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PubMed1992

A one-year study of enteric Campylobacter infections in Singapore.

A total of 7344 inpatients with diarrhoea were investigated for Campylobacter infections in Singapore over one year. Campylobacter species were recovered from 1.2% of diarrhoeal stools; 70.3% of the 91 campylobacters were from children under 5 years of age. Further identification of these isolates showed that 89% were Campylobacter jejuni and 10.9% were C. coli, and a high level of resistance to erythromycin was observed among them. Concomitant isolation of Salmonella species or Shigella species was achieved in eight of the Campylobacter-infected patients. Campylobacter enteritis occurred throughout the year, with the highest isolation rate being recorded in September.

Campylobacter↗
PubMed2005

A new single nucleotide polymorphism in the insulin-like growth factor I regulatory region associates with colorectal cancer risk in singapore chinese.

Elevated levels of plasma insulin-like growth factor I (IGF-I) are a potential risk factor for several cancers, including colorectal cancer. Physiologic levels of plasma IGF-I vary greatly; this variation may be in part genetically determined. We identified two single nucleotide polymorphisms (SNP) in perfect linkage disequilibrium with each other and in partial linkage disequilibrium with a previously studied cytosine-adenine microsatellite [-969(CA)(n)]. We investigated one of the SNPs, -533T/C,and the 969(CA)(n) in relation to the risk of colorectal cancer in a case-control study nested within a cohort of Singapore Chinese (cases/controls = 290:873). The (CA)(21) allele, rather than the previously implicated (CA)(19) allele, was associated with a reduced risk of colorectal cancer (odds ratio for 21/21 versus all other genotypes, 0.48; 95% confidence interval, 0.28-0.84). For the -533C/T SNP, persons carrying one or more copies of the C allele had a decreased in risk of colorectal cancer compared with noncarriers (odds ratio for CC/CT versus TT, 0.58; 95% confidence interval, 0.41-0.82). This association was specific for colon, as opposed to rectal cancer and was modified by age. We also examined a functional insulin-like growth factor binding protein (IGFBP3) promoter SNP, -202 A/C, previously reported to predict serum IGFBP3 levels. Although we were able to confirm this genotype-phenotype association, the -202A/C IGFBP3 SNP was not significantly associated with colorectal cancer risk. In conclusion, we report a novel SNP in the IGF-I regulatory region that is associated with colorectal cancer risk.

Alleles↗
PubMed2005

Uterine artery embolisation for symptomatic fibroids in a tertiary hospital in Singapore.

INTRODUCTION: Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic uterine enlargement due to fibroids has been performed in several overseas centres with promising results. We report our experience with UAE in Singapore General Hospital. MATERIALS AND METHODS: Twenty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via a patient-controlled analgesia pump. The patients were followed up at regular intervals clinically and with transabdominal ultrasonography. RESULTS: Transcatheter UAE was performed on all patients with no major complications. Nineteen patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery. The mean hospital stay was 3.5 days (range, 2 to 9). At a mean follow-up of 56 weeks (range, 6 to 168), all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on ultrasonography. The median size of the uterine volume decreased from 308 to 187 mL while the median diameter of the largest fibroid reduced from 6.2 to 4.6 cm. The median haemoglobin level increased to 12.7 g/dL from the pre-procedural median of 9.9 g/dL. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) at 6 months post-embolisation. She underwent a repeat procedure with complete resolution of symptoms. A second patient had recurrence of symptoms at 12 months, but was subsequently lost to follow-up. CONCLUSION: Mid-term results of UAE for the treatment of symptomatic fibroids in our hospital indicate this to be a safe and effective therapeutic option.

Adult↗
PubMed2005

Measurable predictive factors for progression to AIDS among HIV-infected patients in Singapore.

INTRODUCTION: This study identifies measurable factors at the time of diagnosis that predict the progression to Acquired Immunodeficiency Syndrome (AIDS) among Human Immunodeficiency Virus (HIV)-infected patients in Singapore. MATERIALS AND METHODS: We carried out a retrospective study of 790 HIV-infected patients from 16 May 1985 to 31 December 2001. The end-point was the onset of AIDS-defining illness listed in the 1987 and 1991 revised Centers for Disease Control and Prevention criteria, but excluded CD4 cell counts as a criterion. Using the Kaplan-Meier method, AIDS-free survival curves were plotted for age groups at diagnosis, baseline CD4 counts and periods for utilisation of antiretroviral treatment. A Cox regression model was constructed to determine independent predictors of disease progression. RESULTS: Univariate analysis showed that patients of older age at diagnosis had a significantly higher risk of progression compared to younger patients, and patients with higher baseline CD4 cell counts had a lower risk of progression to AIDS. Adjusting for the simultaneous influence of several covariates on the rate of HIV progression to AIDS, multivariate analysis using the Cox model showed a significantly higher risk of progression for older patients at diagnosis, and the progressive lowering of risk with increasing baseline CD4 cell counts. CONCLUSIONS: This study found older age at diagnosis and baseline CD4 cell counts to be measurable predictors for HIV progression to AIDS at time of diagnosis. Identification of these risk factors enables physicians to provide counselling and advice, and to start appropriate treatment early. This could lower the risk of progression and improve survival.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Narcolepsy in Singapore: is it an elusive disease?

INTRODUCTION: The aims of the study were to determine the demographic, clinical, and polysomnographic characteristics of narcolepsy, and to address the difficulties in diagnosing narcolepsy and cataplexy, which is a cardinal symptom. We also ventured to investigate the differences between narcolepsy with and without cataplexy. MATERIALS AND METHODS: Data were collected retrospectively from patients diagnosed with narcolepsy at the Sleep Disorder Unit of Singapore General Hospital over 5 years. Each patient had had a detailed clinical evaluation and overnight polysomnography (PSG) followed by a multiple sleep latency test (MSLT). RESULTS: A total of 28 cases were studied. Males made up 85.7% of the total and females, 14.3%. The mean age was 30.9 years. All had excessive daytime sleepiness. Other manifestations were cataplexy (48.1%), sleep paralysis (51.9%), hypnogogic hallucinations (84%), disturbed night sleep (29.2%), automatisms (17.4%) and catnaps (95.8%). The mean duration of symptoms was 7.24 years. In the MSLT, the mean values for mean sleep latency and number of sleep onset rapid eye movement (REM) periods (SOREMP) were 4.3 minutes and 2.7, respectively. Narcolepsy was associated with obstructive sleep apnoea and periodic limb movement disorder (35.7%). All the variables were compared between those who had narcolepsy with cataplexy and without cataplexy. The duration of presenting complaint, REM latency, respiratory disturbance index, number of SOREMPs and the presence of sleep paralysis were significantly different in the 2 groups. CONCLUSIONS: Narcolepsy predominantly affects young males. Concurrence of other sleep disorders is not uncommon. Some differences are evident between those who have narcolepsy with and without cataplexy.

Adolescent↗
PubMed2005

Use of physical restraints in nursing homes: current practice in Singapore.

INTRODUCTION: One of the indicators of quality care in nursing homes is the proper use of physical restraints. Restraints have been associated with multiple complications, such as pressure ulcers, incontinence and immobility. The aim of our study was to assess the indication, use and complications related to physical restraints in Singapore nursing homes. MATERIALS AND METHODS: All residents aged >65 years old from 3 nursing homes were included in the study. A geriatrician reviewed the medical records of all elderly residents on restraints. Nursing staff interviews were also done to assess their knowledge regarding restraint use. A brief medical record review was also done for the elderly residents without restraints. RESULTS: Out of 390 elderly residents, 91 were on physical restraints. The mean age of these residents were 80.1 years; 67% were female, 90.1% were Chinese and 82.4% belonged to functional category IV. Both urinary and faecal incontinence were observed in 97.8% of residents. Forty-six (50.5%) residents had no documented indication for restraints. It was noted that 20 (22%) residents were restrained to prevent dislodgement of the feeding tube, 17 (18.7%) were restrained to prevent falls and 8 (8.8%) were restrained for agitation. There were documented trials of removal of restraints for only 21 (23.1%) residents. Alternative approaches, such as diversion technique, were used for 31 (34.1%) residents to avoid restraint use. CONCLUSION: Our study revealed a high rate of restraint use in the nursing homes. A restraint protocol should be available in every nursing home, requiring physician approval for the long-term application of physical restraints and intermittent reviews by physicians to assess the continued need for restraints.

Aged↗
PubMed2005

Investigation of class characteristics in English handwriting of the three main racial groups: Chinese, Malay and Indian in Singapore.

This paper investigated the class characteristics in English handwriting of the Chinese, Malays and Indians in Singapore, many of whom learned their native language as a second language. One hundred and fifty-four handwriting exemplars were collected and features such as letter designs, pen-lifts, letter spacing and embellishments were studied. A number of characteristic features peculiar to the individual racial group were identified, which confirmed the impact of their native language writing systems on English handwriting.

Adolescent↗
PubMed2005

Treatment of benign giant cell tumours of bone in Singapore.

INTRODUCTION: Giant cell tumour (GCT) is a distinct neoplasm of undifferentiated cells. The exact cell of origin is unknown. The multinucleated giant cells present are formed from the fusion of mononuclear cells. Giant cell tumour is more common in Southeast Asia than in the West. The incidence is about 20% compared to 4% to 5% in the West. MATERIALS AND METHODS: Sixteen patients with giant cell tumour were treated in the Singapore General Hospital from 1993 to 2001. The average follow-up period was 64.4 months, with a range of 30 to 132 months. The average age of the patients was 33 years. The tumours were divided into 3 groups. The first group had meticulous curettage and high-speed burring followed by methylmethacrylate cementation. The second group had treatment similar to the first but in addition had an adjuvant treatment with liquid nitrogen, hydrogen peroxide or phenol before cementation of the cavity. The third group had wide resection done. There were 9 in the first group, 5 in the second group and 2 in the third group. The tumours were graded radiologically after the method of Campanacci et al. All patients were followed up clinically and radiologically. Of the 5 in the second treatment group, 1 had phenol irrigation, 2 had cryotherapy and 2 had hydrogen peroxide irrigation intraoperatively. RESULTS: There was a total of 5 recurrences (31%). The 2-year recurrence-free survivorship was 75%. The mean recurrence period was 21 months. There were no complications like fracture, infection or thermal injury to the skin. There was no pulmonary metastasis or mortality. The first group, who had curettage, high-speed burr and cementation, had 44% (4 out of 9) recurrence; the second group, who had treatment like the first with additional adjuvant therapy, had no recurrence; and the third, who had wide resection, had 50% (1 out of 2) recurrence. All the recurrences had a Campanacci grade II or III tumour. There were no recurrences in the group that was treated with curettage, high-speed burr, adjuvant treatment and cementation. CONCLUSION: Currettage, high-speed burring with added phenol/liquid nitrogen treatment and cementation is a useful and safe method in the treatment of giant cell tumours. The advantages include a low recurrence rate, as well as immediate stabilisation allowing early mobilisation. Patients who have Campanacci grade I tumours have the highest chance of being disease-free after the first operation.

Adult↗
PubMed2005

Acceptance of prophylactic surgery and chemoprevention of cancer in Singapore - a survey.

INTRODUCTION: In addition to surveillance practices, chemoprevention and prophylactic surgery can reduce the risk of cancer in individuals at high risk. Sociocultural factors may have a role to play in such decision making. Little is known regarding the factors that play a role in decision making in Singapore. MATERIALS AND METHODS: One hundred and two individuals at normal risk completed a questionnaire on the concept of chemoprevention and prophylactic surgery. The results were analysed using the convenience sampling method. RESULTS: Participants were mostly Chinese (94.1%). More than 90% of the respondents answered the section on prophylactic surgery and chemoprevention. Thirty-eight individuals (41.3%) would not consider prophylactic surgery, while 42 (45.7%) would not consider prophylactic surgery now but might consider it in the future. Twenty-five individuals (26.9%) would not consider chemoprevention by taking a medication, 57% would not consider it now but might in the future. CONCLUSION: A cross-sectional public view suggests that medical prophylaxis is likely to be more acceptable to the general public compared to surgical prophylaxis.

Adolescent↗
PubMed2003

Mass newborn screening in Singapore.

Births in Singapore are almost exclusively in hospitals and this is conducive to mass newborn screening. Mass newborn screeningbegan in 1965 for G6PD deficiency and has led to successful eradication of the complicating kernicterus. Screening has also identified the distinct ethnic and sex linked variations in incidence. The predominant molecular abnormality is the Canton variant. Congenital hypothyroidism screening was started as a pilot project in 1981, then became institution-based in 1985 and nationwide in 1990. The screening is carried out on the cord blood and is now a primary TSH screen. Anincidence of about 1 in 3000 is being obtained and treatment has been started within 2 weeks of birth in almost all babies. A pilot Newborn Screening for hearing impairment started in 1999. Ituses the measurement of Transient Evoked Oto-Acoustic Emissions, is hospital based andcovers about 10% of the newborn population. The program has identified hearing impairment requiring intervention at a rate of about 1:1000 births. A program covering about 50% of the national births has been commissioned by the Ministry of Health to establish epidemiologic data and to document the outcome of early intervention. Mass newborn screening for inborn errors of metabolism is being considered.

Congenital Hypothyroidism↗
PubMed1992

Attitudes to AIDS and sexual behaviour among a cohort of medical students in Singapore.

A survey conducted in 1990 among final year medical students found that most respondents had a good knowledge about AIDS and its routes of transmission. Among the 13.7% of respondents that were sexually active, it was noted that only 35% had used the condom before and that only 20% had used it in the most recent occasion of sexual intercourse. It was noted that only 30% of the sexually active had intention using the condom when they next have sexual intercourse despite the fact that 40% of them were having sexual intercourse with causal partners. Despite having a high knowledge of AIDS, medical students at the National University of Singapore have a low use of condoms.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Comparison of the immune response of four different dosages of a yeast-recombinant hepatitis B vaccine in Singapore children: a four-year follow-up study.

The immunogenicity of four different dosages of yeast-derived hepatitis B vaccine (Merck, Sharp & Dohme: 0.6 micrograms, 1.25 micrograms, 2.5 micrograms and 5.0 micrograms), administered at 0, 1 and 6 months (0-1-6 schedule) intramuscularly, was evaluated in 122 seronegative healthy children 1-12 years of age. Three months after the first dose, 83.9-100% of the vaccinees seroconverted. Peak geometric mean titres (GMT) of between 1088 mlU/ml and 1699 mlU/ml were attained 3 months after completion of the vaccination schedule. After 24 months, anti-HBs (antibody to hepatitis B surface antigen) was detected in 93.1-100% of the vaccinees, but the GMT dropped to between 214.3 mlU/ml and 303.5 mlU/ml. After 48 months, 88.8-100% of the vaccinees continued to possess anti-HBs and 70.3-87% had titres above 10 mlU/ml. As expected, the GMT declined further to between 72.6 mlU/ml and 118.8 mlU/ml. There were no significant differences in seroconversion rates and GMT among the different dosage groups. All the vaccinees remained asymptomatic and free from hepatitis B virus infection. The study showed that reduced dosages of the vaccine (0.6 micrograms, 1.25 micrograms and 2.5 micrograms) were as immunogenic as the standard dose (5 micrograms); the 2.5-micrograms dose was recommended for the national childhood immunization programme in Singapore. No booster is necessary for at least four years after vaccination.

Antibody Formation↗
PubMed2005

Benjamin Henry Sheares, MD, MS, FRCOG: President, Republic of Singapore 1971-1981; Obstetrician and Gynaecologist 1931-1981. A Biography, 12th August 1907-12th May 1981.

From humble origins Benjamin H Sheares with self-discipline and a commitment to excel became an eminent obstetrician and gynaecologist. Beginning in 1942 under difficult conditions he pioneered many improvements in the management of obstetrical and gynaecological patients, and also improved the services and facilities at Kandang Kerbau Hospital so that maternal and neonatal mortality and morbidity were markedly reduced. In January 1951 he became the first Singaporean to be appointed Professor of Obstetrics and Gynaecology in the university, and achieved reknown in his service to patients, the teaching of undergraduates and postgraduates, and in clinical research. His surgical treatment of vaginal agenesis was acknowledged internationally. He was elected President of the Republic of Singapore on 30th December 1970 by Parliament and during his three terms spanning one decade he discharged his duties with thoroughness, distinction, tolerance and a quiet dignity. When he died on 12th May 1981 85,000 people, identifying with his humble origins and his achievements through self-reliance and meritocracy, paid their last respects to him. He had set an example on how to live and depart this life.

Education, Medical↗
PubMed2005

The Singapore years and subsequently.

Tun Dr Mahathir Mohamad was a medical student at the King Edward VII College of Medicine from 1947 to 1953. He described his student days with fondness; he made many friends while he was at the College. He recounted his early days as a doctor before he entered politics in 1964. He became the fourth and longest serving Prime Minister of Malaysia for 22 years from 1981 to 2003. He concluded "The contribution of my Medical College days in Singapore to the racial harmony, peace and prosperity of Malaysia is tangible but unquantifiable."

Education, Medical, Undergraduate↗
PubMed2005

One hundred years of physiology education in Singapore.

Physiology is the study of normal function in the body and how genes, proteins, organ systems interact to maintain health. It provides a foundation for the health sciences profession and life science research. Physiology education in Singapore began soon after the establishment of the Federated States Government Medical School in 1905. The importance of Physiology to medical education was recognised by the appointment of a separate lecturer in Physiology in 1906, followed by the appointment of Professor James Argyll Campbell as the first King Edward VII professor and endowed Chair in Physiology in 1912. The teaching of Physiology in the early days was focused on the basics of normal function with little correlation to clinical problems and application. However, by the 1970s, first-year medical students were given the opportunity to visit hospitals where they were tutored by clinicians to help them apply Basic Physiology to clinical problems. Curriculum changes in the subsequent years emphasised a reduction in content, integration among preclinical subjects, independent learning and clinical relevance. Physiology is taught not only to medical but also dental, pharmacy and life science students. The teaching of Physiology to science students is a collaborative effort between the Department of Physiology, Faculty of Medicine and the Department of Biological Sciences, Faculty of Science. A lot of the teaching of Physiology to life science students occurs not in classrooms but in the laboratories, where students work closely with research supervisors and mentors on research projects. There has been a very significant increase in the number of students doing research projects in Physiology in recent years, especially in the areas of Cell Physiology, Immunology and Neurobiology. The completion of the human genome sequence poses new challenges to understand function, especially how genes, proteins and organ systems interact to sustain function. Physiology education will be increasingly important in the undergraduate and graduate life science and medical curriculum. Further, the country's vision of being the biomedical R&D and healthcare hub for the region means that Physiology education must remain at the forefront to prepare the next generation of doctors, clinician-scientists, researchers and entrepreneurs.

Education, Medical, Undergraduate↗
PubMed2005

The teaching of anaesthesia in Singapore.

This article describes the development of undergraduate and postgraduate anaesthesia teaching and training in Singapore. Anaesthesia teaching has evolved from art and apprenticeship to become systematic, scientific and evidence-based, while retaining an emphasis on hands-on practical training. Simulator training provides unique advantages, which the University Department of Anaesthesia has utilised in integrated medical student teaching.

Anesthesiology↗
PubMed2005

Latex sensitisation in healthcare workers in Singapore.

INTRODUCTION: Epidemiological data on latex sensitisation among Asian healthcare workers is lacking. The aim of the study is to determine the rate of latex sensitisation in our healthcare workers. MATERIALS AND METHODS: We recruited 313 healthcare workers, of which 46.6% were operating theatre staff and 53.4% were non-operating theatre staff. Seventy-one administrative staff served as controls. All participants answered a self-administered questionnaire relating to latex exposure and glove-related symptoms. Latex sensitisation was determined by skin prick testing to latex and latex-specific IgE detection. RESULTS: The prevalence of latex sensitisation among healthcare workers was 9.6%, with no difference between operating theatre and nonoperating theatre staff. Glove-related symptoms were reported in 13.7% of all healthcare workers, of which 22.9% were sensitised to latex. Only 26.7% of latex-sensitised healthcare workers had glove-related symptoms while the rest were asymptomatic. The most common symptoms were itch and hand eczema but the most important discriminating symptom was contact urticaria. Personal history of atopy was more common in sensitised healthcare workers (40.0%) compared to non-sensitised workers (31.8%). Only 1 out of 9 (11.2%) symptomatic latex-sensitised subjects had sought previous medical attention for the problem. CONCLUSIONS: Latex sensitisation among healthcare workers in Singapore should be considered a significant occupational health risk, as it is in the West. Increased screening and awareness of this problem is essential to identify those at risk.

Adult↗
PubMed2005

Transforming Singapore health care: public-private partnership.

Prudent health care policies that encourage public-private participation in health care financing and provisioning have conferred on Singapore the advantage of flexible response as it faces the potentially conflicting challenges of becoming a regional medical hub attracting foreign patients and ensuring domestic access to affordable health care. Both the external and internal health care markets are two sides of the same coin, the competition to be decided on price and quality. For effective regulation, a tripartite model, involving not just the government and providers but empowered consumers, is needed. Government should distance itself from the provider role while providers should compete - and cooperate - to create higher-value health care systems than what others can offer. Health care policies should be better informed by health policy research.

Delivery of Health Care, Integrated↗