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Medical reports are required to support court applications to appoint a deputy to make decisions on behalf of a person who has lost mental capacity. The doctor writing such a medical report needs to be able to systematically assess the mental capacity of the person in question, in order to gather the necessary evidence for the court to make a decision. If the medical report is not adequate, the application will be rejected and the appointment of the deputy delayed. This article sets out best practices for performing the assessment and writing the medical report, common errors, and issues of concern. [ABSTRACT FROM AUTHOR]

The article discusses on the management of medical emergencies of onboard aircraft passengers. Topics mentioned include the practice pointers from an aviation medicine specialist and medical ethicist, the obligation of a doctor to help once he volunteer, and the open communication and collaboration of the doctor to crew and pilot.

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological conditions that are characterized by mucositis, epidermal detachment and erosions. The underlying etiology in SJS and TEN is almost invariably secondary to drugs. Rarely, other causes such as systemic lupus erythematosus (SLE), infections and vaccinations have been implicated. This report describes three patients with SLE who presented with manifestations of SJS/TEN without a clear drug causality. All three patients presented with photodistributed macular exanthema, which evolved to target lesions, bullae, erosions or sheet-like detachment. This was associated with oral mucositis and conjunctivitis. The onset of the rash was insidious with a protracted clinical course. Ultraviolet exposure and steroid tapering appear to be precipitating factors. In two of the patients, SJS and TEN were the initial presentation of lupus. Although SJS and TEN are almost invariably due to medications, they may, rarely, be an initial presentation of lupus, particularly when associated with an initial photodistribution, absence of genital involvement and a prolonged clinical course. [ABSTRACT FROM AUTHOR]

A retrospective study of 37 patients with bullous pemphigoid was conducted at the Middle Road Hospital. The mean age of onset was 58.4 years. There was no significant difference in the incidence between males and females. Singaporeans of Indian origin had a higher incidence of bullous pemphigoid. There was no significant association with internal malignancy. The commonest immunoreactant detected at the basement membrane zone (BMZ) was C3 (87.8 %). There was no correlation between the titre of serum anti BMZ antibody and the clinical activity of the disease. There were nine deaths in this group (24 %). Only two patients (22%) had active skin lesions at the time of death. [ABSTRACT FROM AUTHOR]

Fifty-seven subjects with clinically proven cutaneous candidiasis were entered into a double blind, parallel, randomized comparison of sulconazole nitrate I % cream applied once daily and clotrimazole 1% cream applied twice daily. The duration of active treatment was three weeks with a four-week follow-up without treatment for those clinically cured at Week 3 to determine relapse rate. Sixteen patients failed to complete the study, twelve for reasons unrelated to study medication and four with suspected adverse reactions to sulconazole nitrate. There were no statistically significant differences between the two treatments when considering efficacy parameters (which included KOH microscopic preparation, fungal culture and clinical evidence of fungal infection). There were seven sulconazole nitrate and three clotrimazole treatment failures (ascertained by positive KOH microscopic preparation) at Week 3, this difference not being statistically significant. There were no relapses at the four-week follow-up in patients clinically cured after three weeks active treatment. [ABSTRACT FROM AUTHOR]

Reports on cases of Stevens-Johnson syndrome (erythema multiforme major) have seldom related it to occupational exposure to chemicals. Serious liver involvement is also uncommon. This report describes 5 cases of the syndrome who had been occupationally exposed to trichloroethylene. The circumstantial evidence suggested that the chemical might have been a causative factor in the disease. The liver was involved in all and in 3 it was serious, with one death. The degree of exposure to trichloroethylene varied. The duration of exposure ranged from 2 to 5 weeks. It seemed likely that there was a hypersensitive reaction to trichloroethylene in these cases. [ABSTRACT FROM AUTHOR]

The case is reported of a 56-year-old man with epidermolysis bullosa acquisita (EBA) who developed such severe involvement of the upper respiratory tract that a tracheostomy had to be performed. Control of his disease was ultimately obtained with cyclosporin and the use of this drug in EBA is reviewed. [ABSTRACT FROM AUTHOR]