Ann Acad Med Singap
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Ann Acad Med Singap · May 2002
Comparative StudyAre maternal deaths on the ascent in Singapore? A review of maternal mortality as reflected by coronial casework from 1990 to 1999.
In Singapore, published maternal mortality rates (MMR) over the last decade (1990 to 1999) have been so low (0.0 to 1.0 per 1000 live births and still births) as to imply that maternal deaths are rare to the point of being non-existent in some years. This inference is counterintuitive, and earlier studies on maternal mortality, amniotic fluid embolism (AFE) and pulmonary thromboembolism (PTE) have also suggested otherwise. Accordingly, local trends in maternal mortality warrant further examination. ⋯ This was an upward trend in MMR, as reflected in coronial casework, over the last decade. It would appear that the local, estimated (direct and indirect) maternal mortality prevalence compares favourably with the MMR reported in developed countries. The apparent rate of AFE was no less than 4 times higher than that reported in the United Kingdom, while the maternal mortality rate from PTE was at least as high. Allowing for the possibility that such deaths were under-reported, the actual annual MMR and 10-year prevalence could be appreciably higher than the estimates presented here. There may well be a case for the establishment of a comprehensive database of maternal deaths, that is updated continually and contemporaneously, in Singapore.
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Ann Acad Med Singap · Mar 2002
Two-year outcome of normal-birth-weight infants admitted to a Singapore neonatal intensive care unit.
To describe the characteristics, the immediate and short-term outcome and predictors of mortality in normal-birth-weight (NBW) infants admitted to a tertiary neonatal intensive care unit (NICU) in Singapore. ⋯ Despite their short hospital stay (compared to very-low-birth-weight infants), the high volume of NBW admissions make the care of this population an important area for review to enhance advances in and hence, reduce the cost of NICU care. With improved antenatal diagnostic techniques (allowing earlier and more accurate diagnosis of congenital malformations) and better antenatal and perinatal care (allowing better management of at-risk pregnancies), it is anticipated that there should be a reduction in such admissions with better outcomes. Close follow-up of this high-risk group of infants is also important in order to offer early intervention to those who may possibly have perinatally-related developmental difficulties.
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Ann Acad Med Singap · Mar 2002
Cosmesis in neurosurgery: is the bald head necessary to avoid postoperative infection?
The aims of this study were to prospectively investigate the incidence of postoperative wound infection following elective cranial surgery, when scalp hair removal was limited to the line of the incision, and to see if there was an increased risk of infection. ⋯ In a review of earlier studies and a search into the history of aseptic surgery, no scientific ground for the practice of shaving was found. We suggest that there is no advantage in shaving patients in terms of reducing wound infection rates.
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The upper airway can obstruct due to soft tissues, blood, secretions and infections. In patients who are sedated, anaesthetised or unconscious, the commonest cause is due to loss of airway muscle tone. The usual site of obstruction is the soft palate followed by the epiglottis and occasionally the tongue. ⋯ Oral and nasal airways are useful adjuncts to improve airway patency. In patients who are unconscious or adequately anaesthetised, the laryngeal mask or Combitube could be used especially in the difficult airway situation. As there is a significant decline in performance with time, it is important to maintain airway skills through regular practice and evaluation.
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Ann Acad Med Singap · Mar 2002
Technetium-99m methoxyisobutylisonitrile imaging in the follow-up of differentiated thyroid carcinoma.
To evaluate the potential of technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) imaging as an alternative to I-131 total-body scan (I-131 TBS) for the follow-up of patients with differentiated thyroid carcinoma (DTC). ⋯ Tc-99m MIBI imaging is more sensitive than I-131 TBS in detecting tumours in the neck but less sensitive for metastasis elsewhere, as well as thyroid remnants. Therefore, Tc-99m MIBI imaging should not substitute but rather complement I-131 TBS for evaluation of DTC patients post-radioiodine ablation.