FDG PET/CT is a useful tool in evaluation and follow-up of IgG4-RD, particularly in identifying alternative biopsy sites in patients who present with coronary artery involvement. Hypermetabolic coronary artery masses on FDG PET/CT should raise clinical suspicion of IgG4-RD. As the coronary artery masses may not show decrease in size after treatment, FDG PET/CT is also useful for metabolic response assessment.

Introduction: Clinical bedside point-of-care ultrasonography (POCUS) is an important adjunct to history and physical examination. The objective of this pilot survey is to assess the level of exposure, perceptions, interest levels and possible barriers toward training of POCUS in internal medicine. Methods: In October 2015, all medical doctors who were working in the Singapore General Hospital Internal Medicine Department were invited to complete a hard-copy printed 27-question Likert-scale survey. Results: A total of 124 medical doctors participated in the survey (response rate 82.1%). The proportions of participants who have heard, witnessed, and performed POCUS were 65.6% (N = 82), 71.2% (N = 89) and 41.6% (N = 52), respectively. POCUS was rated highly on usefulness in the practice of internal medicine (M = 8.74; SD = 1.34). The top three POCUS skills that doctors would like to acquire would be (1) procedural guidance POCUS (70.8%); (2) point-of-care cardiac ultrasound (69%) and (3) lung ultrasound 58.4% (based on percentage ranked first through third). The sample mean of interest in undergoing further training in POCUS is 8.91 (SD = 1.27) (0 = not interested, 10 = very interested). The top three barriers identified were (1) lack of an ultrasound machine (M = 7.98 SD = 2.28); (2) cost of an ultrasound machine (M = 7.79 SD = 2.19) and (3) lack of a formal training curriculum (M = 7.25 SD = 2.08) (0 = not a barrier at all, 10 = severe barrier). Conclusions: There is a high level of exposure and interest in POCUS. Doctors perceived bedside POCUS as very useful in the practice of internal medicine. A lack of machine and formal curriculum impedes development of a training program. This pilot survey may serve as a basic needs assessment to an implementation of an internal medicine POCUS training curriculum.

Background Arterial and venous thrombosis are reported to be common in critically ill COVID-19 patients. Method and results This is a national multicenter retrospective observational study involving all consecutive adult COVID-19 patients who required intensive care units (ICU) admission between 23 January 2020 and 30 April 2020 in Singapore. One hundred eleven patients were included and the venous and arterial thrombotic rates in ICU were 1.8% (n = 2) and 9.9% (n = 11), respectively. Major bleeding rate was 14.8% (n = 16). Conclusions Critically ill COVID-19 patients in Singapore have lower venous thromboembolism but higher arterial thrombosis rates and bleeding manifestations than other reported cohorts.

We aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24–6.47) and neutrophil count (aOR 2.39, 95% CI 1.34–4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828–0.979). Median APACHE II score was 19 (IQR 17–22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89–129). Median peak FiO2 was 0.75 (IQR 0.6–1.0), positive end-expiratory pressure 12 (IQR 10–14) and plateau pressure 22 (IQR 18–26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5–13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.

Background Point-of-care bedside lung ultrasound is a diagnostic adjunct in the management of respiratory diseases. We describe the clinical progress and lung ultrasound findings of a Singaporean COVID-19 intensive care unit patient who was diagnosed with COVID-19 infection. Methods The clinical course of one COVID-19 patient managed in the intensive care unit was traced. The patient was diagnosed with COVID-19 virus infection and intubated after developing respiratory failure. Serial point-of-care bedside lung ultrasound was performed by the managing intensivist daily, and correlated with the clinical progress and chest X-ray imaging done for the patient. Results The patient exhibited lung ultrasound findings consistent with that described for viral pneumonias. This included numerous B-lines and subpleural consolidations with disrupted pleural lines distributed symmetrically, predominantly in bilateral upper BLUE points, and lower BLUE points bilaterally. Coalescing B-lines leading on to the development of bilateral “white lung” were associated with worsening acute respiratory distress syndrome. An increased density or reduction of the B-lines was associated with clinical improvement or deterioration, respectively. Conclusions Trained clinicians, who are familiar with point-of-care lung ultrasonography, may consider point-of-care bedside ultrasound as an important adjunct to history and physical examination for the diagnosis and management of COVID-19 when advanced imaging is not available because of logistical reasons or infectious control. This applies in particular to cases where resources are limited, and patient transfers to facilities offering such services may prove hazardous.