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At least 487 records · Page 27Linked to original sources
PubMed2006

Characteristics of basal cell carcinoma amongst Asians in Singapore and a comparison between completely and incompletely excised tumors.

BACKGROUND: Most published series of basal cell carcinomas (BCCs) are based on Caucasian populations. Very little is known about the characteristics of incompletely excised BCCs in Asians. OBJECTIVES: This study examines the characteristics of BCCs in Asian residents in Singapore, and compares incompletely with completely excised tumors after conventional surgical excision. PATIENTS AND METHODS: A retrospective study was conducted using the case records of patients who had a primary BCC excised at the National Skin Centre between 1991 and 1995. RESULTS: A total of 185 histologically confirmed BCCs were recorded in 166 patients (male to female ratio, 0.95; mean age, 70.9 years). The highest proportion (27.1%) was in the 81-90-year age group. Compared with census data, a significantly higher proportion of patients with BCCs were Chinese (P < 0.001). The tumors averaged 12.0 mm in diameter and the majority (84.3%) were located on the head and neck. In 28 lesions (15.1%), the tumors were incompletely excised, with those on the nose and nasolabial folds being most frequent. Incompletely excised BCCs were more likely than completely excised lesions to be located on the mid-face and trunk (P = 0.003), but there was no significant correlation with tumor size, tumor duration, or patient age, race, and gender. The overall recurrence rate was 1.6% over a mean follow-up time of 74 months. CONCLUSIONS: BCCs are more common amongst Chinese in Singapore and occur chiefly in the elderly. Conventional surgical excision with margin control achieves a satisfactory tumor clearance rate of 84.9%. Incomplete excision is associated with tumor location on the mid-face and trunk rather than tumor size or duration.

Adult↗
PubMed2006

Identification of nine new HLA class I alleles in volunteers from the Singapore stem cell donor registries.

Based on unusual probe hybridization patterns, two human leukocyte antigen (HLA)-A, five HLA-B, and two HLA-C alleles (A*240208, A*3211Q; B*1822, B*3938Q, B*4606, B*4607N, B*5139; Cw*0321, Cw*0734) were identified in individuals from the Singapore Bone Marrow Donor Program and Singapore Cord Blood Bank. Eight of the nine alleles encode amino acid substitutions altering the antigen-binding region including three alleles with changes altering a cysteine at codon 164 (A*3211Q, B*3938Q, B*4607N). This substitution either eliminates a key disulfide bond or results in a stop codon, both likely affecting the expression of the HLA molecules. Only one allele (A*240208) carries a synonymous substitution.

Alleles↗
PubMed2004

Aeroallergen sensitization in pediatric allergic rhinitis in Singapore: is air-conditioning a factor in the tropics?

Singapore is a unique blend of a tropical environment with a high standard of hygiene and public health care. The objective was to define the prevalence, clinical characteristics, and environmental risk factors of specific aeroallergen sensitization in pediatric allergic rhinitis patients in this unique environment. The method adopted was a retrospective analysis of allergic rhinitis patients, undergoing aeroallergen skin prick testing (SPT), in the outpatient specialty clinic of the KK Children's hospital, from July 2001 to June 2002. A total of 202 patients were included, 161 (80%) males, 167 (83%) Chinese, age mean 7.6 yr (range 2-14 yr). The most prevalent clinical symptoms were: watery rhinorrhea 61%, blocked nose 61%, sneezing 52%, snoring 17%, and epistaxis 12%. SPT results were positive for house dust mites in 97% of children, pets (20%), molds (19%), pollens (15%), and kapok (10%). Mold sensitization was significantly more prevalent in households without air-conditioning (aircon), 49% vs. 10% with aircon (odds ratio 9.4, 95% CI 3.8-22.9). Polysensitization (sensitization to three or more allergens) was similarly more prevalent in households without aircon, 51% vs. 14% with aircon (odds ratio 6.4, 95% CI 2.8-14.7). It was concluded that indoor aeroallergen sensitization is the major associated factor with clinical allergic rhinitis in children in Singapore. Patients living in households without air-conditioning are at increased risk of mold sensitization and polysensitization.

Adolescent↗
PubMed1995

Does routine gowning reduce nosocomial infection and mortality rates in a neonatal nursery? A Singapore experience.

A 1 year prospective study on routine gowning before entering a neonatal unit was conducted in a maternity hospital in Singapore. This study was done based on previous work by Donowitz, Haque and Chagla and Agbayani et al., as there have been no known studies done in Singapore. The aim of the study was to test the hypothesis that routine gowning before entering a neonatal nursery does not reduce nosocomial infection and mortality rate. A total of 212 neonates from the neonatal intensive care unit (NICU) and 1694 neonates from the neonatal special care unit (NSCU) were studied. Neonates admitted during the 1 year study were assigned to the gowning (control) and no routine gowning (trial) group on every alternate 2 months. The hospital infection control nurse provided data on nosocomial infection. The overall nosocomial infection rate in the NICU was 24% (25 of 104 admissions) during gowning periods compared to 16.6% (18 of 108 admissions) when plastic aprons were not worn before entry. In the NSCU, the overall infection rate was 1.5% (12 of 800 admissions) during gowning periods compared to 2.1% (19 of 894 admissions) when no gown was worn before entry. Results of the study found no significant differences in the incidences of nosocomial infection and mortality in the neonates. The cost of gowns used during the no routine gowning periods was S$2012.8 compared to S$3708 used during the routine gowning procedure. The investigators recommend that routine gowning before entering a neonatal unit is not essential and cost effective for the purpose of reducing infection. Rather the focus should be on adequate handwashing by all hospital personnel and visitors before handling neonates.

Cross Infection↗
PubMed1997

Population based standards for pulmonary function in non-smoking adults in Singapore.

Ethnic differences in lung function are well recognized, hence the use of normative data should therefore be based on reference equations that are derived specifically for different ethnic groups. We have collected data (n = 406) for population-based reference values of lung function from randomly selected samples of healthy non-smoking adults of both gender (aged 20-79 years) for each of the three major ethnic groups (Chinese, Malay and Indians) in Singapore. Lung function forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, diffusion capacity (transfer factor) for carbon monoxide (DLCO), total lung capacity (TLC), residual volume (RV), RV/TLC and functional residual capacity (FRC) was measured using standardization procedures and acceptability criteria recommended by the American Thoracic Society. Lung function values were predicted from age, height, weight, body mass index (BMI) and transformed variables of these anthropometric measures, using multiple regression techniques. Ethnic differences were demonstrated, with Chinese having the largest lung volumes and flow rates, and Indians the smallest. These prediction equations provide improved and additional (TLC, RV, RV/TLC, FRC) population-based reference values for assessment of pulmonary health and disease in Singapore.

Adult↗
PubMed2005

Visual experience during phacoemulsification under topical anaesthesia: a nationwide survey of Singapore ophthalmologists.

BACKGROUND: All patients undergoing phacoemulsification under topical anaesthesia experience a variety of visual sensations that may be frightening in a small proportion of patients. This study evaluates Singapore ophthalmologists' knowledge and practices regarding patients' visual experience during phacoemulsification under topical anaesthesia. METHODS: A nationwide survey of all ophthalmologists in Singapore who had performed at least one cataract surgery within the last year was carried out. Questions regarding patients' experience were asked. Surgeons were also asked about patients' fear during surgery, usefulness of preoperative counselling and feedback from patients postoperatively. RESULTS: Of 105 ophthalmologists 89 responded, of which 44 performed phacoemulsification under topical anaesthesia. The percentage of respondents who thought that the patients experienced the various visual sensations were: no light perception (4.6%), light perception (97.7%), one or more colours (95.5%), flashes of light (77.3%), movements (90.9%), instruments (61.4%), surgeon's hands/fingers (56.8%), surgeon (47.7%) and change in brightness of light (90.9%). Although 52.3% of surgeons believed that patients may be frightened by their visual experience and 50.0% felt that preoperative counselling would be useful in reducing such fear, only 11.4% routinely offered preoperative counselling and 18.2% counselled their patients occasionally. In total, 50.0% ophthalmologists had patients who reported to them that they could see during surgery, whereas 20.5% had been told by patients that they were frightened by the visual experience. CONCLUSION: Despite the awareness of patients' visual experience and the belief that preoperative counselling may be useful, most ophthalmologists do not counsel their patients preoperatively.

Anesthesia, Conduction↗
PubMed2005

Utility values and myopia in medical students in Singapore.

PURPOSE: Although technologies to correct myopia have progressed in recent years, it is not known how cost-effective such technologies are. In this paper, utility values of myopic medical students in Singapore were ascertained as a first step to deriving weights for quality adjustment in future cost-effectiveness studies of such technologies. METHODS: Students (n = 120) aged 18-22 years with myopia (spherical equivalent at least -0.5 D) from Singapore's sole medical school were recruited. Information on lifetime intention to undergo refractive surgery, contact lens use, proportion of waking time spent wearing corrective devices, and utility values using the time trade-off and standard gamble for death methods, were obtained. RESULTS: The mean utility values for time trade-off and standard gamble were 0.97 (95% confidence interval 0.96-0.98, median 1.00) and 0.99 (95% confidence interval 0.98-0.99, median 1.00), respectively. Utility values were significantly higher among those who reported a probability of less than 50% that they would undergo refractive surgery within their lifetime, compared with those who reported a probability of 50% or more (means 0.98 vs. 0.95, P < 0.001). CONCLUSION: Utility values in myopic medical students obtained in this study appear to be relatively high, compared with those obtained for other ophthalmic conditions.

Adolescent↗
PubMed1990

The influence of dialect group on peptic ulcer frequency amongst the Chinese in Singapore.

In Singapore, peptic ulcer is more common amongst Chinese than amongst Malays or Indians. Earlier work has suggested that, amongst female Chinese, Cantonese women are more susceptible to ulcer disease when compared to females of other dialect groups. The aim of the present study was to confirm or refute this possibility. The dialect group distribution of 897 Chinese patients with peptic ulcer (duodenal ulcer 601, gastric ulcer 296) was compared with that of non-ulcer dyspepsia patients and 1602 general medical patients attending the same medical units. The proportion of various dialect groups (including Cantonese) was similar in all patient groups. The proportion of ulcer patients presenting with haemorrhage was also similar in the different dialect groups. We conclude that no major dialect differences exist in peptic ulcer frequency amongst the Chinese in Singapore.

China↗
PubMed1999

The economic cost of asthma in Singapore.

BACKGROUND: Asthma is a common chronic disorder. In Singapore, it is estimated that 140,000 individuals have current asthma and more than 100 individuals die of this disease annually. OBJECTIVE: This study estimates the economic cost of asthma, both direct and indirect, to the patient and community. METHOD: Direct cost estimates were based on all levels of medical care, which included inpatient care, emergency room visits, specialist outpatient and primary healthcare, and medication costs. Indirect costs were estimated from cost of time lost by patients and their families attending to medical needs and the loss of productivity due to absenteeism. These estimates were calculated to the 1992/93 US dollar. RESULTS: The total cost of asthma in Singapore was estimated to be US $33.93 million per annum. This was made up of US $17.22 million in direct costs and US $16.71 million in indirect costs. Inpatient hospitalisation accounted for the largest proportion of direct medical expenditure, approximately US $8.55 million. The loss of productivity from acute asthma accounted for the largest proportion of the indirect costs at US $12.70 million. The cost estimates did not include premature death due to disease. These estimates represent approximately US $238 per asthmatic person per year or US $11.90 per person per year. CONCLUSION: This study shows that the economic cost of asthma is also considerable in populations outside the Western hemisphere, and justifies the need for a concerted effort to reduce asthma morbidity worldwide.

Asthma↗
PubMed1986

Atypical condylomas of the cervix uteri in Singapore women: a histopathological and immunohistochemical study.

Subclinical flat cervical warts are commonly recognized by means of colposcopy. These warty lesions frequently contain cellular atypia of a varying degree showing all the features of cervical intraepithelial neoplasia (CIN) together with the features of wart virus infection e.g. koilocytosis. Human papillomavirus (HPV) antigens and DNA have been found in these lesions which can be called atypical condylomas. The presence of such markers in lesions regarded as having neoplastic potential implicates HPV in cervical carcinogenesis. We investigated a group of Chinese women in Singapore to see whether this hitherto unstudied group showed HPV markers, in particular, HPV antigens by means of the peroxidase-antiperoxidase (PAP) staining technique. We found that histological warty change and HPV antigens were commoner in early compared with advanced CIN. These results, which are similar to previous studies, suggest that the aetiology of cervical carcinoma is probably no different in Singapore than in the West. They also suggest that HPV infection of the cervix is endemic in non-Western countries as well as in the West and may play a role in cervical carcinogenesis in diverse racial groups.

Antigens, Neoplasm↗
PubMed2005

Health economics of renal replacement therapy: perspectives from Singapore.

The prevalence of end-stage renal disease (ESRD) in Singapore is high and projected to increase sharply due to the aging population and the high prevalence of diabetes. The number of patients treated with dialysis was projected to rise from 2633 in 1999 to nearly 6000 in the year 2010. The cost of dialysis provision was estimated to increase 2.5-fold from US dollar 90 million in 1999 to US dollar 241 million in 2010. To address this, the Singapore Ministry of Health launched three initiatives in the year 2000: First, to reduce the incidence of ESRD through (1) primary prevention of diabetes, (2) community-based screening to facilitate early detection of patients with diabetes, (3) improving glycemic and blood pressure (BP) control of diabetics in the primary care setting, and (4) the establishment of dedicated Renal Retardation clinics to optimize BP control (and glycemic control for diabetics), and reduce the level of proteinuria in patients at high risk of ESRD development. Second, to increase the percentage of ESRD patients treated with continuous ambulatory peritoneal dialysis (CAPD), which is a lower-cost modality compared with hemodialysis; and third, amendments to the existing opt-out legislation for organ procurement for transplantation to increase the supply of kidneys for cadaveric renal transplant.

Humans↗
PubMed1985

Suicide in the island of Singapore.

In a study of suicide in Singapore in 1980 there were 230 cases and the suicide rate for the general population was 9.5 per 100,000. The age-specific rates increased steeply after 50 years and there was a male preponderance especially in the age group 60 years and over. Comparing the three major ethnic groups in Singapore, the highest rate was seen in the Indians and Chinese, whereas the Malays had the lowest. Amongst the suicides there were 59 (25.7%) with mental illness, mainly schizophrenia, and they were of a younger age group, 20-39 years. The commonest method of suicide was jumping from high-rise flats.

Adolescent↗
PubMed1988

The prevalence of transsexualism in Singapore.

The prevalence of transsexualism in Singapore was estimated by counting all the patients who sought sex-reassignment surgery and were subsequently diagnosed as transsexuals by psychiatrists. Up to 1986, there were a total of 458 Singapore-born transsexuals, of which 343 were males and 115 were females. This was a prevalence of 35.2 per 100,000 population age 15 and above (or 1/2900) for male transsexualism, and 12.0 per 100,000 (or 1/8300) for female transsexualism. The sex ratio was about 3 males to 1 female. The main reason for the high prevalence was the availability of sex-reassignment surgery.

Adolescent↗
PubMed1999

Indoor air quality and the law in Singapore.

With the greater use of air-conditioned offices in Singapore, achieving good indoor air quality has become an important issue. The laws that impose duties upon designers and contractors with respect to the design and construction of air-conditioning and mechanical ventilation (ACMV) systems are set out in the Building Control Regulations and the Singapore Standard Code of Practice for Mechanical Ventilation and Air-conditioning in Buildings (hereinafter "SS CP 13:1980"). ACMV maintenance is governed by the Environmental Public Health Act, the Building and Common Property (Maintenance and Management) Act, and the Land Titles (Strata) Act, as well as by lease or tenancy agreements. Designers, contractors, developers, building owners and management corporations may also be liable to the workers, occupants and other premises users for indoor air quality (IAQ)-related injuries under the general principles of contract and tort. Recently, the Guidelines for Good Indoor Air Quality in Office Premises was issued by the Ministry of Environment to complement SS CP 13:1980 toward improving the indoor air quality of air-conditioned office premises. Although the Guidelines have no statutory effect, they may be adopted as contractual requirements in construction, lease and maintenance contracts. They may also be used to determine the relevant standard of duty of care required to discharge tortious liability. This paper looks at the existing laws and rules affecting the design, construction and maintenance of air-conditioned offices in light of Part III of the Ministry's Guidelines.

Air Conditioning↗
PubMed2003

Indoor air quality and energy performance of air-conditioned office buildings in Singapore.

An integrated indoor air quality (IAQ)-energy audit methodology has been developed in this study in Singapore, which provides a rigorous and systematic method of obtaining the status-quo assessment of an 'IAQ signature' in a building. The methodology entails a multi-disciplinary model in obtaining measured data pertaining to different dimensions within the built environment such as the physical, chemical, biological, ventilation, and occupant response characteristics. This paper describes the audit methodology and presents the findings from five air-conditioned office buildings in Singapore. The research has also led to the development of an indoor pollutant standard index (IPSI), which is discussed in this paper. Other performance indicators such as, the ventilation index and the energy index as well as the building symptom index (BSI) are also presented and discussed in the context of an integrated approach to IAQ and energy. Several correlation attempts were made on the various symptoms, indoor air acceptability, thermal comfort, BSI and IPSI, and while BSI values are found to correlate among them as well as with IAQ and THERMAL COMFORT acceptability, no such correlation was observed between BSI and IPSI. This would suggest that the occupants' perception of symptoms experienced as well as environmental acceptability is quite distinct from IAQ acceptability determined from empirical measurements of indoor pollutants, which reinforces the complex nature of IAQ issues.

Air Conditioning↗
PubMed2000

Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates from pediatric patients in Singapore.

One hundred eighty Streptococcus pneumoniae strains isolated from children at a pediatric hospital in Singapore from 1997 to 1999 were serotyped and their antimicrobial susceptibility patterns were determined. Sixty-three percent of the isolates were resistant to penicillin. Significantly large numbers of the strains investigated were resistant to trimethoprim-sulfamethoxazole (87.8%), tetracycline (71.7%), erythromycin (67.8%), and chloramphenicol (40%). Penicillin and multidrug resistance was mostly associated with the frequently isolated S. pneumoniae isolates of serotypes (serotypes 19F, 23F, 6B, and 14). Isolates of serotype 19F, the serotype most commonly encountered in Singapore (41.1%), had the highest prevalence of penicillin (78.4%) and multidrug resistance (94.6%). Most of the invasive S. pneumoniae isolates (8 of 17; 47. 1%) were of serotype 14.

Anti-Bacterial Agents↗
PubMed2004

Use of mycobacterial interspersed repetitive unit-variable-number tandem repeat typing to examine genetic diversity of Mycobacterium tuberculosis in Singapore.

Strain typing using variable-number tandem repeats of mycobacterial interspersed repetitive units (MIRU-VNTR) is a powerful tool for studying the epidemiology and genetic relationships of Mycobacterium tuberculosis isolates. For this study, isolates from 291 patients in Singapore were genotyped by this method. One hundred sixty-six distinct MIRU-VNTR patterns were detected. One hundred sixty-two strains were grouped into 1 of 35 different MIRU-VNTR clusters and 131 isolates were unique. In this sample collection, 9 of the 12 MIRU-VNTR loci were moderately or highly discriminative according to their allelic diversities. The Hunter-Gaston discriminatory index was 0.975, indicating the high power of discrimination of MIRU-VNTR typing. By direct comparisons with previously typed MIRU-VNTR patterns and by genetic relationship analyses, we could identify and clearly define four epidemic groups of M. tuberculosis in our sample, corresponding to the W/Beijing, East-Africa-Indian, Haarlem, and Delhi genotype families. Furthermore, MIRU-VNTR typing was able to clearly distinguish ancestral and modern M. tuberculosis strains as defined by TbD1 genomic deletion analysis. These results indicate that MIRU-VNTR typing can be a useful first-line tool for studying the genetic diversity of M. tuberculosis isolates in a large urban setting such as Singapore.

Alleles↗
PubMed2006

Establishment of ST30 as the predominant clonal type among community-associated methicillin-resistant Staphylococcus aureus isolates in Singapore.

The number of infections attributable to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Singapore is progressively increasing. Most cases in the past 2 years were caused by Panton-Valentine leukocidin-positive isolates belonging to sequence type 30, according to multilocus sequence typing. This has clearly become the predominant sequence type among CA-MRSA isolates in Singapore.

Community-Acquired Infections↗