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At least 865 records · Page 48Linked to original sources
PubMed1998

Cardiovascular risk factors in relation to cigarette smoking: a population-based survey among Asians in Singapore.

To investigate how cigarette smoking increases the risk of cardiovascular disease, risk factors were compared between 166 cigarette smokers and 312 non-smokers, in a random sample of males (Chinese, Malays and Asian Indians) aged 30-69 years from the general population of Singapore. There was adjusted for age and ethnic group. The prevalence of hypertension was lower in cigarette smokers (15.2%) than non-smokers (21.9%), with the difference reduced by adjustment for body mass index (BMI). Smokers had: lower mean serum HDL-cholesterol (0.76 versus 0.81 mmol/l) and higher mean serum fasting triglyceride (1.92 versus 1.71 mmol/l), which will increase atherosclerosis; higher mean plasma fibrinogen (2.75 versus 2.67 g/l) and plasminogen activator inhibitor 1 [PAI-1] (24.9 versus 22.2 ng/ml), which will increase thrombosis; and lower mean plasma vitamin C (4.4 versus 6.4 mg/l) and serum selenium (118 versus 123 microg/l), which may increase atherosclerosis. Adjustment for BMI slightly increased the differences for HDL-cholesterol, fasting triglyceride, fibrinogen and PAI-1, indicating that less generalised obesity among smokers reduces their increased cardiovascular disease risk. Smoking was not found to be related to: diabetes mellitus; serum total cholesterol, LDL-cholesterol, apolipoproteins A1 and B and lipoprotein(a); plasma factor VIIc and prothrombin fragment 1 + 2; and plasma vitamins A and E and serum ferritin. There was no evidence of increased insulin resistance in smokers, as measured by mean fasting serum insulin.

Adult↗
PubMed1997

Mortality among infants with high-risk congenital diaphragmatic hernia in Singapore.

Several factors suggested to predict mortality in congenital diaphragmatic hernia (CDH) have not always been applicable in different centers. A retrospective review was conducted of 19 consecutive neonates in Singapore in whom CDH was diagnosed within 12 hours of birth to identify factors associated with mortality. Of the 19 cases, 15 (79%) were diagnosed using antenatal ultrasonography. Eight (42%) underwent primary repair at a median age of 23 hours (range, 12 to 50 hours). Of the 19 infants, 15 died (mortality rate, 79%). Survivors until hospital discharge were compared with nonsurvivors. Antenatal diagnosis and stomach position in left-sided defects had no effect on outcome, although polyhydramnios tended to be associated with nonsurvival. Significant postnatal factors associated with mortality included a low arterial pH level, low initial arterial-alveolar oxygen ratio, high initial alveolar-arterial oxygen gradient, as well as high oxygenation and ventilation indices. These results reflect difficulty in oxygenation because of pulmonary hypoplasia despite evidence of adequate ventilation. There was no difference between survivors and nonsurvivors in either their initial or best postductal blood gases. The "Bohn quadrants" did not aid in predicting survival of infants who underwent repair because all eight such infants had best postductal carbon dioxide values of less than 40 mm Hg and ventilation indices of less than 1,000. Yet only four (50%) survived until hospital discharge. Large-scale evaluation of these factors may be required in the future to demonstrate their validity and reliability because of changing management strategies for CDH.

Carbon Dioxide↗
PubMed2002

Single stroke dementia: insights from 12 cases in Singapore.

BACKGROUND: Vascular dementia (VaD) is occasionally caused by a single, strategically located stroke. In this report, we describe the clinical and anatomical features of 12 cases of strategic single infarct dementia (SSID) from Singapore. METHODS: Each patient completed a standardized diagnostic evaluation including history, neurological and neuropsychological examination, laboratory testing, and brain imaging. Dementia was diagnosed using the Diagnostic and Statistical Manual, 3rd edition, revised (DSM-III-R) criteria, and VaD was diagnosed using the National Institute of Neurologic Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria. VaD patients whose brain imaging study revealed a single cerebrovascular event were diagnosed with SSID. RESULTS: We identified 12 cases of SSID among 125 VaD patients (9.6%). Stroke mechanism was lacunar infarction in five cases, embolism in four cases, large vessel thrombosis in two cases, and parenchymal hemorrhage in one case. The most commonly impaired cognitive domains on neuropsychological testing were visual memory, visuoconstruction, and language. In 11 of the 12 SSID cases, the stroke was located in the left hemisphere. The thalamus, either alone or as the proximal portion of a posterior cerebral artery infarction, was involved in 8 of the 12 cases. Stroke locations in the nonthalamic SSID cases included left angular gyrus, subcortical left frontal lobe including minor forceps, left basal forebrain and medial frontal lobe plus anterior corpus callosum (proximal anterior cerebral artery infarction), and anterior corpus callosum alone. CONCLUSIONS: Various stroke mechanisms may produce SSID. In our SSID cases, vascular damage almost always involved the left hemisphere and frequently involved the thalamus and major interhemispheric or intrahemispheric white matter pathways.

Aged↗
PubMed2003

Chemical characterization of rainwater at Singapore.

A short term study of the chemical composition of rainwater was carried out from November 1999 to October 2000 in Singapore. The rainwater was typically acidic with a mean pH of 4.2. Sulfate was the most abundant ion and comparable to the results reported for other industrialized regions. The concentrations of major ions (NH(4)(+), Ca(2+), K(+), Na(+), Mg(2+), SO(4)(2+), NO(3)(2-), Cl(-), HCOO(-), CH(3)COO(-)) varied monthly. Results show that local meteorological conditions influence the chemical compositions to a significant extent. The pollutants in rainwater were derived from long range and local (industry and traffic) sources.

Acid Rain↗
PubMed2003

Lung pathology of severe acute respiratory syndrome (SARS): a study of 8 autopsy cases from Singapore.

Severe acute respiratory syndrome (SARS) is an infectious condition caused by the SARS-associated coronavirus (SARS-CoV), a new member in the family Coronaviridae. To evaluate the lung pathology in this life-threatening respiratory illness, we studied postmortem lung sections from 8 patients who died from SARS during the spring 2003 Singapore outbreak. The predominant pattern of lung injury in all 8 cases was diffuse alveolar damage. The histology varied according to the duration of illness. Cases of 10 or fewer days' duration demonstrated acute-phase diffuse alveolar damage (DAD), airspace edema, and bronchiolar fibrin. Cases of more than 10 days' duration exhibited organizing-phase DAD, type II pneumocyte hyperplasia, squamous metaplasia, multinucleated giant cells, and acute bronchopneumonia. In acute-phase DAD, pancytokeratin staining was positive in hyaline membranes along alveolar walls and highlighted the absence of pneumocytes. Multinucleated cells were shown to be both type II pneumocytes and macrophages by pancytokeratin, thyroid transcription factor-1, and CD68 staining. SARS-CoV RNA was identified by reverse transcriptase-polymerase chain reaction in 7 of 8 cases in fresh autopsy tissue and in 8 of 8 cases in formalin-fixed, paraffin-embedded lung tissue, including the 1 negative case in fresh tissue. Understanding the pathology of DAD in SARS patients may provide the basis for therapeutic strategies. Further studies of the pathogenesis of SARS may reveal new insight into the mechanisms of DAD.

Adult↗
PubMed2003

Individual and familial characteristics of youths involved in street corner gangs in Singapore.

Thirty-six youths involved in street corner gangs in Singapore were compared with 91 age-matched controls on measures of self-esteem, aggression, dysfunctional parenting and parent-adolescent communication. Results revealed that gang youths had lower self-esteem and higher levels of aggression than controls. Of note were the findings that gang youths reported a relative absence of parental abuse and indifference, and experienced less open communication and higher levels of over-control with their mothers, but not fathers. These findings diverge from anticipated familial correlates of antisocial activity in youths and were discussed with reference to cultural factors and their implications on prevention and intervention.

Adolescent↗
PubMed2001

Dengue seroepidemiology in Singapore.

The resurgence of dengue in Singapore since 1986 had been associated with an adult predominance and a very low incidence in children. No study had been carried out to investigate this finding. Here we report a serological study of 1068 children aged 0 to 15 years. There is a significant rise in seroconversion in children aged 6 years and older coinciding with the start of formal schooling. This suggests that there may be a change in the location where dengue is acquired.

Adolescent↗
PubMed1999

Resurgence of mumps in Singapore caused by the Rubini mumps virus vaccine strain.

The measles, mumps, and rubella vaccine containing the highly attenuated Rubini mumps virus strain conferred no protection against acute parotitis in vaccinated children in Singapore. Its introduction into the national childhood immunisation programme has resulted in a reduction in the seroprevalence of mumps to prevaccination levels.

Adolescent↗
PubMed1999

Outbreak of Nipah-virus infection among abattoir workers in Singapore.

BACKGROUND: In March 1999, an outbreak of encephalitis and pneumonia occurred in workers at an abattoir in Singapore. We describe the clinical presentation and the results of investigations in these patients. METHODS: Clinical and laboratory data were collected by systemic review of the case records. Serum and cerebrospinal fluid (CSF) samples were tested for IgM antibodies to Nipah virus with an IgM capture ELISA. Reverse-transcriptase PCR was done on the CSF and tissue samples from one patient who died. FINDINGS: Eleven patients were confirmed to have acute Nipah-virus infection based on raised IgM in serum. Nipah virus was identified by reverse transcriptase PCR in the CSF and tissue of the patient who died. The patients were all men, with a median age of 44 years. The commonest presenting symptoms were fever, headache, and drowsiness. Eight patients presented with signs of encephalitis (decreased level of consciousness or focal neurological signs). Three patients presented with atypical pneumonia, but one later developed hallucinations and had evidence of encephalitis on CSF examination. Abnormal laboratory findings included a low lymphocyte count (nine patients), low platelet count, low serum sodium, and high aspartate aminostransferase concentration (each observed in five patients). The CSF protein was high in eight patients and white-blood-cell count was high in seven. Chest radiography showed mild interstitial shadowing in eight patients. Magnetic resonance imaging (MRI) showed focal areas of increased signal intensity in the cortical white marker in all eight patients who were scanned. The nine patients with encephalitis received empirical treatment with intravenous aciclovir and eight survived. INTERPRETATION: Infection with Nipah virus caused an encephalitis illness with characteristic focal areas of increased intensity seen on MRI. Lung involvement was also common, and the disease may present as an atypical pneumonia.

Abattoirs↗
PubMed1997

Attitudes of the Singapore public to actions suggesting child abuse.

OBJECTIVE: The aim was to ascertain the views of the Singapore public on the acceptability of actions of an abusive nature. METHOD: In-depth interviews were carried out with 401 randomly sampled respondents in relation to a range of actions. Questions were asked concerning the acceptability of 18 actions, whether circumstances might justify eight of them, how respondents felt about reporting child abuse and whether they could recall any case they had come across. RESULTS: Respondents strongly disapproved of sexually motivated acts, and were more disapproving of physical abuse or neglect than of emotional abuse or neglect. Circumstances did affect how the less extreme actions were viewed. Respondents supported reporting child abuse, but were somewhat against mandatory reporting. They were able to recall details of a number of possible cases. CONCLUSION: We argue that definitions of child abuse should be general and not tied to specific actions, since the effects of actions may vary across cultures, and should be treated as an empirical matter. This allows a research agenda that focuses on the consequences of actions rather than issues of definition.

Adolescent↗
PubMed1986

Evaluation of a low dose of hepatitis B vaccine given within a childhood immunisation programme in Singapore.

The feasibility of introducing low dose (5 micrograms) hepatitis B (HB) virus vaccination at birth and again 1 and 2 months later as part of an existing primary immunisation programme of childhood, was assessed in 662 healthy newborn Singapore children. The vaccine (B-Hepavac, Menck, Sharp and Dohme) was given to three neonatal groups: those born to HB surface antigen (sAg)-negative mothers, HBsAg-positive/HBeAg-positive mothers and HBsAg-positive/HBeAg-negative mothers. A dose of 5 micrograms was compared in a randomised study with the more usual 10 micrograms dose given at the same intervals. Neonates born to HBsAg-positive/HBeAg-positive mothers were also given hepatitis B immunoglobulin (HBIg) at birth. The 5 microgram dose of vaccine was as immunogenic as the 10 microgram dose in all three groups of children studied. At 1 year, anti-HBsAg seroconversion among infants of antigen-negative mothers was 95.8% for the 5 microgram dose and 91.9% for the 10 microgram dose. Suppression of anti-HBsAg formation was not seen even when maternal anti-HBsAg was present or HBIg given. Among infants born to HBsAg-positive/HBeAg-positive mothers, passive plus active immunisation was 100% protective at doses of 5 micrograms and 10 micrograms vaccine in the newborns who were HBsAg-negative at 24 h. Seroconversion after both the 5 and 10 microgram doses of vaccine was reduced, however, to 88% in each group of infants who were already HBsAg-positive at 24 h of age. Overall, passive plus active immunisation as well as HB vaccine alone (5 micrograms dose), given within the existing but expanded primary immunisation programme of childhood, was effective in preventing infection and the chronic carrier state in newborns exposed to risk of HB virus infection during infancy.

Carrier State↗
PubMed2000

Homeostasis model assessment in a population with mixed ethnicity: the 1992 Singapore National Health Survey.

We studied insulin resistance and beta-cell function with reference to ethnic group, glucose tolerance and other coronary artery disease risk factors in a cross section of the Singapore population which comprises Chinese, Malays and Asian Indians. 3568 individuals aged 18-69 were examined. Blood pressure, anthropometric data, blood lipids, glucose and insulin were assayed in the fasting state. Glucose and serum insulin were measured 2 h after an oral glucose challenge. Insulin resistance and beta-cell function were calculated using homeostasis model assessment. Asian Indians had higher insulin resistance than Chinese or Malays. Impaired glucose tolerance (IGT) and diabetes mellitus (DM) were associated with greater insulin resistance and impaired beta-cell function compared to normal glucose tolerance (NGT). Insulin resistance was positively correlated with blood pressure in women and total cholesterol, LDL cholesterol and triglyceride in both men and women. It was negatively correlated with HDL cholesterol and LDL/apolipoprotein B ratio. beta-cell function showed no significant correlations with the cardiovascular risk factors studied. It appears that both impaired beta-cell function and insulin resistance are important for the development of hyperglycemia whereas insulin resistance alone seems more important in the development of coronary artery disease as it correlates with several known coronary artery disease risk factors.

Adolescent↗
PubMed2003

Providing health care for older persons in Singapore.

Health care social policy in Singapore has passed the burden of care to the individual and the family on the rationale that it would enable the state to contain the costs of long-term care by channelling some of its funds to community services and to providing essential health services to all Singaporeans and not just the older group. While a wide array of services has come into existence, there is a lack of integration between the available resources and needs of the individual/family and what has been availed at the community and state levels. Part of the problem lies in the stringent criteria to which the state allows subsidies to be used; the lack of understanding with regard to the profile of users of services; and the case manager approach in offering services. Mapping health care has proven more difficult than anticipated because ageing is a diverse experience, varying by gender, race, income, religion and intergenerational relationships. A social policy does not apply to a 'universal citizen' and services that exist in the public sphere should not exist as merely commodified services which require a great deal of institutional processing.

Aged↗
PubMed1998

Comparison of three methods for the molecular typing of Singapore isolates of enterococci with high-level aminoglycoside resistances.

Enterococci are frequently isolated as nosocomial pathogens and have often acquired intrinsic drug resistances. Molecular typing techniques have been developed to assist in epidemological and infection control measures. This study investigates enterococci with high-level aminoglycoside resistance (HLAR) from the National University Hospital (NUH) of Singapore, and evaluates and compares three methods for typing: restriction enzyme analysis by conventional gel electrophoresis [restriction fragment length polymorphism (RFLP)], pulsed-field gel electrophoresis (PFGE), and polymerase chain reaction (PCR) using random amplified polymorphic DNA (RAPD). Fifty-two isolates of Enterococcus faecalis and 13 isolates of Enterococcus faecium were used for the study. The numbers of patterns obtained for E. faecalis and E. faecium were 26 and 4, respectively by the RFLP method, and very similar discrimination was obtained by PFGE. RAPD PCR results were not reliably reproducible. A single pattern type by RFLP accounted for 16 of the E. faecalis isolates, suggesting hospital spread.

Aminoglycosides↗
PubMed2002

Road traffic accident mortality in Singapore.

The aim of this study was to identify factors that contribute to road traffic accident mortality and the patterns of injuries sustained by these victims, with a view to identifying areas for future intervention. All road traffic accident deaths that occurred in Singapore over a period of 1 year were reviewed. A total of 226 deaths occurred: 82.3% of the victims were male. The median age was 31 years. Blood alcohol was detected in 42 (18.7%) victims. In general, head (86.7%), followed by thoracic (67.7%) and abdominal (31.4%) injuries, were the most common injuries. Severe lower extremity trauma was most common among pedestrians and pedal cyclists (20.6% and 11.0%, respectively). The mean Injury Severity Score was 38.7. The relative risk of mortality between motorcyclists and motorcar drivers was 18.8:1. Suggestions for future prevention and intervention include stricter enforcement of speed limits, more severe penalties for drunk driving, helmet use among pedal cyclists, and the introduction of pre-hospital advanced airway management.

Abbreviated Injury Scale↗
PubMed2003

W135 meningococcal carriage in association with the Hajj pilgrimage 2001: the Singapore experience.

An international outbreak among pilgrims returning from the Hajj (pilgrimage to Mecca) and their close contacts was caused by W135 Neisseria meningitidis. In Singapore, this strain is a new emerging problem, clearly associated with this outbreak. We investigated the extent of transmission of N. meningitidis in Hajj pilgrims and their contacts, in order to provide evidence for developing a rational public health policy. We found a high acquisition rate of W135 N. meningitidis in Singaporean pilgrims during the Hajj with substantial transmission to their household contacts. These findings would support a policy of eradication of pharyngeal carriage in returning pilgrims to prevent introduction and dissemination of meningococci.

Carrier State↗
PubMed2002

Characterization of pyrazinamide and ofloxacin resistance among drug resistant Mycobacterium tuberculosis isolates from Singapore.

OBJECTIVES: To evaluate rapid molecular approaches for the detection of pyrazinamide (PZA) and ofloxacin resistance, by screening 100 known drug-resistant Mycobacterium tuberculosis isolates. METHODS: Mycobacterium tuberculosis isolates were tested for phenotypic resistance to pyrazinamide and ofloxacin using the BACTEC 460 radiometric method and the E-test, respectively. Mutation screening was done by amplifying the pncA, gyrA, and gyrB genes by the polymerase chain reaction (PCR) and direct automated sequencing. RESULTS: Twelve isolates were PZA-resistant and 8 of 12 (66.7%) isolates had missense mutations or deletions at the pncA gene, suggesting that mutation or deletion at the pncA gene is the major molecular mechanism of PZA resistance among the Singaporean isolates. Using the E-test, 48 isolates were resistant to ofloxacin, with minimum inhibitory concentrations of 4 microg/mL or higher. No mutations were observed at the quinolone resistance-determining region (QRDR) of gyrA in all isolates. At the QRDR of gyrB, mutations were present in 1 of 48 ofloxacin-resistant isolates and 0 of 19 ofloxacin-susceptible isolates. CONCLUSIONS: In Singapore, genotypic analysis of resistance to PZA and ofloxacin is inadequate and should be complemented by conventional methods.

Amidohydrolases↗
PubMed1999

Imported malaria in a Singapore hospital: clinical presentation and outcome.

OBJECTIVE: To evaluate the clinical presentation and outcome of imported malaria. METHODS: A retrospective chart review was conducted of patients with imported malaria admitted to the Communicable Disease Centre (CDC), Singapore (a 130-bed tertiary referral center) from January 1992 to December 1993. An imported case was defined as a smear-positive infection that was acquired in another country. RESULTS: Among 200 malaria patients hospitalized at CDC, 168 imported cases (137 males and 31 females, 131 nonresidents and 37 residents) were studied. The mean age was 31.6 6 10.5 years. The countries visited were India (49.4%), Indonesia (16.7%), and Bangladesh (13%). Five patients had chemoprophylaxis and 36 patients had experienced previous malaria infection. The predominant symptoms were fever (97.6%), chills (79.2%), and rigors (67.9%). Hepatomegaly was detected in 56 (33.3%) and splenomegaly in 49 patients (29.2%). Plasmodium vivax was present in 132 patients, Plasmodium falciparum in 29, and mixed P. vivax and P. falciparum in 7 patients. Parasitemia ranged from 0.1% to 8.0%. Of the vivax cases, 130 were treated with chloroquine, followed by primaquine in 123 patients. Quinine was given to 36 patients (29 falciparum malaria and 7 mixed infections). Median time to fever defervescence was 2 days. Complications occurred in three patients (2 with shock and 1 with pulmonary edema). According to World Health Organization gravity criteria, body temperature over 40 degrees C was detected in six patients, bilirubinemia higher than 50 mmol/L in nine, parasitemia over 5% in five, glycemia less than 2.2 mmol/L in two patients. There were five relapses. No death was recorded. CONCLUSION: Plasmodium vivax is the most common cause of imported malaria, with the majority acquired from the Indian subcontinent. Only a few patients presented with severe malaria.

Adolescent↗