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PubMed1992

Diagnostic value of the Widal test for typhoid fever in Singapore.

A study was conducted to assess the diagnostic value of the Widal test in patients with bacteraemic typhoid fever. The Widal test was carried out on 25 bacteriologically proven cases of typhoid fever and 50 patients with non-typhoid fever. All the patients with non-typhoid fever had an O agglutinin titre of less than 1:40, while 82% had an H agglutinin titre of less than 1:40. In the patients with typhoid fever, 56% had an O agglutinin titre of greater than or equal to 1:40 and 72% had an H agglutinin titre of greater than or equal to 1:40. Typhoid patients with titres greater than or equal to 1:40 for O and H antigens of Salmonella typhi were significantly different (P less than 0.01) from those with non-typhoid fever. The O agglutinin was highly specific (100%) in the diagnosis of the disease. The study shows that a single Widal test is useful in the diagnosis of typhoid fever in Singapore.

Adolescent↗
PubMed2004

Type 2 diabetes in Singapore: the role of exercise training for its prevention and management.

The prevalence of type 2 diabetes has been increasing in Singapore and is a major risk factor for cardiovascular disease. Exercise training is an important therapeutic modality for managing glycaemic control and improving cardiovascular health among persons with type 2 diabetes. It may also help to prevent or delay the onset of this harmful condition. This review examines the evidence and possible mechanisms by which exercise training produces these benefits, and gives a brief review of appropriate exercise activities.

Diabetes Mellitus, Type 2↗
PubMed2004

Familial risk of allergic rhinitis and atopic dermatitis among Chinese families in Singapore.

INTRODUCTION: This study aims to determine the familial risk of atopic dermatitis (AD) and allergic rhinitis (AR) in Chinese children. MATERIALS AND METHODS: A cross-sectional study was conducted in a housing estate in Singapore. Data was collected using an interviewer-administered questionnaire. Participants included 257 Chinese families. Prevalence rate ratios (PRRs) and 95% confidence interval (CI) were calculated. RESULTS: For AD in all children, an increasing trend was found with PRRs of 1.9 (95% CI, 0.3 to 11.8) and 1.5 (95% CI, 0.4 to 5.5) for only father and only mother affected, respectively, to 2.3 (95% CI, 0.4 to 13.7) for both parents affected. In AR, a PRR of 2.7 (95% CI, 1.8 to 3.9) and 2.2 (95% CI, 1.5 to 3.2) for only father and only mother affected, respectively, and 4.5 (95% CI, 3.3 to 6.1) for both affected was found. The PRR (2.2; 95% CI, 1.4 to 3.7) of the first child developing AR when paternal or maternal history was positive was similar. This rose to 3.4 (95% CI, 2.2 to 5.1) when both parents also had AR. The PRR of the second child developing AR was 3.9 (95% CI, 1.7 to 8.9) when the first child alone was positive for AR and 7.0 (95% CI, 3.5 to 13.9) when both parents and the eldest child had AR. CONCLUSION: A positive family history increases the risk of developing AD and AR with increasing risk dependent on number of relatives affected. The second child's risk of AR is also associated with AR in the first child, suggesting mechanisms of incomplete penetrance.

China↗
PubMed2004

Ethnic differences among Chinese, Malay and Indian patients with type 2 diabetes mellitus in Singapore.

INTRODUCTION: Ethnic differences exist in patients with diabetes mellitus. Not much is known about such differences in Asian populations. The aim of the study was to determine ethnic differences among Chinese, Malay and Indian patients with type 2 diabetes mellitus in Singapore. METHODS: The study design was cross-sectional, involving 967 patients who were attending follow-up care for type 2 diabetes mellitus at a primary care clinic. Data collection was by patient interview, examination, and from case records. Blood and urine samples were collected for analysis of indicators of diabetic control and albuminuria. RESULTS: Malays had the highest mean body mass index (BMI) after controlling for age, gender, duration of diabetes and exercise status. Adjusted mean BMI for Malays was 27.4kg per square metres, Indians 25.7kg per square metres, Chinese 24.9kg per square metres, with the p value being less than 0.01. HbA1c levels were highest among Indians after controlling for age, duration of diabetes, body mass index and treatment. Adjusted mean HbA1c for Indians was 8.3 percent, Malays 8.0 percent, and Chinese 7.7 percent, with the p value being less than 0.01. Compared with Chinese, Indians were more likely to have a positive family history of diabetes (prevalence rate ratio (PRR) of 1.3, 95 percent confidence interval (CI) of 1.0 to 1.7), but were less likely to have associated hypertension (PRR of 0.7, 95 percent CI of 0.5 to 1.0) and microalbuminuria and macroalbuminuria (PRR of 0.6, 95 percent CI of 0.4 to 1.0). CONCLUSION: Ethnic differences exist with regard to BMI, diabetic control as reflected by HbA1c levels, family history of diabetes, presence of associated hypertension, and severity of albuminuria. Indians, while having poorer control of diabetes, are less prone to hypertension and renal complications than Chinese.

Aged↗
PubMed2004

Genital herpes in a sexually-transmitted infection clinic in Singapore: a 1-year retrospective study.

INTRODUCTION: This study describes the clinical features of genital herpes seen in a sexually-transmitted infection (STI) clinic in Singapore and the characteristics of the affected population. The distribution of herpes simplex virus (HSV) subtypes within the population, correlation of HSV culture result with duration of disease and prescribing habits of doctors were also examined. MATERIALS AND METHODS: This is a retrospective study of cases of genital herpes seen at the Department of Sexually-transmitted Disease Control (DSC) clinic over a 1-year period. All records of clinically diagnosed HSV genital infections at the DSC clinic in 2001 were retrieved and reviewed and the data collated. RESULTS: There were 324 cases of genital herpes, of which 153 (47.2%) were first-episode and 171 (52.8%) were recurrent HSV infections. There were 259 males and 65 females; their mean age was 35.2 years (range, 17 to 75 years). Of the 241 cases with positive culture results, 28 (11.6%) tested positive for herpes simplex virus type 1 (HSV-1) and 213 (88.4%) were positive for herpes simplex virus type 2 (HSV-2). HSV-1 accounted for 19.3% of first-episode and 4.7% of recurrent infections. HSV-2 accounted for 80.7% of first-episode and 95.3% of recurrent infections. Cultures taken from lesions < or = 4 days, between 5 and 7 days and > 7 days of onset were positive in 79.2%, 75.7% and 75% of cases, respectively. Oral acyclovir was prescribed more commonly in females (53.8%) than in males (21.6%). CONCLUSION: Genital herpes is a common STI seen at the DSC clinic. HSV-2 is the most common cause of genital herpes and accounts for most of the recurrent cases seen.

Acyclovir↗
PubMed2004

Work-related injury sustained by foreign workers in Singapore.

INTRODUCTION: Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED). MATERIALS AND METHODS: Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. RESULTS: There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P < 0.0001) than the mean age 37.8 years (SD 14) of local workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of foreign workers, more (P < 0.0001) common than 4.3% of local workers, resulting in 2 out of 3 foreign workers death. Though the pattern of injuries was similar between foreign and local workers, foreign workers needed longer (P = 0.03) sick leave and more (P = 0.01) foreign workers were hospitalised, giving a ratio of 2 foreign workers for every 1 local worker hospitalised. CONCLUSION: Foreign workers had no difficulty accessing ED and hospital care for work-related injuries. The pattern and severity of injuries were similar between foreign and local workers but more foreign workers were hospitalised.

Accidents, Occupational↗
PubMed2004

Treatment of latent TB infection for close contacts as a complementary TB control strategy in Singapore.

OBJECTIVE: To describe our initial experience with treatment of latent tuberculosis infection (LTBI) for close contacts of infectious TB cases in Singapore, an intermediate TB burden country with mass BCG (re)vaccination since the 1950s. METHODS: Screening of 5699 contacts of 1374 index cases notified in 1998 was carried out at the TB Control Unit. RESULTS: Seventy-five per cent (4239) completed tuberculin skin testing (TST). Fifty-three cases of TB disease were detected (0.9% yield). Twenty-one per cent (895/4239) of the TST-screened contacts were started on LTBI treatment, comprising 92% (810/883) of contacts with TST > or = 15 mm, 5% (64/1195) of those with TST 10-14 mm and 1% (21/2161) of those with TST < 10 mm. The regimen utilized was isoniazid for 6 months in adults and 9 months in children. Eighty-one per cent completed treatment. The incidence of isoniazid-induced hepatitis was 0.45%. Over the ensuing 4 years, one case of active TB was reported among those treated for LTBI, and 10 cases (five without TST readings) were notified among contacts who did not receive treatment. CONCLUSIONS: Where good case-finding and treatment of TB disease exist, and where resources permit, LTBI treatment for close contacts is feasible as a complementary TB control strategy in an intermediate TB burden country with a BCG-vaccinated population.

Adjuvants, Immunologic↗
PubMed2004

The pivotal role of the pathology laboratory in the context of a Singapore cervical cancer screening programme.

Singapore is poised to implement a national cervical screening programme and pathology laboratories have a pivotal role to play. This review describes the laboratory examination of Pap smears and the importance of providing a first class service. This will require sufficient experienced cyto-technologists and pathologists. There also needs to be a mechanism in place to monitor all stages of the Pap smear, from the time it is taken until it is reported. The Bethesda System for reporting Pap smears, new smear collection devices, liquid-based specimens, use of computer screening and other measures to enhance laboratory standards, are also discussed.

Female↗
PubMed2004

Pattern of injuries in helmeted motorcyclists in Singapore.

BACKGROUND: Singapore has a mandatory helmet law for motorcyclists. This study aimed to determine the injuries sustained by helmeted motorcyclists presenting to the emergency Department (ED). METHODS: Adult victims of motor vehicular incidents (MVI) who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. RESULTS: Motorcyclists formed 49.1% (1018) of all MVI victims, of whom 96.1% were men. The mean age was 32.5 years (SD 13.1), significantly younger (p<0.0001) than the mean age of 36.4 years (SD 16.4) among other MVI victims. The proportions of motorcyclists and other MVI patients admitted to the hospital were not different. Among those admitted, significantly fewer (p = 0.001) motorcyclists (32.2%) sustained head injury compared with other MVI victims (46.8%) but among the motorcyclists with head injury, more than one third (34.2%) had severe head injury. The proportion of patients with thoracic injury was not different (p = 0.93) between motorcyclists (10.2%) and other MVI victims (9.9%). However, among those with thoracic injury, 79.2% of motorcyclists had severe thoracic injury, significantly more (p = 0.04) than 50% of other MVI patients. Wounds, fractures, and/or dislocations of the limbs (p<0.001) were significantly more among motorcyclists compared with other MVI patients. CONCLUSION: Compared with other MVI victims, fewer helmeted motorcyclists sustained head injury. When head injury occurs in helmeted motorcyclists, it tends to be more severe. Motorcyclists remain vulnerable to extremity injury and to severe chest injury.

Accidents, Traffic↗
PubMed2003

Informed consent in clinical research: policies and practices in Singapore.

The policies and practices for obtaining informed consent from research subjects in clinical research play a vital role in determining a nation's success as a center for clinical research. The difficulty lies in the fact that while on the one hand, informed consent is a necessary pre-condition for ethical clinical research, a scrupulous observance of the guidelines for informed consent could, on the other hand, cripple medical research. Crippling of ethical medical research can be adverse to public interest, and consequently, unethical. Hence, a fine balance must be struck in the application of the guidelines for obtaining informed consent. This, in turn, would depend on the constitution and skill of research ethics committees who are appointed to consider and approve clinical research proposals. The discussion below addresses the above difficulty with recommendations that could further enhance Singapore's image as a regional clinical trial hub.

Clinical Trials as Topic↗
PubMed2004

Coronary artery ectasia: a ten-year experience in a tertiary hospital in Singapore.

INTRODUCTION: Coronary artery ectasia (CAE) is a well-recognised, albeit rare, angiographic finding of abnormal coronary dilatation. To our best knowledge, its incidence has never been described in Singapore. We aimed to determine the incidence of CAE at our teaching hospital and to describe patient and angiographic characteristics. MATERIALS AND METHODS: Cases were identified through a search of our hospital's computer database and all records were reviewed. RESULTS: Over the 10-year study period (1992-2001), 8641 patients underwent coronary angiography. CAE was diagnosed in 104 patients, giving an incidence of 1.2%. The majority (74%) were male. The median age was 54 years (range, 25 to 79 years). Sixty-six per cent of patients were Chinese, 19% Malays, 12% Indians and 3% other races. Concomitant diabetes mellitus was present in 31%, hypertension in 58% and dyslipidaemia in 63% of patients. Co-existent obstructive coronary artery disease was present in 82% of cases. The frequency of arterial involvement was: right coronary artery (RCA), 65%; left anterior descending artery (LAD), 48%; circumflex artery (CX), 43%; and left main artery (LM), 2%. CAE affected only 1 major vessel in 62% of cases and all 3 vessels in 20%. Eighteen patients were advised to undergo bypass surgery, while percutaneous coronary intervention was recommended in 26 patients. CONCLUSIONS: The incidence of ectasia was 1.2%. The majority of patients were males in their sixth decade with underlying dyslipidaemia or hypertension. CAE was associated with obstructive coronary artery disease in more than 80% of cases. The RCA was most commonly affected and most patients had single vessel involvement.

Adult↗
PubMed2004

Nuclear cardiology in Singapore: a review.

Since its introduction in Singapore more than 10 years ago, nuclear cardiology has now become an integral part of comprehensive cardiac workup of patients with a variety of cardiac diseases. We trace its local development from the 1980s to its present-day role in cardiac evaluation, and into the potential future of genetic and molecular cardiology.

Cardiology↗
PubMed2004

Public attitudes to emergency medical services in Singapore: EMS day 2002.

INTRODUCTION: In the year 2002, the Society for Emergency Medicine in Singapore Chapter of Paramedics organised the first emergency medical services (EMS) day, to educate the public about basic emergency response skills and to increase public awareness of the local EMS System. METHODS: This was an observational, cross-sectional study. A survey was conducted to find out about the knowledge and attitudes of the public and paramedic volunteer instructors towards the local EMS System. RESULTS: Two hundred and six (81.4 percent) out of 253 members of the public and 70 paramedics (100 percent) responded. For the public, the majority were females (86 percent), mean age (standard deviation [sd]) was 15.9 (7.9) years, range 11.0 to 67.0 years. For the paramedics, mean (sd) age was 26.6 (3.8) years. 61.9 percent were females. The public showed good knowledge of the emergency ambulance number and the indications for calling an ambulance. Public expectations of ambulance response times were significantly shorter than paramedics. They were also less comfortable with ambulance crews performing advanced life support interventions compared with the paramedics. CONCLUSION: Continuing efforts should be made to increase public awareness of the EMS system as well as to manage public expectations regarding response times and the roles of paramedics. EMS day represents one such opportunity.

Adolescent↗
PubMed1992

The effect of prenatal diagnosis on the incidence of Down syndrome livebirths in the Singapore General Hospital.

During a 3-year-period between January 1988 and December 1990, there were 12 Down Syndrome (DS) livebirths out of 13,794 livebirths at the Department of Obstetrics and Gynaecology, Singapore General Hospital, giving an incidence of 1 in 1,150 livebirths or 0.87 per thousand. There were 1569 mothers who were 35 years or older at the expected date of delivery (EDD) and 5 of these 12 DS livebirths were from these older mothers. Although only 11.5% of all mothers were 35 years or more, as a group, these older mothers contributed to 42% of the DS livebirths. There were 5 DS fetuses diagnosed prenatally and 4 were aborted electively. The fifth DS fetus which was diagnosed prenatally was allowed to continue to term because of the mother's religious objection to an induced abortion. The failure to offer prenatal diagnosis and selective procreation to all mothers 35 years or older had resulted in 4 unnecessary DS births, reducing our DS detection rate by a factor of 33%. All these 4 cases were booked late for antenatal care.

Adult↗
PubMed2004

Cost-effectiveness analysis of colorectal cancer screening strategies in Singapore: a dynamic decision analytic approach.

A dynamic decision analytic framework using local statistics and expert's opinions is put to study the cost-effectiveness of colorectal cancer screening strategies in Singapore. It is demonstrated that any of the screening strategies, if implemented, would increase the life expectancy of the population of 50 to 70 years old. The model also determined the normal life expectancy of this population to be 76.32 years. Overall, Guaiac Fecal Occult Blood Test (FOBT) is most cost effective at SGD162.11 per life year saved per person. Our approach allowed us to model problem parameters that change over time and study the utility measures like cost and life expectancy for specific age within the range of 50- 69 through to 70 years old.

Aged↗
PubMed2004

Initial experience of macular translocation in Singapore - one-year results.

INTRODUCTION: This paper reports the 1-year results of the first 2 cases of macular translocation in Singapore. CLINICAL PICTURE: A 66-year-old female and a 45-year-old male Chinese presented with subfoveal choroidal neovascularisation (CNV) in their right eyes. The woman's condition was secondary to pathological myopia while the man's was idiopathic. Their preoperative best-corrected visual acuities were 6/15-2 and 6/30, respectively. TREATMENT: Both patients underwent macular translocation with punctate retinotomies and chorioscleral infolding (limited macular translocation) in their affected eye. OUTCOME: Both patients achieved effective macular translocation postoperatively. Their CNVs became extrafoveal and were ablated with conventional laser photocoagulation in the early postoperative period. They did not recur and their visual acuities improved to 6/9-1 and 6/12 at 1 year postoperatively, respectively. CONCLUSION: Macular translocation is a new treatment modality that offers patients with subfoveal CNV a chance of improving their vision, potentially to a level that may allow reading and driving.

Aged↗
PubMed2004

Case reports of two biopsy-proven patients with Creutzfeldt-Jakob disease in Singapore.

INTRODUCTION: Creutzfeldt-Jakob disease (CJD) is the most common transmissible human subacute spongiform encephalopathy. There is limited literature on CJD in Southeast Asia. We describe the clinical course and diagnostic evaluation of 2 Singapore patients with biopsy-proven CJD. CLINICAL PICTURE: Two patients presented with non-specific symptoms such as withdrawal, forgetfulness, asthenia, giddiness and insomnia. Both patients had spontaneous myoclonic jerks and impairment of multiple neurologic systems (visual, pyramidal, cerebellar and neurocognitive systems). Magnetic resonance imaging and electroencephalography provided helpful supportive evidence. Diagnosis of CJD was established on brain biopsy. Histological features included spongioform degeneration, neuronal cell loss and astrocytosis. TREATMENT/OUTCOME: Treatment remains palliative. Deterioration in their clinical condition was relentless, progressing to a totally dependent state within 10 to 12 months. CONCLUSION: The early features of CJD can be varied and non-specific. It is important for physicians from different specialties to be cognisant of the clinical manifestations of CJD and the appearance of supportive and definitive investigations.

Biopsy, Needle↗
PubMed2004

Clinical management of osteoporosis in Singapore.

Osteoporosis is as common in Singapore as it is in Western countries and the incidence of hip fractures has risen five times among women in the last 30 years. Current treatment involves appropriate use of bone mineral density measurements and many medications are now available which can substantially reduce the risk of fractures. Increasing awareness of osteoporosis in the general population and keeping doctors updated about the latest trends in management are extremely important.

Bone Density↗