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TTSH Medical Digest Apr-Jun 2010

TTSH Medical Digest Apr-Jun 2010

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TTSH Medical Digest Apr-Jun 2010
TTSH Medical Digest Apr-Jun 2010

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Published by: Tan Tock Seng Hospital on Jun 18, 2012
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CENTRAL APPOINTMENTTel:6357 7000Tel:6357 8000(for private appointments only)NHG PARTNERSDirect Access Hotline: 9666 6698 ARTIFICIAL LIMB CENTREProsthetic-Orthotic ServicesTel : 6259 4026Podiatry ServicesTel : 6259 2678HEALTH ENRICHMENT CENTREHealth Screening & AssessmentTel: 6357 2233 / 35
Important TTSH contact numbers
Tan Tock Seng Hospital 11 Jalan Tan Tock Seng Singapore 308433Tel: 6256 6011 Fax: 6252 7282 Website: www.ttsh.com.sg
LASIK CENTRETel: 6357 8000 (General Appointments)Tel:6357 2255 (Laser Hotline)MOBILE DIABETIC PHOTOGRAPHYSERVICE FOR GPsTel:9665 1034ONCOLOGY SERVICESTHE CANCER INSTITUTE@TAN TOCK SENG HOSPITALMedical OncologyTel:6357 2390Radiation OncologyTel:6357 1080REHABILITATION CENTRETel:6450 6181SMOKING CESSATION SERVICESTel:6357 8010THERAPY SERVICESPhysiotherapyTel:6357 8307DBC neck and back careTel:6357 8309Occupational TherapyTel:6357 8338Speech and Language TherapyTel:6357 8324 / 27TRAVELLERS’ HEALTH & VACCINATION CENTRETEL:6357 2222
HP-CCS-ED JUN-10-6K
M
edical
digest
* Pre-registration is required for all Public Forums and CME Programmes. **Please keep a lookout for the latest event updates on our website at www.ttsh.com.sg
TITLE OF EVENT / ORGANISING DATE & VENUEREGISTRATION FEESINTENDEDCOURSE TOPICDEPARTMENTTIMEPARTICIPANT
PUBLIC FORUM
Public Forum (English) -CataractDept. ofOpthalmology14 August 20101.30pmConference Room 1& 2, Level 1, TTSHTo register, please call6357-8266 or email:eye@ttsh.com.sg$5NIL
Diary Dates
Public Forums and Continuing Medical Education (CME) Programmes @ TTSH
TITLE OF EVENT / ORGANISING DATE & TIME VENUEREGISTRATION FEESCMECOURSE TOPICDEPARTMENTPOINTS
CME PROGRAMME
GP Symposium:General MedicineDept. of GeneralMedicine14 August 20101.30pm - 4.00pmTheatrette, Level 1,TTSHPlease contact Ms DebraLee at 6357-7893 or email:debra_lee@ttsh.com.sgFree2 CME points will beawardedResearch MethodologyWorkshopNHG Eye Institute21 August 20108.00am - 12.30pmTheatrette, Level 1,TTSHPlease contact MrsWasumathe Sukumar at6357-7687 or email:wasumathe_sukumar@nhg.com.sgFreeCME points will beawardedTendon Repair Workshop2010Dept. of OrthopaedicSurgery21 August 20109.00am - 1.00pm Animal Lab, Level 1,TTSHPlease contact Ms NorlizahKassim at 6357-7597 oremail:norlizah_khaidura_kassim@ttsh.com.sgFree2 CME points will beawardedGP Symposium:Diagnosis and Managementof Common Thyroid DisordersDept. of Endocrinology21 August 20101.15pm - 4.00pmTheatrette, Level 1,TTSHPlease contact Ms CynthiaLee at 6357-2373 or email:cynthia_lee@ttsh.com.sgFree2 CME points will beawardedGP Symposium:Diabetes MellitusDept. of Endocrinology21 August 20101.30pm - 4.00pmTheatrette, Level 1,TTSHPlease contact Ms CynthiaLee at 6357-2373 or email:cynthia_lee@ttsh.com.sgFree2 CME points will beawardedGP Forum:GastroenterologyDept. ofGastroenterology4 Sept 20101.30pm - 4.00pmTheatrette, Level 1,TTSHPlease contact Chiang HanFong at 6357-7897 or email:han_fong_chiang@ttsh.com.sgFreeCME points will beawardedGP Workshop:Eye Examination in FamilyPracticeDept. of Opthalmology18 Sept 20101.30pm - 4.00pmTTSH Eye Centre,Level 1Please contact Lalitha6357-7648 or email:lalitha_k@ttsh.com.sgTTSH and NHG staff:$102 CME points will beawarded
 Apr.May.Jun. 2010
MICA (P) 031/04/2010
contents
1 AN UPDATE ON ANTIDEPRESSANTS5SHORT NOTES FROM YOUR CLINICAL IMMUNOLOGY LABORATORY, PART 510ATRIAL FIBRILLATION FOR THE NON-CARDIOLOGIST14RADIOLOGY QUIZ16
ECG QUIZ
18DIARY DATES
 
From The Editor
Dr Leong Khai PangEDITORMedical Digest
Most of us tried very hard to endear ourselves to the interviewers in thehigh-stake medical school selection exercise. I remember my pre-admission interview – I put on my best clothes and made my way to theCollege of Medicine Building. I did not prepare anything and simplyhoped for the best. I encountered a large interviewing team, none ofwhom I recognised then; the only panelist I now recall was the lateProfessor Wong Poi Kwong. The questions put to me were neither tootricky nor too difficult because it was a kinder world then.Compared to 20 or 30 years ago, the game has now changed. Candidatesare coached on interview techniques and come prepared with a curriculumvitae listing impressive accomplishments. Candidates can find lists ofquestions they are likely to be asked in the interview on the Internet (forexample, the University of Colorado posts a good selection onhttp://www.colorado.edu/aac/PreMed_interviewquestions.pdf).When asked the question, “Why do you want to be a doctor?”, someof us answered, “Because I want to help others.” Interviewers oftentease us by demanding why we cannot do the same as social workers,nurses or bus drivers. Actually, the best way to make a positive impactin the lives of a great number of people is to be a good politician. Othersmention individuals or events that inspired us. Some talk about theremuneration or respect that the profession commands.I suppose that before we became doctors, we never truly know whatthe profession required of us. Now that we do, could we have answeredthe question in a better way? Perhaps we will respond this way – “I wantto be in a profession that will challenge me to the limits of my abilities;I want to give all that I have, intellectually and physically; I want a jobin which the intangible and spiritual rewards outweigh the material; Iwant to experience life at its rawest, deepest and most tender levels;I want to possess a set of skills that will find good use in any situationthat I am in, be it in a modern hospital or a rural outpost, in peacetimeor in conflict; I want to be part of the great tradition in which hard-earnedwisdom is passed from generation to generation, to the benefit of all; Iwant to make an original contribution to medical knowledge if given thechance; I want to find the golden mean between the demands of theprofession and of my family.”If any potential student gives this response in the interview, he or sheshould be commended for having read Medical Digest!
 Apr.May.Jun. 2010
While every endeavour is made toensure that information herein isaccurate at the time of publication,Tan Tock Seng Hospital shall not beheld liable for any inaccuracies. Theopinions expressed in this publicationdo not necessarily reflect those ofTan Tock Seng Hospital. The contentsof this publication may not bereproduced without writtenpermission from the publisher.
We value your feedback.Please email your questions,comments or suggestions to:med_digest@ttsh.com.sgPlease also contact us for notification ofchange of postal address orfor requests of additional copies.
EDITOR
Dr Leong Khai Pang
MEMBERS
Dr Jackie TanDr Jaideepraj RaoDr Lee Cheng ChuanDr Khian Chong YawDr David FooDr Gregory KawDr Nikolle TanDr Ernest KwekMs Lim Wan Peng
EDITORIAL ASSISTANT
Ms Michelle Lee
DESIGNER
Ms Zaonah Yusof
 
Therapeutics Update
 An Update on
 Antidepressants
The mechanism of action ofantidepressants involves inhibiting thereuptake of monoamines (such asserotonin, noradrenaline, anddopamine), blocking monoaminereceptors, or inhibiting the monoamineoxidase enzyme.
3
Older classes ofantidepressants include monoamineoxidase inhibitors (MAOIs) and tricyclicantidepressants (TCAs). Medicationsin these two classes generally affecta wide range of neurotransmittersystems and cause many undesirableside effects. Newer antidepressantsinclude the selective serotonin reuptakeinhibitors (SSRIs), serotonin andnoradrenaline reuptake inhibitors(SNRI), mirtazapine, and bupropion.These antidepressants usually targetsingle or dual neurotransmitters.
MONOAMINE OXIDASE INHIBITORS
Traditional monoamine oxidaseinhibitors (MAOIs) are non-selectiveand irreversible inhibitors of bothmonoamine oxidase A (MAO-A) and B(MAO-B) enzymes. By inhibiting bothMAO-A and MAO-B, they inhibit thefirst-pass metabolism of exogeneoustyramine, resulting in an accumulationof tyramine which may causehypertensive crisis.
4
Patients takingMAOIs should be counselled abouttheir potential drug-drug and drug-food interactions. Patients takingMAOIs may experience hypertensivecrisis if they consume tyramine-richfoods, such as aged cheese, soyproducts or yeast extracts (such asMarmite). They are also oftenassociated with side effects such asorthostatic hypotension, headache,insomnia, weight gain, sexualdysfunction, edema, drowsiness andsedation.
5
Newer MAOIs, such as moclobemide,is a reversible inhibitor of monoamineoxidase A, an enzyme that actsselectively on noradrenaline andserotonin. Unlike irreversible MAOIs,moclobemide is less likely to causehypertensive crisis with tyramine-richfood but caution should still beexercised when titrating dosesupwards.
6
Common side effects ofmoclobemide include dizziness,insomnia and nausea. No dosageadjustment is required in renalimpairment but dosages should bereduced to half to a third in liverimpairment. Use of moclobemide withother medications that can increaseserotonin levels can lead to the
1:
MEDICAL DIGEST
 According to the World Health Organization (WHO), it is estimated that 5 to 10 per cent of the population at anygiven time is suffering from depression needing psychiatric or psychosocial intervention, but only 30 per cent ofthese received appropriate care.
1
With advances in pharmacotherapy and a better knowledge of the biochemicalbasis of depression, many medications have been developed for the treatment of depression and prevention ofrelapses. The treatment of depression in patients with appropriate agents, at an appropriate dose over an appropriatelength of time, together with non-pharmacologic therapies, has been shown to be cost-effective.
2
This article coversthe pharmacotherapy of depression in adults.

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