Singap Med J
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Noninvasive ventilation (NIV) with continuous positive airway pressure (CPAP) has been shown to decrease endotracheal intubation and mortality in patients with acute cardiogenic pulmonary oedema (ACPE). The Three Interventions in Cardiogenic Pulmonary Oedema showed no advantage of NIV over standard medical therapy. This meta-analysis is an update on the efficacy and safety of two different forms of NIV (noninvasive pressure support ventilation [NIPSV] vs. CPAP) in patients with ACPE. ⋯ NIPSV appears to be as safe and efficacious as CPAP, if titrated rather than fixed pressures are employed.
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Case Reports
Tenosynovial giant cell tumour of the posterior cruciate ligament and its arthroscopic treatment.
Tenosynovial giant cell tumours originate from synovial tissues of the joints, tendon sheaths, mucosal bursas or fibrous tissues adjacent to tendons. Tenosynovial giant cell tumours are rarely intra-articular. We report a giant cell tumour of the tendon sheath arising from the posterior cruciate ligament diagnosed by magnetic resonance imaging and resected arthroscopically in a 54-year-old woman.
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Fasting during the month of Ramadan is one of the five holy pillars in the Islamic faith and is an obligation for all its followers. Prolonged fasting may precipitate or exacerbate gastrointestinal (GI) complaints. This study assessed the impact of Ramadan on referrals for upper GI endoscopy in a tertiary referral centre. ⋯ This study showed that significantly less workload was generated during the fasting month of Ramadan compared to the non-fasting months. There were also some differences in the referral sources, ethnicity and the endoscopic findings.
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Double dislocations of the thumb at the metacarpophalangeal joint (MCPJ) and interphalangeal joint (IPJ) occurring at the same time are seldom seen in medical practice. The sporadic occurrence of this interesting injury makes it difficult to formulate a clear management protocol. We report an unusual combination of injury involving the right thumb of a 60-year-old man, where the IPJ was dislocated dorsally with a volar dislocation of the MCPJ. ⋯ At six months' follow-up, the patient had a full painless range of movement in his thumb with no instability. To our knowledge, this is the first reported case of a thumb double dislocation where the injury was open at both joints. This is also the first case where a volar dislocation of the MCPJ was treated successfully by closed reduction, with an excellent functional outcome.
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The aim of this study was to establish reference values of peak systolic blood flow velocity measurement in the foetal middle cerebral artery (MCA-PSV) in the local Asian obstetric population and to compare our reference ranges with those of previously-published studies. ⋯ MCA-PSV increases with advancing gestational age. There appear to be differences between Asian and non-Asian reference ranges for MCA-PSV.