No abstract

The COVID‐19 pandemic has enveloped the world and there has been a high incidence of occupational dermatoses related to Personal Protective Equipment (PPE) amongst healthcare workers (HCWs) during this period. Prevention and management of these conditions will not only improve staff morale and quality of life, but will also minimize the risk of breaching PPE protocol due to such symptoms. The tropical climate in Singapore predisposes HCWs to more skin damage and pruritus due to intense heat, high humidity and sun exposure. The effects of friction, occlusion, hyperhidrosis and overheating on the skin in the tropics should not be neglected. Preventive measures can be taken based on our recommendations, and the working environment can be made more conducive for frontline HCWs. We review the literature and discuss various preventive and management strategies for these occupational skin diseases for our frontline HCWs, especially those working in less controlled working environments beyond the hospital in Singapore. Shorter shifts and frequent breaks from PPE are recommended. Duration of continuous PPE‐usage should not exceed 6 h, with breaks in non‐contaminated areas every 2–3 h to hydrate and mitigate the risk of skin reactions. Other strategies, such as teledermatology, should be considered so that consultations can remain accessible, while ensuring the safety and well‐being of our clinical staff.

No abstract

The nutcracker syndrome is a rare clinical manifestation of symptoms caused by the compression of the left renal vein by an overriding superior mesenteric artery, an anatomical variant otherwise known as the nutcracker phenomenon. Usually present in women and children, when symptomatic, it commonly presents with hematuria, proteinuria, and chronic pelvic pain. Effective modalities of treatment apart from conservative management, include both invasive surgical procedures such as renal vein transposition and autotransplantation of the kidney and more popular recently, the less invasive endovascular stenting. Both options, however, are not without complications, such as, retroperitoneal hematomas or stent migration, thrombosis and restenosis. We now present a case of spontaneous renosplenic shunting in a 68-year-old lady of Chinese descent with the nutcracker syndrome?the first of such cases to be ever reported in a patient with no preexisting predilection for chronic liver disease and portosystemic shunting. Despite having significant pelvic venous congestion as evident on computed tomography scans, she remained asymptomatic. This may present a novel paradigm shift for the treatment of the nutcracker syndrome ?surgical creation of a renosplenic bypass instead of current modalities, an alternative solution which can be performed laparoscopically and is without problems related to stent use. The creation of laparoscopic splenorenal bypass has been reported once thus far in Cleveland Ohio by Chung and Gill with good symptomatic improvement but no further studies since to validate its long-term effectiveness.

SUMMARYGluteal compartment syndrome usually occurs secondary to prolonged immobility and recumbency following alcohol and drug abuse. The resultant pain and swelling in the lower limb may be misdiagnosed as deep vein thrombosis. Once compartment syndrome is diagnosed, urgent decompression fasciotomy is required. The outcome is poor if the diagnosis is missed or delayed. We report such a case.