Introduction: In this study, we described paediatric sports injuries seen in the paediatric emergency department of a large, tertiary paediatric hospital in Singapore and evaluated risk factors for severe sports injuries.

Methods: This is a retrospective review of a paediatric trauma surveillance registry from February 2012 to October 2017, including patient demographics, type of sports, circumstances, type of injuries, and clinical management in the hospital. Patients 5 to 17 years old with a sports-related injury were included.

A Cyclic Phosphoramidate Prodrug of 2'-Deoxy-2'-Fluoro-2'--Methylguanosine for the Treatment of Dengue Virus Infection.

Monophosphate prodrug analogs of 2'-deoxy-2'-fluoro-2'--methylguanosine have been reported as potent inhibitors of hepatitis C virus (HCV) RNA-dependent RNA polymerase. These prodrugs also display potent anti-dengue virus activities in cellular assays although their prodrug moieties were designed to produce high levels of triphosphate in the liver. Since peripheral blood mononuclear cells (PBMCs) are among the major targets of dengue virus, different prodrug moieties were designed to effectively deliver 2'-deoxy-2'-fluoro-2'--methylguanosine monophosphate prodrugs and their corresponding triphosphates into PBMCs after oral administration.

Stepwise Evolution of Fragment Hits against MAPK Interacting Kinases 1 and 2.

Dysregulation of translation initiation factor 4E (eIF4E) activity occurs in various cancers. Mitogen-activated protein kinase (MAPK) interacting kinases 1 and 2 (MNK1 and MNK2) play a fundamental role in activation of eIF4E. Structure-activity relationship-driven expansion of a fragment hit led to discovery of dual MNK1 and MNK2 inhibitors based on a novel pyridine-benzamide scaffold.

Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review.

Background: Patients with prolonged length of hospital stay (LOS) not only increase their risks of nosocomial infections but also deny other patients access to inpatient care. Hepatobiliary (HPB) malignancies have some of highest incidences in East and Southeast Asia and the management of patients undergoing HPB surgeries have yet to be standardized. With improved neurosurgery techniques for intracranial aneurysms and tumors, neurosurgeries (NS) can be expected to increase.

Discovery of Dengue Virus NS4B Inhibitors.

The four serotypes of dengue virus (DENV-1 to -4) represent the most prevalent mosquito-borne viral pathogens in humans. No clinically approved vaccine or antiviral is currently available for DENV. Here we report a spiropyrazolopyridone compound that potently inhibits DENV both in vitro and in vivo.

Lead optimization of spiropyrazolopyridones: a new and potent class of dengue virus inhibitors.

Spiropyrazolopyridone 1 was identified, as a novel dengue virus (DENV) inhibitor, from a DENV serotype 2 (DENV-2) high-throughput phenotypic screen. As a general trend within this chemical class, chiral resolution of the racemate revealed that R enantiomer was significantly more potent than the S. Cell-based lead optimization of the spiropyrazolopyridones focusing on improving the physicochemical properties is described.

Retrospective study of elderly frequent attenders presenting with chest pain at emergency department.

Background: The aims of the study were to identify the characteristics of elderly frequent attenders to the emergency department (ED) presenting with chest pain and to assess the 1-year prognosis for developing adverse cardiac events.

Findings: Patients over 75 years old, with four or more attendances to the ED between 1 January 2010 and 31 December 2010 with at least one attendance due to chest pain, were selected from a database. Data was collected on demographic details, visit history, disposition and admission outcomes.

Modulation of inflammation and pathology during dengue virus infection by p38 MAPK inhibitor SB203580.

Dengue virus (DENV) infection could lead to dengue fever (DF), dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). The disease outcome is controlled by both viral and host factors. Inflammation mediators from DENV-infected cells could contribute to increased vascular permeability, leading to severe DHF/DSS.

Indolcarboxamide is a preclinical candidate for treating multidrug-resistant tuberculosis.

New chemotherapeutic compounds against multidrug-resistant Mycobacterium tuberculosis (Mtb) are urgently needed to combat drug resistance in tuberculosis (TB). We have identified and characterized the indolcarboxamides as a new class of antitubercular bactericidal agent. Genetic and lipid profiling studies identified the likely molecular target of indolcarboxamides as MmpL3, a transporter of trehalose monomycolate that is essential for mycobacterial cell wall biosynthesis.

A rare cause of Takotsubo cardiomyopathy related left ventricular apical thrombus requiring surgery.

We present the case of a 48 year-old male with a history of cystic fibrosis who presented with massive haemoptysis and was later found to have Takotsubo cardiomyopathy. He subsequently developed a left ventricular (LV) thrombus which was successfully removed via a left apical ventriculotomy. Surgical management of LV thrombus related to Takotsubo cardiomyopathy is warranted in a selected population of patients and a left apical ventriculotomy provides good access with minimal complications in the post operative setting.

Mycobacterium tuberculosis infection induces hypoxic lung lesions in the rat.

Hypoxia is believed to influence the metabolic state of Mycobacterium tuberculosis and cause phenotypic drug resistance. Using pimonidazole adduct staining, we show that lung lesions of infected rats contain regions of low oxygen tension. Our results support the use of the rat model for evaluating anaerobic drug activity in vivo.

Simplified cerebral protection using unilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest.

Background: Antegrade cerebral perfusion is one of the most reliable methods of organ protection during hypothermic circulatory arrest for aortic arch surgery. We used a simplified antegrade cerebral perfusion technique with low mortality and morbidity.

Methods: Between January 2005 and August 2008, 21 patients underwent aortic arch surgery with unilateral antegrade selective cerebral perfusion through the brachiocephalic artery and moderate hypothermic circulatory arrest.

Zosteriform herpes simplex.

Herpes simplex virus (HSV) infection, though most commonly seen in the oral, perioral and genital areas, can occur anywhere on the body. After primary infection, HSV then establishes latency in sensory nerve ganglia and reactivates intermittently, precipitated by various factors. These reactivations may be recurrent and appear in a dermatomal distribution, mimicking herpes zoster, often leading to misdiagnosis if no confirmatory laboratory tests are carried out.

Mitral valve annular dilatation caused by left atrial myxoma.

We report a case of mitral valve annular dilatation caused by a large left atrial myxoma. A 69-year-old woman presented in pulmonary oedema. She was found to have a large left atrial myxoma prolapsing into the left ventricle in diastole causing severe functional mitral stenosis.

Giant morgagni hernia causing cardiac tamponade.

A 57-year-old man presented with worsening symptoms of shortness of breath and chest pain. He was found to have a giant Morgagni hernia with severe compression of his right ventricle on computed tomography scan. The hernia which contained greater omentum, small intestine and transverse colon was urgently repaired through a median sternotomy and laparotomy with a polypropylene mesh.

Ultra-low dose aprotinin decreases transfusion requirements and is cost effective in coronary operations.

Background: The recommended dose of aprotinin has been shown to reduce blood loss and need for blood transfusions, but the cost precludes its routine use. This study was designed to determine whether a less expensive, ultra-low dose of aprotinin is effective when used in coronary artery bypass grafting with left internal mammary artery.

Methods: Patients (n = 202) were randomized to receive either placebo or aprotinin, 0.