Ann Acad Med Singap
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Ann Acad Med Singap · Sep 2004
Review Comparative StudyUnrelated umbilical cord blood transplantation in children and adults.
Umbilical cord blood (UCB) has recently been explored as an alternative haematopoietic stem cell (HSC) source for allogeneic immunotherapy in both adults and paediatric patients with haematological malignancies and marrow failure syndromes. The relative ease of procurement, tolerance of 1-2 antigen human-leukocyte antigen (HLA) mismatch and the lower than anticipated risk of severe graft-versus-host disease has made UCB an appealing alternative to marrow-derived HSC. ⋯ The use of reduced-intensity or nonmyeloablative preparative regimens to allow engraftment of UCB broadens the scope of patients who may benefit from allogeneic immunotherapy, particularly the elderly and medically infirm patients with no matched sibling donor. Further studies on improving graft cell dose such as the use of ex vivo expansion of UCB cells and multiple-unit transplant are currently being pursued, so as to make this potentially curative procedure available to more patients.
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Betel quid chewing is an ancient practice common in many countries of Asia and among migrated communities in Africa, Europe and North America. It enjoys complete social acceptance in many societies and is also popular among women. In its most basic form, betel quid consists of betel leaf (Piper betel), areca nut, the main psychoactive ingredient, and slaked lime (calcium hydroxide). ⋯ In recent years, commercially-manufactured non-perishable forms of betel quid (pan masala or betel quid mixtures and gutka), not containing betel leaf, have been marketed. Within a short period of about 2 decades, this industry has risen in value to several hundred US million dollars. Use of areca nut in any form is not safe for oral health; the use of commercially manufactured forms seems even riskier.
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Ann Acad Med Singap · Jul 2004
Appropriateness of the use of parenteral nutrition in a local tertiary-care hospital.
Parenteral nutrition (PN) is an important supportive therapy for critically ill patients who have non-functioning gut. However, it is an expensive therapy and carries significant complications. The objective of our audit was to determine the appropriateness of prescription of PN in our hospital, based on the American Society for Parenteral and Enteral Nutrition (ASPEN) 2002 guidelines. In our hospital, the prescription of PN is managed by the Nutrition Support Team. ⋯ Our audit showed that 15.9% of PN prescriptions were inappropriate according to the ASPEN guidelines. This was largely attributed to premature initiation of PN for postoperative ileus. We believe that these PN courses could have been avoided if these patients had been tried on naso-jejunal tube feeding, or oral nutrition with the use of prokinetics during the postoperative period.
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The prevalence of recreational drug abuse among young adults, including women, has increased markedly over the last 2 decades. Nearly 90 % of these women are of childbearing age. Marijuana remains the drug most commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anaesthetic management of pregnant patients with a history of marijuana abuse. ⋯ In the absence of uniform anaesthetic guidelines for pregnant patients with a history of drug abuse, including abuse of marijuana, the decision regarding administration of peripartum analgesia or anaesthesia should be individualised and conducted on a case-by-case basis.
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Ann Acad Med Singap · May 2004
Case ReportsPlantar dislocation of lateral tarsometatarsal joint: a case of subtle Lisfranc injury.
We present a rare case of plantar dislocation of the cuboid, fourth and fifth metatarsal joints. Fracture-dislocation in the midfoot region may be subtle and difficult to recognise at the emergency department. ⋯ This case was unusual in that there was lateral tarsometatarsal disruption with neither diastasis between the first and second metatarsals nor injury to either the first or second tarsometatarsal joints. The plantar direction of dislocation was also unusual as these injuries are usually dorsal.