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Klebsiella bacteraemia: a report of 101 cases from National University Hospital, Singapore.

One hundred and one cases of Klebsiella bacteraemia from the National University Hospital, Singapore, were reviewed retrospectively. There were 54 (53.5%) males and 47 (46.5%) females. Mean (+/- SE) age was 54 (+/- 2.4) years. Overall mortality was 26%. Nosocomial infections accounted for 20%. Underlying diabetes mellitus and malignancy were present in 36 and 26% respectively. The source of the bacteraemia was not known in 33% of cases, 17% had liver abscess, 29% had urinary tract infections, 9% had pneumonia, 10% had an abscess separate from the liver, and 3% had biliary sepsis. Elevated alkaline phosphatase (> 100 U-1) was seen in all cases of liver abscess (sensitivity 100%, specificity 27%). Nonsurvivors had a significantly lower platelet count than survivors (104 +/- 25 x 10(9)/l vs. 176 +/- 15 x 10(9)/l, unpaired t-test P < 0.05), and a platelet count of less than 150 x 10(9)/l was associated with a significantly higher mortality (37% vs. 11%, chi 2 P < 0.01). Nosocomial infection was associated with 45% mortality, whereas community-acquired infection had a lower rate of 21%, this was not statistically significant. Seventy-eight per cent of these Klebsiella isolates were sensitive to gentamicin and cotrimoxazole, and 100% to imipenem.

Anti-Bacterial Agents↗

Molecular epidemiology of hepatitis B virus vaccine variants in Singapore.

Perinatal infection with variants of hepatitis B virus occurs despite combined immunoprophylaxis with hepatitis B immunoglobulin and currently licensed plasma-derived and recombinant yeast hepatitis B vaccines. Several variants have been detected during a large study of infants born to carrier mothers in Singapore. The most frequent variant was a virus in which a single amino acid substitution Gly to Arg occurred at amino acid position 145 of the outer protein coat of the virus. Similar mutations have been described in Italy, Japan, the USA and a number of other countries. The emergence of antibody escape mutants is a cause for concern for the detection of virus and possibly for future immunization programmes.

Amino Acids↗

The role of Chinese traditional medical practice as a form of health care in Singapore--III. Conditions, illness behaviour and medical preferences of patients of institutional clinics.

Both the modern scientific and the Chinese traditional forms of health care are within easy geographical, economical and quantitative accessibility to the people in Singapore. The fourth component of accessibility, socio-cultural component encompasses the social milieu surrounding the individual, and the values and beliefs attached to diseases and health care services. This paper reveals the findings of a survey of a quota sample of patients in institutional clinics providing Chinese traditional medical consultations. The survey aimed to look at the types of illness conditions presented in these clinics, the multi-usage of both modern and traditional health care by these patients, and the inter-relationship between illness behaviour and differential preferences of treatment methods for various disease conditions.

Adolescent↗

Breastfeeding trends in Singapore.

About 60% of well-to-do mothers in Singapore initiate breastfeeding. This value compares favourably with the 36% recently recorded for poor mothers, but is still unacceptably low compared to the 85-95% of well-to-do mothers and 90% of poor mothers who breastfed in the 1950s and 1960s. There has been a general decline in the incidence of breastfeeding over the last 35 years. Differences between the well-to-do and poor groups were initially small. A pronounced decline in the incidence of breastfeeding among the well-to-do mothers followed; a reversal in this downward trend in well-to-do mothers over the past 10 years has narrowed, and indeed reversed, the difference between the two groups. Similar trends can be found for the duration of breastfeeding. Whilst the overall decline probably reflects increasing affluence and 'Westernization' of the population the variation between these two economic groups is probably a result of differences in education. Among the three major ethnic communities, Chinese favoured breastfeeding least and Malays favoured it most. The differences are believed to be related to cultural differences and the ability of traditional practices and beliefs among the ethnic groups to resist the modern trend towards bottlefeeding.

Breast Feeding↗

Balancing hot and cold--balancing power and weakness: social and cultural aspects of Malay jamu in Singapore.

Jamu (Malay phytopharmaceuticals) are popular among the Malays of the whole Malayan archipelago and have been known for centuries. The non-western pharmaceutical concept of jamu has its own cultural and social implications, with relations to Malay health beliefs, philosophy and religion. In the metropolitan city state of Singapore jamu exist in a special situation between a western and Southeast-Asian world-view, between standards of western science and Malay tradition. The endeavour to 'translate' the jamu concept of medication into the one of standardised pharmaceuticals is doomed to fail, since these concepts are not compatible.

Asia, Southeastern↗

Nitrate consumption and the incidence of gastric cancer in Singapore.

The nitrate content of a wide variety of vegetables, fruits and meat purchased in Singapore were determined by high-pressure liquid chromatography. From the 1982 statistical figures of retained imports and local production of these items the average per capita daily consumption of nitrates was calculated and found to be 215 mg, one of the highest reported figures in the world. Two vegetables are not so popular with the Malays and Indians who comprise 21% of the population. If their consumption of these vegetables is ignored then the per capita daily nitrate consumption of the Chinese population amounts to 250 mg and those of the Malays and Indians to 113 mg. Although these may be overestimates they do appear to show an association with the male gastric cancer incidence rates (age-adjusted) of 44.8 for the Chinese, 10.3 for Malays and 19.4 for the Indians. This could, however, be a chance association.

Chromatography, High Pressure Liquid↗

The complete sequence of a Singapore isolate of odontoglossum ringspot virus and comparison with other tobamoviruses.

The complete sequence of a Singapore isolate of odontoglossum ringspot virus (ORSV-S1) comprises 6609 nucleotides (nt) and four open reading frames (ORFs 1 to 4). The 126/183-kDa RNA-dependent RNA polymerase (RdRp), 33-kDa movement protein (MP) and 18-kDa coat protein (CP) cistrons are located at nt 63-3401/4901, 4807-5718, and 5721-6197 on the genome, respectively. The 5' UTR contains three copies of an 8-base direct repeat and (CAA)n motifs. Characteristic tRNA-like structure and three consecutive homologous regions were present in the 3' UTR. The genomic RNA and MP of ORSV-S1 are one of the longest among all members of the TOV group. Phylogenetic analysis of all four genes indicates evolutionary divergence, but within each gene there are some degrees of evolutionary convergence. The conserved amino acid sequences in the MP can be used for the classification of tobamoviruses.

Amino Acid Sequence↗

Toxicological screen on gastric aspirates: the Singapore experience.

In the early eighties, in response to increasing self-poisoning incidents by pharmaceuticals in Singapore, a comprehensive wide-sweep screen for these drugs in clinical gastric aspirates was devised and implemented by us. The toxicological screen which involved quadruplicate extractions, two in acidic conditions and the other two in alkaline conditions, required the following analyses to be carried out: UV on the acidic fraction, TLC on the basic fraction and mega-bore capillary GC/NPD (nitrogen phosphorus detector) on the combined fraction. The combined fraction if necessary was subjected to GC/MS analysis. Our screen satisfied the need to confirm the analytical outcome of one method by another. Combining the acidic and basic fractions for a single GC analysis saves on instrument time and manpower. All coma and emergency cases were required to undergo GC/MS analysis to prove the identity of toxic agents beyond reasonable doubt. Quality control procedures were instituted at key steps to ensure quality of analytical outcome.

Calibration↗

Analysis of the D1S80 locus by amplified fragment length polymorphism technique in the Chinese, Malays and Indians in Singapore.

The distributions of the D1S80 alleles and genotypes in the Chinese, Malays and Indians in Singapore were determined by amplified fragment length polymorphism (AMP-FLP) analysis. The distributions of the observed genotypes for the three races conformed to Hardy-Weinberg expectations. The system was applied to 19 families whose paternity had been established by restriction fragment length polymorphism (RFLP) analysis. In all cases, Mendelian inheritance of the alleles at the D1S80 locus could be demonstrated. D1S80 typing on DNA recovered by differential extraction of forensic specimens which included vaginal swabs, urethral swabs and seminal stains yielded consistent results.

Alleles↗

Sudden infant death in a tropical environment: Singapore's experience.

A total of 206 cases of sudden infant deaths examined at the Institute of Science and Forensic Medicine, Singapore, over a 5 year period (1989-93) were identified to assess the pattern of sudden death in this age group, which was subdivided into the neonatal and post-neonatal periods. A total of 34% (70) of infant deaths occurred in neonatal life and the remaining 66% (136) in the post-neonatal period; 90% of the neonatal deaths were natural, of which over half were due to congenital heart disease and complications of prematurity. Unnatural deaths in this period were uncommon, there being only seven such deaths. In the post-neonatal period, unnatural deaths constituted 25% of the total with trauma and aspiration heading the list. Natural deaths in the post-neonatal period are predominantly due to infections (34%) and a group of sudden natural deaths with minimal findings (31%). The latter group may arguably represent cases of Sudden Infant Death Syndrome (SIDS). The yearly incidence of this group in our study varied between 0.08 to 0.2 per 1000 live births, which is considerably lower than the incidence quoted for Western populations. The criteria for the classification and the impact of sudden infant deaths in Asian countries are discussed.

Cause of Death↗

Anisometropia in Singapore school children.

PURPOSE: To report the prevalence rates of anisometropia in a school population and determine the relative contribution of refractive power and axial length to the measured anisometropia. DESIGN: Population-based cross-sectional study. METHODS: Autorefraction, keratometry, and ultrasonography studies were made. SETTING: Three schools, located on the eastern, northern, and western part of Singapore. STUDY POPULATION: In all, 1,979 children aged 7 to 9 years were recruited for this study. The study sample included Chinese (n = 1,481), Malay (n = 324), and Asian Indian (n = 174) children; 720 subjects have myopia (spherical equivalent <= -0.5 diopters) in at least one eye. MAIN OUTCOME MEASURE: Anisometropia. RESULTS: The prevalence rates of anisometropia, in terms of spherical equivalent (SE) difference of at least 1.5 diopters and 2.0 diopters were 1.57% (95% confidence interval [CI]: 1.1, 2.2) and 1.01% (95% CI: 0.6, 1.6), respectively. The prevalence rate of anisometropia (at least 2.0 diopters) among the children with at least one myopic eye was 2.4% (95% CI: 1.4, 3.8), whereas in those without any myopic eyes, the prevalence rate was only 0.2% (95% CI: 0.06, 0.8). The spherical equivalent difference between the right and left eyes was positively correlated with the difference in axial lengths (P <.001). The difference in corneal refractive power is not statistically different between the anisometropic and the nonanisometropic children. CONCLUSIONS: The anisometropia prevalence rate in a childhood population with a relatively high prevalence of myopia was reported. The origin of the anisometropia is axial, and these results suggest that the differential rate of elongation between the two eyes of nonmyopic subjects results in anisometropia.

Anisometropia↗

Prevalence and causes of amblyopia in a population-based study of young adult men in Singapore.

PURPOSE: To determine the prevalence and causes of amblyopia in young adult Chinese, Indian, and Malay men in Singapore. DESIGN: A population-based cross-sectional study. METHODS: Best-corrected visual acuities of all Singaporean men born in the years 1978 to 1983 were measured before enlistment into military service. Those with BCVA of 6/12 or worse were examined by an ophthalmologist for the presence of amblyopia and other causes. RESULTS: Of the 122,596 men examined, there were 428 with amblyopia, an overall prevalence of 0.35%. The prevalence was similar among Chinese (0.34%), Malays (0.37%), and Indians (0.41%, P = .52). Anisometropic amblyopia was the most common type of amblyopia and strabismic amblyopia was more common in Indians. There were little racial differences in the prevalence of meridional or form deprivation amblyopia. CONCLUSION: The overall prevalence of amblyopia was low and was similar among the three racial groups in young adult Singaporean males.

Adolescent↗

Detection of narrow angles and established angle closure in Chinese residents of Singapore: potential screening tests.

PURPOSE: To assess the performance of peripheral and central anterior chamber depth (ACD) measurements, and autorefraction, in identifying Chinese people with occludable drainage angles or established primary angle closure. DESIGN: Population-based cross-sectional analysis. METHODS: Subjects aged 40 years and older were drawn from a representative sample of Chinese Singaporean residents. Limbal chamber depth (LCD) was estimated and central ACD was measured using optical pachymetry and ultrasound. An autorefraction was taken for all subjects. Angle width and the presence of peripheral anterior synechiae were determined by gonioscopy. Receiver operating characteristic curves were generated to show the performance of these tests in detecting occludable angles. RESULTS: A total of 1090 subjects were examined. The prevalence of occludable angles was 6.5%. LCD measurement performed best in detecting occludable angles (area under the curve [AUC] 0.904, 95% confidence interval [CI] 0.870, 0.937). Optical pachymetry and ultrasound measurement of ACD performed less well (AUC 0.859 and 0.810, respectively), and autorefraction performed poorly in detecting occludable angles (AUC 0.632). LCD also gave the best performance in detecting primary angle closure (AUC 0.782, 95% CI 0.727, 0.837). CONCLUSIONS: Limbal LCD estimation outperforms other methods of measuring ACD as a screening tool for the detection of occludable drainage angles in the Chinese population of Singapore.

Adult↗

The use of sewage sludge and horticultural waste to develop artificial soil for plant cultivation in Singapore.

Greenhouse pot experiments were performed with Ipomoea aquatica (Kang Kong) to evaluate artificial soil produced from poor fertility subsoil, horticultural compost, and sewage sludge. The addition of horticultural compost and sewage sludge to subsoil substantially improved plant growth, improved the physical properties of subsoil and enriched subsoil by essential nutrients for plants. The effect was enhanced when the two ingredients were added to subsoil together. The highest yield of biomass of I. aquatica was observed in artificial soil prepared by mixing subsoil with 4% (wet weight/wet weight) of horticultural compost and 2% (dry weight/wet weight) of sewage sludge. The contents of heavy metals in plants, grown in the artificial soil, were significantly lower than toxic levels. The artificial soil could be recommended for urban landscaping and gardening in Singapore.

Conservation of Natural Resources↗

The impact of skin banking and the use of its cadaveric skin allografts for severe burn victims in Singapore.

The skin banking programme was set-up in Singapore in 1998 to provide a ready source of allografts for patients with severe burns. The process and problems in establishing a local skin bank will be described together with a retrospective review of skin allograft recipients to determine the efficacy of the programme. For the skin bank set-up, pertinent issues related to legislation, methods, logistics, quality assurance and donation rate are discussed. In this retrospective review, a comparison between patients who had early complete excision with skin allograft transplantation and those who received conventional staged excision and coverage, was analysed in terms of clinical profile and outcome using statistical methods. The former group presented a significant reduction of mortality rate and hospital stay by 29% and 10 days, respectively. The establishment of the skin bank has helped in the management of severe burn patients by facilitating early excision and allografting. In a Burn Centre, therefore, it is essential to have an ample supply of skin allograft for burn victims in readiness for mass disaster situations.

Adolescent↗

Actinomyces in cervical smears of women using the intrauterine device in Singapore.

OBJECTIVES: Reproductive tract actinomyces have been associated with the use of intrauterine contraceptive device (IUCD). Thus, there is a need to evaluate the prevalence of colonization with Actinomyces israelii in a cohort of Singaporean women using an IUCD. Second, the occurrence of actinomycosis in colonized women and the clinical need to remove the IUCD and/or possibly the need to treat asymptomatic carriers with antibiotics were evaluated. METHODS: The study population consisted of 1,108 IUCD users attending the Fertility Control Clinic, National University Hospital, Singapore. RESULTS: In our study, the prevalence of actinomyces-positive cervical smears among IUCD users was 13.7%; the incidence of actinomyces-positive smears was similar with Copper T (34.2%), Multiload (32.9%) and Nova T (32.9%) IUCDs. We found no association with the duration of use of IUCD and actinomyces infection. In our study, 150 out of 152 (98.7%) IUCD users with actinomyces-positive smears were asymptomatic, and only 2 out of 152 (1.3%) who had actinomyces-positive cervical smears developed pelvic inflammatory disease at 6 months. CONCLUSIONS: Our study suggests that removal of the IUCD in asymptomatic women with actinomyces-positive cervical smear is not necessary. Moreover, we suggest that asymptomatic carriers of actinomyces do not require preemptive antibiotic treatment.

Actinomyces↗

Susceptibility testing of Singapore strains of Mycoplasma hominis to tetracycline, gatifloxacin, moxifloxacin, ciprofloxacin, clindamycin, and azithromycin by the Etest method.

The minimal inhibitory concentrations of tetracycline, gatifloxacin, moxifloxacin, ciprofloxacin, clindamycin and azithromycin for 28 Singapore clinical Mycoplasma hominis strains were studied using the Etest method. Different incubation conditions did not affect susceptibility categories, except for tetracycline intermediate-susceptibility strains. Tetracycline-susceptibility was only 35.7%. All strains were susceptible to the fluoroquinolones and clindamycin but resistant to azithromycin.

Anti-Bacterial Agents↗

Genetic data for the 13 CODIS STR loci in Singapore Indians.

Allele frequencies for the 13 CODIS short tandem repeat (STR) loci included in the AmpFISTR Profiler Plus and AmpFISTR Cofiler kits (Applied Biosystems, Foster City, USA) were determined in a sample of 174 unrelated Indians in Singapore.

DNA Fingerprinting↗