ABSTRACT:By examining key milestones, challenges and future directions, this review chronicles the evolution of clinical toxicology in Singapore into a recognised subspeciality and thriving community of practice. Poisoning trends have transitioned alongside socioeconomic changes from agricultural toxins to pharmaceuticals, substance misuse and prescription drugs. Currently, toxicology services have expanded across public hospitals, offering 24/7 consultations and managing selected cases in short-stay observation units to optimise resources. Singapore's hazardous material (HazMat) preparedness includes specialised HazMat Medical Life Support training, antidote and personal protective equipment (PPE) stockpiling, and deployment of semi-automated decontamination facilities. Research has focused on case reports and description of local poisoning epidemiology. Toxicology has also been integrated into nursing, undergraduate medical and residency curricula, with a national fellowship programme in the pipeline. Challenges include the latent HazMat threat, rising burden of poisoning cases, continual evolution of synthetic drugs and occupational hazards from emerging industries. Future directions should emphasise interdisciplinary collaboration, regional partnerships and leveraging artificial intelligence and toxicogenomics to enhance care.
Background: The lived experiences of people with diabetic foot ulcers (DFUs) are rarely studied through artefact based approaches. Patient artefacts can help reify experiences and memories and elicit information that is not easily accessed by other methods, providing new insights into psychosocial impacts, coping strategies, and patient advice to peers. Aim: To analyse the lived experiences of DFU patients, through artefacts and accompanying narratives. Methods: At an outpatient multidisciplinary podiatry clinic, 10 DFU patients each contributed a personal artefact symbolising their DFU journey, and completed an accompanying open-ended survey. Artefacts and data were analysed via reflexive thematic analysis, with the social-ecological model (SEM) as an organising and sensitising framework. Results: Artefacts helped paint a richer picture of the experiences of DFU patients, elicit emergent findings from narratives, and symbolise key aspects of lived experiences. Participants reported a wide range of impacts, both to their lives and those of their caregivers, and were willing to share advice, based on their DFU journeys, with other patients. Conclusion: Artefacts and their accompanying stories provide a richer picture of, and insights into, DFU patient experiences, meriting further exploration in qualitative studies of people with DFUs.
Background: Diabetic peripheral arterial disease (PAD) involves complex pathophysiology, including accelerated atherosclerosis and impaired microvascular blood flow. However, the interplay between femoral arterial inflammation, atheroma plaque formation, arterial blood flow and microvascular perfusion remains unclear. This study investigated these relationships using multimodality imaging techniques. Methods: Nine patients with diabetes and PAD and 10 healthy controls were enrolled. Participants underwent hybrid 18F-fluorodeoxyglucose PET/MRI to assess arterial inflammation and microvascular perfusion, duplex ultrasound to evaluate plaque burden and ankle–brachial index and toe–brachial index measurements to determine arterial blood flow. Microvascular perfusion was assessed using blood oxygen level-dependent and intravoxel incoherent motion MRI techniques. Results: Compared with healthy controls, PAD participants exhibited impaired microvascular perfusion, evidenced by prolonged time-to-peak, attenuated maximum T2* and reduced perfusion fraction and pseudo-diffusivity (p<0.05 for all) on blood oxygen level-dependent and intravoxel incoherent motion MRI. 18F-Fluorodeoxyglucose PET/MRI revealed a negative correlation between the maximum target-to-background ratio and toe–brachial index (ρ=−0.57; p<0.05). Although microvascular perfusion was correlated with arterial blood flow, no association was found between arterial inflammation and microvascular perfusion. Conclusions: Multimodality imaging demonstrated an interplay between arterial inflammation, atheroma plaque formation, reduced arterial blood flow and impaired microvascular perfusion in participants with diabetes and PAD. These findings provide valuable insights into the pathophysiology of diabetic PAD and support the potential for personalised disease management and treatment discovery.
INTRODUCTION:Parenchymal haematoma (PH) is a potentially serious complication post endovascular treatment (EVT) and is associated with poor functional outcomes. It is unknown if modifiable factors can improve the outcomes of patients with PH. This study aimed to determine whether successful reperfusion is associated with favourable outcome in patients with ischemic stroke despite this complication. METHODS:In an international multi-centre study, favourable outcomes (mRS0-2) of patients achieving successful reperfusion (TICI 2b/3) were compared with outcomes of those with unsuccessful reperfusion. RESULTS:346 patients were included in the final analysis. 36 patients had unsuccessful reperfusion (10.4%) while 310 had successful reperfusion (89.6%). Amongst patients with PH post-EVT, successful reperfusion conferred better 3-month favourable outcomes (20.32% vs 5.56%; p=0.032) and lower mortality rates (40.32% vs 72.22%; p <0.001) compared with patients who had unsuccessful reperfusion. CONCLUSION:Successful reperfusion remains a strong predictor of favourable outcome and reduced mortality in ischemic stroke patients with parenchymal haematoma post endovascular treatment.
