Cache - a signaling domain common to animal Ca(2+)-channel subunits and a class of prokaryotic chemotaxis receptors.
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Amino Acid Motifs↗
Biomedical subjects
V Anantharaman
Publications and source records attributed to V Anantharaman.
Changes in chest electrode impedance.
The Prehospital Defibrillation Program in Singapore has in some cases shown a lower amplitude of ventricular fibrillation (VF) than considered the norm. The electrode skin impedance (ESI) refers to the skin impedance determined between two electrodes placed at specific positions on the body surface. The objective of this prospective study was to measure the ESI of patients at 5 Hz and 2 kHz frequencies, and assess its change with time from the application of electrodes, the difference between the ESI at two different sets of electrode placement positions, and correlation with patient factors. Patients who were 25 years or older and not critically ill had their ESI measured with a modified Heart-Save 911 defibrillator, using signal frequencies at 5 Hz and 2 kHz, at 10 seconds, 1 and 2 minutes after electrodes application. Two sets of positions were used; position 1 where an electrode is placed in the right subclavicular region and another just lateral to the apex beat on the left and position 2, which represents the mirror-image of position 1. Thirty-six each of men and women patients were studied. The mean age and weight were 59.9 +/- 13.5 years and 56.8 +/- 24.1 kg respectively. There was no significant correlation between the ESI and patients' body weight or sex. However, there was a significant decrease in the ESI with time from application of electrodes at both positions (P < .05) with the two different frequencies. The ESI was lower when measured at lower frequencies and higher when taken at higher frequencies, but there was no statistically significant difference between the two mirror-image positions used. Thus, with lower frequency, the electrocardiogram amplitude of VF recorded on the automated external defibrillator could be enhanced.
Adult↗
The short-stay emergency observation ward is here to stay.
The traditional venue for the management of most medical and surgical emergencies has been the in-hospital environment. It is only when patients have been fully evaluated and treated that they are discharged. The increasing cost of hospital stay and burgeoning cost of health care are forcing the medical profession to consider options where illnesses can be managed on a more ambulatory basis. The objective of this study was to assess the volume, characteristics, and disposition of emergency department (ED) patients who were managed in the Short-Stay Emergency Observation Ward (SSEOW). A retrospective study of all patients managed in the SSEOW at the Singapore General Hospital (SGH) from July 1 to December 31, 1997 was conducted. The ED case-records of all observed patients were reviewed. Demographic data as well as information on duration of stay, provisional diagnoses, investigations performed, treatment rendered, and disposition were collected. A total of 114,586 patients were seen at the ED during the study period. There were 9,126 (7.9%) patients who were observed and 1,756 (19.2% of observed or 1.5% of total ED attendance) were subsequently admitted. The median duration of observation was 5.6 +/- 9.2 hours. The hospitalization rate for male and female patients was almost equal (19.2% versus 19.3%) and those 60 years and older (3,559 or 39.00%) had the highest hospitalization rate (28.0%). The higher the triage priority, the more likely the patient was to be observed and subsequently admitted. Most were observed between 2 to 4 hours (3,288 or 36.0%) and the largest group comprised of those with abdominal complaints (4,115 or 45.1%). Patients with alcohol-related problems were observed the longest (6.7 + 9.8 hours) but had the lowest hospitalization rate (2.6%). The SSEOW allowed a 6.4% savings to direct inpatient admission at SGH. The SSEOW represent a management area for the delivery of short-term and diagnostic care on an ambulatory basis. It is accessible, safe and effective in reducing adions.
Adolescent↗
Chest impedance: characteristics of local patients.
The Pre-hospital Defibrillation Program in Singapore has in some cases demonstrated a lower amplitude of Ventricular Fibrillation (VF) than considered the norm. The Electrode Skin Impedance (ESI) refers to the skin impedance determined between two electrodes placed at specific positions on the body surface. The objective of this prospective study was to measure the ESI of patients at 5 Hz and 2 kHz frequencies, and assess its change with time from the application of electrodes, the difference between the ESI at two different sets of electrode placement positions and correlation with patient factors. Patients who were 25 years or older and not critically ill had their ESI measured with a modified Heart-Save 911 defibrillator, using signal frequencies at 5 Hz and 2 kHz, at 10 seconds, 1 and 2 minutes after electrodes application. Two sets of positions were used; Position 1 where an electrode is placed in the right infra-clavicular region and another just lateral to the apex beat on the left and Position 2, which represents the mirror image of Position 1. 36 each of male and female patients were studied. The mean age and weight were 59.9 +/- 13.5 years and 56.8 +/- 24.1 kg respectively. There was no significant correlation between the ESI and patients' body weight or sex. However, there was a significant decrease in the ESI with time from application of electrodes at both Positions (p < 0.05) with the two different frequencies. The ESI was lower when measured at lower frequencies and higher when taken at higher frequencies, but there was no statistically significant difference between the two mirror-image positions used. Thus, with lower frequency, the ECG amplitude of VF recorded on the automated external defibrillator could be enhanced.
Adult↗
Hypotension in acute myocardial infarction patients given streptokinase.
OBJECTIVE: This is a prospective cohort study done over a period of one year to look at hypotension that developed in the local Acute Myocardial Infarction (AMI) patients given Streptokinase (SK). METHOD: Suitable patients with AMI (those with ischaemic chest pain most severe within the last 8 hours, ST-segment elevation and no contraindications) were selected for thrombolysis with SK given as the standard dose of 1.5 mega-units diluted in 100 mls of normal saline and infused over 60 minutes. (Group A). The AMI patients who did not receive SK (Group B), were analysed separately and acted as "controls", as it was not possible to withhold thrombolytic therapy in a group of patients in a completely randomised fashion. The pulse, non-invasive blood pressure and electrocardiogram were monitored and recorded. RESULTS: Of 120 patients analysed, 70 received SK (Group A) and 50 (Group B) did not due to a variety of reasons. There was no statistically significant difference in the sex, age and body weight distribution as well as the initial mean arterial blood pressure (MAP) in the two groups. The MAP showed a statistically significant decrease at 15 minutes (105.6 to 81.4 mmHg, 95%CI: 13.965, 28.178) and 30 minutes (105.6 to 89.6 mmHg, 95%CI: 10.929, 19.814) after the commencement of SK in Group A patients. When analysed separately, the decrease in MAP was also statistically significant at 15 minutes (95%CI: 4.263, 22.014) for those with anterior AMI and both at 15 (95%CI: 19.112, 41.299) and 30 minutes (95%CI: 1.191, 28.716) for those with inferior AMI. There was no statistically significant decrease noted in Group B patients and the door-to-needle time for Group A patients was 37.2+/-6.0 minutes. The SK infusion time for Group A patients who developed hypotension was prolonged to 95.3+/-14.1 minutes. CONCLUSION: Hypotension was more commonly noted in the AMI patients given SK. The MAP tend to decrease in the first 30 minutes after commencing the SK infusion. It is thus possible to conclude that the hypotension was at least partly due to SK and is probably a rate-related phenomenon.
Aged↗
Island Life.
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Emergency Medical Service Communication Systems↗
Emergency medicine in Singapore: past, present, and future.
What began in 1948 as a "Casualty and Outpatient Service" at the Singapore General Hospital grew into the first 24-hour emergency unit in 1964 and has since expanded to the current emergency departments of the 6 public hospitals providing acute 24-hour accident and emergency services with an annual patient load of up to 540,000. In 1984, emergency medicine was recognized as a distinct medical specialty by the Ministry of Health. Five years later, structured academic postgraduate training programs were introduced. In 1990, a specialist training committee for emergency medicine was appointed to oversee the development of advanced training in emergency medicine locally. Seven areas of subspecialization have since been identified and are in various stages of development: emergency cardiac care, emergency trauma care, emergency toxicology, prehospital emergency care, pediatric emergency medicine, disaster medicine, and observation medicine. The achievements in emergency medicine in Singapore can help to provide a model for the future development of emergency medicine in other similar environments.
Emergency Medical Services↗
Hospital resuscitation of cardiac arrest patients.
Resuscitation of collapsed cardiac patients is often a not-too-successful affair. It has been repeatedly emphasised that the most important aspect of cardiac resuscitation is early access, early recognition of ventricular fibrillation and early defibrillation in patients with ventricular fibrillation. However, the co-ordination of the various phases of cardiac resuscitation itself, which is often forgotten, would need a good organisation so that a systematic assessment of the patient can be done while resuscitation is in progress. In this report, we describe a case of successful prolonged cardiac resuscitation with emphasis on the organisation of resuscitation as well as early defibrillation. We would also like to emphasise that all procedures that were done were performed correctly and their effects on the monitored patient were assessed frequently so as to maximise efficiency, myocardial salvage and patient survival.
Aged↗
Pseudo myocardial infarct--electrocardiographic pattern in a patient with diabetic ketoacidosis.
Diabetic ketoacidosis is an extremely serious complication of diabetes mellitus. It arises because of a complex disturbance in glucose metabolism. There is usually a precipitating cause such as sepsis or myocardial infarction. If not recognised and appropriately treated, it can have devastating consequences. This is a case report of a patient with severe diabetic ketoacidosis and interesting electrocardiographic findings. The initial electrocardiographic (ECG) findings were suggestive of an acute myocardial infarction. The ECG changes normalised remarkably following initial management of the diabetic ketoacidosis. There have been only occasional reports of hyperkalemia causing electrocardiographic changes, closely resembling those of acute myocardial infarction.
Blood Gas Analysis↗
Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage.
STUDY OBJECTIVE: To compare the efficacy of the Valsalva maneuver with that of carotid sinus massage (CSM) in terminating paroxysmal supraventricular tachycardia (SVT) in the ED. METHODS: This prospective, randomized case study was performed in the ED of a tertiary care institution. Patients were at least 10 years of age with regular narrow complex tachycardia and had an ECG diagnosis of SVT. Patients with regular narrow complex tachycardia were randomly assigned to undergo either the Valsalva maneuver or CSM. If the tachycardia was not terminated by the method chosen by randomization, then the alternative method of vagal maneuver was used. If the tachycardia was not converted by both methods of vagal stimulation, patients would undergo either synchronized electrical cardioversion or a pharmacologic method of conversion at the discretion of the treating physician, depending on the patient's hemodynamic status. RESULTS: One hundred forty-eight instances of SVT were studied Sixty-two patients underwent Valsalva maneuver first with conversion in 12 (success rate of 19.4%). Eighty-six underwent CSM first with conversion in 9 (success rate 10.5%). Carotid sinus massage was used in the 50 cases of SVT in which conversion was not achieved with the Valsalva maneuver. Conversion occurred in 7 cases (success rate 14.0%). For the 77 cases of SVT in which initial CSM did not achieve conversion, conversion occurred in 13 with the Valsalva maneuver (success rate 16.9%). The Valsalva maneuver and CSM achieved conversion in a total of 41 instances of SVT (success rate 27.7%). CONCLUSION: Vagal maneuvers are efficacious in terminating about one quarter of spontaneous SVT cases. There is no detectable difference in efficacy between the Valsalva maneuver and CSM.
Adult↗
Brain attack: the multifaceted potential for action.
BACKGROUND: Stroke is the number 3 killer in Singapore and a common contributor to morbidity statistics. This study was done to look at the profile of patients with acute stroke presenting to the Emergency Department, Singapore General Hospital, from 1 October to 31 November 1996. The data will help plan and guide future early interventional trials as well as look into possible areas of improvement in the multidisciplinary approach to stroke. METHOD: This is a retrospective study and patients records were traced using ICD-9 codes. A total of 309 patients were identified for the period of review; of this, the records of 240 patients were obtained (77.7%). RESULTS: The results revealed that local stroke patients are young (two-thirds are < 70 years) and live in high-rise accommodation (84.2%) with their families. The predominant risk factor was hypertension (80%) and weakness was the most common presentation (25%). Stroke patients are presenting at a later stage (only 16.7% presented within 6 hours of onset) and the average length of hospital stay was between 10 and 12 days. CONCLUSION: This study identified the multiple measures at various stages of the stroke chain, required to build up a concerted effort against Brain Attack.
Acute Disease↗
Public complaints and the emergency department.
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Communication↗
Battered women: presentation at A&E departments in Singapore.
This study was undertaken to assess the characteristics of battered women seen at the A&E department in Singapore. The first part was conducted at the A&E department of a general hospital in Singapore from July 4, 1992 to November 9, 1992. Ninety-six victims were interviewed using a standard questionnaire. Information was obtained about the characteristics of victims, assailants and the assaults as well as the cause of presentation. In order to verify the universality of the findings, battered women seen at A&E departments of the four main general hospitals on the island from November 1, 1993 to January 31, 1994 were interviewed using a similar questionnaire. We found that the majority of the women were beaten by someone they knew and, for most, it was not a first-time assault. Most times, no weapon was used. Injuries were sustained mainly to the face and extremities. The majority of the victims were at the A&E department either because of the medical examination required in conjunction with a police report or because of the severity of their injuries.
Adolescent↗
Therapeutic regimes for acute bronchial asthma.
No uniform guidelines currently exist for the initial drug therapy of asthma or for the criteria to assess efficacy of initial therapy. A study with 71 subjects aged between 15 and 40 years was conducted to compare the usefulness of three commonly used asthma treatment regimes, viz subcutaneous adrenaline, nebulised salbutamol and intravenous aminophylline. Parameters used to monitor response were pulse rate (PR), respiratory rate (RR), Peak Expiratory Flow Rate (PEFR) and Patient's Subjective Assessment Scale (PSAS). All patients in the three treatment groups were comparable at pre-treatment, except for the Salbutamol group which appeared to have asthma of a milder severity based on PSAS scores alone. Following treatment, improvements were noted in Peak Flow Rate and PSAS. These improvements were greatest in those groups treated with salbutamol and adrenaline (p = 0.04 for PEFR and 0.01 for PSAS). Salbutamol treated patients also had significant improvements in Respiratory Rate (p < 0.05). The results were not conclusive as to whether adrenaline or salbutamol was the superior drug. Salbutamol and adrenaline are preferred to aminophylline in the initial treatment of acute bronchial asthma.
Acute Disease↗
Burns mass disasters: aetiology, predisposing situations and initial management.
Many agents that are encountered daily are liable to cause burns mass disasters. These include flames, hot water and steam, combustible gases and liquids, molten liquids, boiling liquid expanding vapour explosion, chemicals and explosives. They result in disaster when certain lacks in safety occur. The proper management of such burns victims begins with rescue. At the disaster site, triage is important to separate the living from the dead, decide on priorisation for initial treatment and then evacuation to an appropriate facility. Proper management requires team effort and should be continued en-route to hospital. Repeat triage and use of clear guidelines in the Emergency Department ensure optimal and rapid care of the casualties. Finally psychological support for victims, relatives, rescuers and health workers must not be forgotten.
Burns↗
Cardiac life support training: the Ministry of Health's experience.
This study reviews the records of all cardiac life support training courses conducted at the Ministry of Health's Life Support Training Centre situated in Singapore General Hospital over a six period from 1985 to 1990. A total of 1,789 persons were trained in Basic Life Support (BCLS), 65 as BCLS Instructors, 267 in Advanced Cardiac Life Support (ACLS), 276 in Emergency Cardiac Care (ECC) and 24 in Emergency Cardiac Defibrillation (ECD). These courses have involved a total of 1111 doctors, 1248 nurses and 62 ancillary staff. At the end of the course, 90.7% of those learning BCLS agreed that they would use their CPR skills, if required. Only 60% felt they would use mouth-to-mouth ventilation. Of 415 who expressed an interest in becoming instructors, 15.7% have, to-date, been trained. While more than 80% of persons learning, ACLS were doctors, only 25% of these were willing to instruct. There are currently 14 ACLS instructors. The ECC courses were modified from the ACLS course and taught to Emergency Room doctors only. It was found to be immensely popular with 98% expressing benefit. The ECD programme trained emergency ambulance nurses in the use of semi-automatic electrical defibrillators. The marked increased in yearning for cardiac life support skills amongst medical and nursing staff has been a major factor in the proliferation of life support training programmes at the Centre. Nurturing this enthusiasm is the key to ensuring that the programmes continue to expand for the benefit of both inpatients and the out-of-hospital lay public.
Attitude of Health Personnel↗
Synthesis and selective class III antiarrhythmic activity of novel N-heteroaralkyl-substituted 1-(aryloxy)-2-propanolamine and related propylamine derivatives.
The synthesis and biological evaluation of a series of novel 1-(aryloxy)-2-propanolamines and several related deshydroxy analogues are described. Compounds 4-29 were prepared and investigated for their class III electrophysiological activity in isolated canine Purkinje fibers and in anesthetized open-chest dogs. None of these compounds showed any class I activity. On the basis of the in vitro data, structure-activity relationships for the series are discussed. Two compounds, N-[4-[2-hydroxy-3-[methyl(2-quinolinylmethyl)amino] propoxy]phenyl]methanesulfonamide (12,WAY-123,223) and N-[2-[[methyl[3-[4-[(methylsulfonyl)amino]phenoxy]propyl] amino]methyl]-6-quinolinyl]-methanesulfonamide (24, WAY-125,971) were identified and characterized as potent and specific class III antiarrhythmic agents in vitro and in vivo. Compound 12 was found to be orally bioavailable, to produce large increases of ventricular fibrillation threshold (VFT), and, in some instances, to restore sinus rhythm from ventricular fibrillation in anesthetized open-chest dogs at a dose of 5 mg/kg (iv). The enantiomers of 12 (i.e., 13 and 14) were synthesized and were found to exhibit similar electrophysiological effects in the Purkinje fiber screen. Compound 24, a propylamine analogue with potency and efficacy comparable to those of UK-68798 (2) and E-4031 (3), was studied in voltage-clamp experiments (isolated cat myocytes) and was found to be a potent and specific blocker of the delayed rectifier potassium current (IK).
Animals↗