Singap Med J
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Ketamine, a dissociative anaesthetic in use since 1970, produces prominent psychoactive effects in humans. Its non-medical use has raised concerns in many countries, including Singapore. This paper narrates the psychedelic and psychotic effects of ketamine in two ketamine dependent patients who have presented to the psychiatric service. ⋯ However, breaking the ongoing addiction cycle seemed more difficult. The neuro-pharmacological mechanisms of these phenomena are largely due to its complex multi-receptors actions, notably through the excitatory amino acids through mainly the N-methy-D-aspartate (NMDA) receptors. The detection of ketamine abuse requires a high index of suspicion and needs to be considered when there is an acute presentation with multi-modal hallucinations and psychosis.
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Intussusception is a common but life threatening gastrointestinal emergency that occurs in the infant or young child. A three-year-old boy presenting with abdominal pain and vomiting was diagnosed to have the target sign on ultrasonography. An ileocolic intussusception was initially reduced using air enema. ⋯ For treatment, air enema is usually perferred to barium enema. Air enema is a safe, rapid, and clean procedure that has been shown to achieve a high reduction rate, comparable to that of barium enema. Ultrasonographically-guided hydrostatic reduction of intussusception has also been recently described and is an effective alternative.
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Free wall rupture of the left ventricle remains a lethal complication of acute myocardial infarction. Nevertheless, where it presents subacutely with tamponade, salvage with a good outcome is still possible with timely pericardiocentesis preceding definitive repair using a sutureless technique.
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Comparative Study
Clinical outcomes of patients with biopsy-proven lupus nephritis in NUH.
To review the clinical outcomes of Systemic Lupus Erythematosus (SLE) patients with biopsy-proven lupus nephritis with regards to the histological features and treatment. ⋯ Renal involvement in SLE occurs early in the disease and is associated with other organ systems involvement. Only 44% were in complete remission. Thirty-four percent had relapsed. Renal survival was 88% in this cohort.
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Peripheral nerve blocks are associated with minimal haemodynamic disturbance. It is perhaps ideal for high-risk surgical patients who cannot tolerate the adverse consequences of even the slightest attenuation of haemodynamic response. ⋯ In this report, a 56-year-old man with severe sepsis and recent myocardial infarction presents for an urgent above knee amputation. We present the practical benefits of a combined sciatic-femoral nerve block on such a patient.