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PubMed2005

Anaphylaxis in adults referred to a clinical immunology/allergy centre in Singapore.

INTRODUCTION: To study the clinical features and causes of anaphylaxis in consecutive adult patients referred to a clinical immunology/allergy centre in Singapore. METHODS: A retrospective review of 67 consecutive adults with anaphylaxis who presented from July 1, 1998 to February 28, 2002 was performed. Anaphylaxis was defined as a severe life-threatening systemic IgE-mediated hypersensitivity reaction. Non-steroidal anti-inflammatory drug-induced idiosyncratic reactions and other non-IgE mediated reactions were excluded. Hypotension and bronchospasm were not required to make a diagnosis. The aetiology was determined from clinical history followed by measurement of allergen-specific IgE levels, skin prick test with commercially-available allergen extracts or prick-prick test with the fresh/cooked/canned food products. RESULTS: The mean age of patients was 32.9 +/- 10.9 (range 19-57) years. There were 44 (65.7 percent) males and 23 (34.3 percent) females. The main causes were food (44.8 percent), insect stings (32.8 percent) and idiopathic (22.4 percent). There were no cases due to drugs or natural rubber latex. Seafood (crustaceans and molluscs) comprised 66.7 percent of food-induced anaphylaxis. Honeybee and wasp stings together comprised 45 percent of insect venom anaphylaxis. The most common manifestations were dyspnoea (59.7 percent), urticaria (58.2 percent), angioedema (44.8 percent), and syncope (43.3 percent). Hypotension was documented in only 28.4 percent of cases. CONCLUSION: Food (crustaceans and molluscs) was the most common cause followed by insect stings or bites. The inability to identify the causative insect in 50 percent of cases with insect venom anaphylaxis limited the role of specific immunotherapy. Compared to other reported series, there were no cases of drug or latex anaphylaxis.

Adult↗
PubMed2005

Insect venom hypersensitivity: experience in a clinical immunology/allergy service in Singapore.

INTRODUCTION: To study the profile of patients with allergy to the venom of insect stings. METHODS: 31 consecutive cases referred to our clinical immunology/allergy outpatient service from June 1, 1998 to June 30, 2002 were reviewed. RESULTS: These patients comprised 3.5 percent of 889 cases referred during the study period. Their mean age was 28.8 +/- 10.5 (range 19-57) years and the majority were males (90.3 percent). Of these, 20 (64.5 percent) were Chinese, four (12.9 percent) were Malays and seven (22.6 percent) were of other races. 19 patients (61.3 percent) were men from the uniformed services including 12 (63.2 percent) full-time National Servicemen. 71 percent (22 patients) were stung for the first time. Urticaria (22 cases, 71.0 percent), dyspnoea (13, 41.9 percent), angioedema (12, 38.7 percent) and syncope (ten, 32.3 percent) were the most common manifestations of insect allergy. Anaphylaxis occurred in 22 (71.0 percent) cases, constituting 30.1 percent of all cases of anaphylaxis referred to our service during the study period. Although the causative insect was identified as honeybee (12, 38.7 percent), ant (four, 12.9 percent), wasp (three, 9.7 percent), and fire ant (two, 6.5 percent) by the majority of patients, ten (32.2 percent) patients were unable to identify the causative insect. The two patients stung by fire ants were Americans working in Singapore who had been stung while in the United States. Among those with anaphylaxis, honeybee, wasp and fire ant venom, for which specific immunotherapy is available, were identified as the cause in 40.9 percent, 4.5 percent, and 4.5 percent, respectively. CONCLUSION: Insect venom hypersensitivity made up 3.5 percent of allergy/immunology referrals and 32.8 percent of cases of anaphylaxis referred to our institution. The majority were military servicemen who developed allergic reactions during the course of duty. The inability to identify the causative insect in 50 percent with sting anaphylaxis limits the role of specific immunotherapy in our patients.

Adult↗
PubMed1992

Disparity between medical and dental care of institutionalised elderly in Singapore.

Elderly persons tend to give dental care a lower priority than medical care. This study examined existing arrangements for and financial support of dental and medical care to elderly persons living in 68 long-term care facilities in Singapore. The chief administrators of all the homes for the aged were interviewed regarding the provision of physical and financial access to dental and medical care for their residents. Information was verified with a random selection of their residents. Results showed that a significantly higher number of homes (93 per cent) assumed responsibility for the provision of medical care than for dental care (70.7 per cent). A significantly greater proportion of them offered in-house medical care (42.6 per cent) than in-house dental care (5.9 per cent). Financial support for payment of providers' fees, hospitalisation and the transportation costs of ambulatory visits for both medical and dental care was found to be similar but generally inadequate. Greater commitment towards improving physical and financial access to dental care for the institutionalised elderly is necessary.

Aged↗
PubMed2005

Contact screening and latent TB infection treatment in Singapore correctional facilities.

SETTING: Singapore, a city-state with a tuberculosis (TB) incidence rate of 47 per 100000 population in 2000. OBJECTIVES: 1) To report our experience with contact investigation and latent TB infection (LTBI) treatment in high-risk contacts with unknown human immunodeficiency virus (HIV) status in correctional facilities (CFs) (prisons/drug rehabilitation centres); and 2) to compare the yield of contact screening in this setting with that in the community (household/family) setting. METHODS: The tuberculin skin test (TST) readings of 704 CF contacts screened from 1999 to 2001 were compared with those of 2729 household/family contacts who underwent screening in 2000. RESULTS: Respectively eight (1.1%) and 20 (0.7%) active TB cases were detected among the CF and community contacts. A significantly higher proportion of CF contacts had first (non-conversion) TST readings > or =15 mm (39% vs. 22%, OR 2.3; 95%CI 1.9-2.7; P < 0.001), and 10-14 mm (26% vs. 18%, OR 1.6; 95%CI 1.3-2.0; P < 0.001) and TST conversion (43% vs. 20%, OR 2.9; 95%CI 1.7-4.9; P < 0.001). LTBI treatment was started in 65% of the CF contacts screened; 87% completed treatment. CONCLUSION: We found a high LTBI rate among CF contacts, presenting an opportunity for intervention.

Adult↗
PubMed2006

HPB Online: an electronic health education portal in Singapore.

In 2001, the Health Promotion Board (HPB) developed HPB Online, an internet-based health education portal to disseminate health messages. The objective of this article is to describe the structure of HPB Online, review its reach as a tool to deliver health information in Singapore, and discuss the advantages of using the internet to complement traditional media such as the television, newspapers and radio. Since its inception in 2001, the numbers of page-views, monthly visits and repeat visitors have increased markedly. The most popular webpages have consistently been Food Info Search. The average length of visit also showed a gradual increase during the study period, from about 11.0 minutes in January 2002 to 18.5 minutes in December 2004. The key advantage of using the HPB Online is that it allows quick delivery of information to the public and this is ideal for time-sensitive issues. It helps Singaporeans to make better informed decisions to maintain and to improve their health. With its high utilisation, the HPB will continue to use the internet as part of its multichannel marketing strategy to disseminate health information.

Health Education↗
PubMed2006

Epidemiology of pre-eclampsia and eclampsia at the KK Women's and Children's Hospital, Singapore.

INTRODUCTION: The incidences and characteristics of pre-eclampsia (PE) and eclampsia in KK Women's and Children's Hospital (KKH), a tertiary obstetrical referral centre in Singapore, were studied. METHODS: The incidences and types of PE between July 1999 and June 2003 were derived from the pregnancy disease databases. The characteristics of women with PE in relation to the general obstetric population were analysed on the age, race, parity, types of delivery, gestation at delivery and mortality. Case records of eclampsia were analysed. RESULTS: A total of 2,213 (3.6 percent) out of 61,595 deliveries were complicated by PE between July 1999 and June 2003. Incidence rates for mild or unspecified PE, severe PE, eclampsia and PE superimposed on hypertension were 2.47 percent (1,518), 0.97 percent (599), 0.02 percent (10) and 0.14 percent (85), respectively. The incidence increased with multiple pregnancies: from 3.5 percent in singletons to 7.5 percent in twins, 19.4 percent in triplets and 25.0 percent in quadruplets. The Caesarean section rate for PE was 46.1 percent compared with 23.7 percent in the hospital population. The proportion of premature birth (<37 weeks) in PE was 31.0 percent and that of severe prematurity (<32 weeks) was 5.7 percent, while hospital population proportions were 9.8 percent and 1.3 percent, respectively. The perinatal mortality rate (PMR) of PE was 11.0/1,000 births (population PMR was 4.4/1,000 births). There were only ten cases of eclampsia out of 61,595 deliveries (1:6160) giving an incidence of eclampsia of 16.2/100,000 deliveries. There was no stillbirth, neonatal and maternal death among the eclamptic patients. CONCLUSION: The incidence and outcome of eclampsia in KKH showed a significant reduction over the years due to improved obstetrical care. While PE is still common, eclampsia is now a very rare disease outcome.

Adult↗
PubMed2005

Occupational health practice in the Singapore Navy.

Occupational health practice in the military is challenging and also an important facet of the overall healthcare service delivery. This paper describes how it enhances the operational readiness of the Republic of Singapore Navy during peacetime and operations, the organisational framework of occupational health services and the foreseeable challenges.

Delivery of Health Care↗
PubMed2006

Helmet use and bicycle-related trauma in patients presenting to an acute hospital in Singapore.

INTRODUCTION: To describe the relationship between bicycle helmet use and injury pattern sustained by patients presenting to an emergency department (ED) in Singapore for bicycle-related trauma. METHODS: Data was collected from all individuals treated for bicycle-related trauma between September 1, 2004 and May 31, 2005 using a closed-ended questionnaire. RESULTS: 160 bicyclists with mean age of 34.4 years (range 10 to 89 years) were surveyed. Among them, 80 percent were male and 30.6 percent were non-residents. Helmets were worn by 10.6 percent of the patients. Alcohol was clinically detected in 11.3 percent of bicyclists. There was no difference in bicycle helmet use between Singaporeans and non-residents (p-value is 0.275). However, compared to younger bicyclists, bicyclists aged 30 years or older (p-value is less than 0.05), and compared to recreational or sport bicyclists, those who commute by bicycle, tended not to wear helmets (p-value is less than 0.01). Compared to Singaporeans (p-value is less than 0.05), non-residents and bicyclists aged 30 years or older (p-value is 0.011) believed that helmets did not protect against head injury. Comparing the helmeted group with the non-helmeted group, injury patterns by body region were: head injury 5.9 percent versus 40.0 percent (p-value is less than 0.01); facial injury 5.9 percent versus 37.1 percent (p-value is less than 0.05). Not wearing a helmet, being hit by a motor vehicle and age were significantly associated with higher injury severity scores, after adjusting for several potential confounding factors. CONCLUSION: Bicycle helmet use was low in our sample of injured patients. When worn, protection against injury was demonstrated. A campaign to promote use of bicycle helmets should be targeted at non-residents and older bicyclists. Authorities should consider compulsory helmet laws for bicyclists and expanding anti-drunk driving campaigns to target alcohol-intoxicated bicyclists.

Accidents, Traffic↗
PubMed2006

Unintentional injuries in infants in Singapore.

INTRODUCTION: To describe the risk factors, causes and outcome of infant injuries so as to guide the formulation of injury prevention strategies specific for Singapore babies less than one year old. METHODS: Demographical, socio-economic data, and data on the circumstances of injury, nature, severity of injury and clinical outcome of all infants less than one year old and who sought medical attention for or died from unintentional childhood injuries or poisoning, at the Emergency Departments of three SingHealth hospitals, two SingHealth primary care polyclinics and the Forensic Medicine Department, Health Sciences Authority during a six-month period, were extracted from a larger Childhood Injuries Surveillance database and analysed. RESULTS: 405 cases of accidental injury and poisoning in infants aged less than one year were seen from February to July 2002. 40.5 percent of injuries occurred when infants were left alone. Most infants were aged between nine months to one year (37 percent), male (57.3 percent), first-born (57.3 percent) and Chinese (69 percent), with no past medical history (96.1 percent). 91 percent of the injuries occurred at home, of which 60.5 percent occurred in the bedroom. Falls were the major mechanism of injury (77 percent). A total of 431 injuries were sustained. 63 percent were head injuries - mainly stable head injuries, which made up 93.1 percent of all the head injuries. 67.5 percent of the cases were discharged without follow-up, while 17.9 percent required hospital admission, mostly to the general ward (98.6 percent of total admissions), and to the neurosurgery department (84.9 percent of total admissions). There were two fatalities in this study population. The mechanisms and patterns of injury changed with increasing motor ability of the infants. CONCLUSION: Parents and caregivers of infants should be taught and reminded about the age specific measures in injury prevention as their wards go through the various developmental stages in the first year of life. Emphasis should be placed on close caregiver supervision, identifying potential injury hazards in the home, fall prevention, adopting safe infant care practices and the safe use of infant care products.

Accident Prevention↗
PubMed2006

Liver transplantation in Singapore 1990-2004.

INTRODUCTION: Liver transplantation is the accepted standard of care for patients with hepatocellular carcinoma, decompensated liver cirrhosis, and acute liver failure. Since the first liver transplant done in Singapore in 1990, results have been improving. We review the overall results of liver transplantation over the last 15 years. METHODS: All transplant cases from 1990 to 2004 were reviewed retrospectively. RESULTS: 100 liver transplants were performed over the last 15 years; four in the first five years and 96 in the subsequent ten years. Overall one- and five-year survival rates were 80 percent and 78 percent, respectively. 44 were paediatric transplants, of which biliary atresia was the commonest indication for paediatric transplant. 56 were adult transplants of which hepatocellular carcinoma and decompensated hepatitis B cirrhosis were the commonest indications for adult transplant. Infection remained the commonest cause of mortality. CONCLUSION: The number of transplants carried out per year was small due to the low cadaveric donation rate, but the survival of liver transplant patients was comparable to well-established liver transplant centres.

Adolescent↗
PubMed2006

SARS in Singapore--key lessons from an epidemic.

The rapid containment of the Singapore severe acute respiratory syndrome (SARS) outbreak in 2003 involved the introduction of several stringent control measures. These measures had a profound impact on the healthcare system and community, and were associated with significant disruptions to normal life, business and social intercourse. An assessment of the relative effectiveness of the various control measures is critical in preparing for future outbreaks of a similar nature. The very "wide-net" surveillance, isolation and quarantine policy adopted was effective in ensuring progressively earlier isolation of probable SARS cases. However, it resulted in nearly 8000 contacts being put on home quarantine and 4300 on telephone surveillance, with 58 individuals eventually being diagnosed with probable SARS. A key challenge is to develop very rapid and highly sensitive tests for SARS infection, which would substantially reduce the numbers of individuals that need to be quarantined without decreasing the effectiveness of the measure. Daily temperature monitoring of all healthcare workers (HCWs) in hospitals was useful for early identification of HCWs with SARS. However, daily temperature screening of children in schools failed to pick up any SARS cases. Similarly, temperature screening at the airport and other points of entry did not yield any SARS cases. Nevertheless, the latter 2 measures probably helped to reassure the public that schools and the community were safe during the SARS outbreak. Strong political leadership and effective command, control and coordination of responses were critical factors for the containment of the outbreak.

Disease Outbreaks↗
PubMed2006

Plasma and urine amino acid profiles in a healthy adult population of Singapore.

INTRODUCTION: The analysis of amino acids in plasma and urine was introduced in Singapore when a laboratory for the investigation of inherited metabolic disorders was established by the Ministry of Health. Reference ranges are required for interpreting test results and making diagnoses. Initially, reference ranges established for Caucasians were used as there were no local data and we were unable to find data obtained by the same analytical method for Asian populations. This was not considered an ideal and long-term solution, as Singaporeans may have amino acid concentrations quite different from those of Caucasians due to genetic factors, dietary difference, environment, and other influences. This study was therefore undertaken when a number of healthy laboratory personnel volunteered to provide specimens for the study. MATERIALS AND METHODS: Sixty healthy male and female laboratory workers not on any form of medication were recruited. They consisted of 24 males (range, 23 to 58 years) and 36 females (range, 20 to 60 years), with a mean age of 38.7 years. Non-fasting random blood and urine specimens were collected on ice. Removal of protein and peptides from heparinised plasma and urine was achieved by ultrafiltration through protein-exclusion membrane. Amino acid analysis on the ultrafiltrate was performed by a dedicated Beckman 6300 Amino Acid Analyzer using a cation exchange resin column and post-column colour reaction with ninhydrin reagent. Urine creatinine was measured by a Beckman LX 20 PRO Analyzer. Results for urine amino acids were expressed as micromol/mmol of creatinine. RESULTS: Reference ranges for 32 amino acids in blood plasma and 36 amino acids in urine were calculated by a non-parametric method using the SPSS statistical calculation software. The ranges cover 95% of the population and the low and high limits of each reference range represent the 2.5th percentile and 97.5th percentile of the frequency distribution respectively. CONCLUSIONS: We observed differences in the reference ranges of several plasma and urine amino acids between Singaporean and Caucasian populations. Moreover, the list of urine amino acids for Caucasian population is incomplete. We have therefore discontinued the use of reference values established for Caucasians and adopted the results of this study for our patient diagnostic work.

Adult↗
PubMed2006

Singapore National Medical Image Resource Centre (SN.MIRC): a world wide web resource for radiology education.

Radiology education is heavily dependent on visual images, and case-based teaching files comprising medical images can be an important tool for teaching diagnostic radiology. Currently, hardcopy film is being rapidly replaced by digital radiological images in teaching hospitals, and an electronic teaching file (ETF) library would be desirable. Furthermore, a repository of ETFs deployed on the World Wide Web has the potential for e-learning applications to benefit a larger community of learners. In this paper, we describe a Singapore National Medical Image Resource Centre (SN.MIRC) that can serve as a World Wide Web resource for teaching diagnostic radiology. On SN.MIRC, ETFs can be created using a variety of mechanisms including file upload and online form-filling, and users can search for cases using the Medical Image Resource Center (MIRC) query schema developed by the Radiological Society of North America (RSNA). The system can be improved with future enhancements, including multimedia interactive teaching files and distance learning for continuing professional development. However, significant challenges exist when exploring the potential of using the World Wide Web for radiology education.

Computer-Assisted Instruction↗
PubMed2006

Study of inherited metabolic disorders in Singapore - 13 years experience.

INTRODUCTION: Recommended by the National Advisory Council of the Disabled, the Ministry of Health of Singapore supported a nationwide study of inherited metabolic disorders (IMDs). When the 5-year project ended, investigations were provided as a diagnostic service. This paper documents our 13-year experience. MATERIALS AND METHODS: Patients with symptoms suggestive of an IMD were referred. Investigations on heparinised blood and/or urine included amino acid analysis using a Beckman 6300 Amino Acid Analyser, organic acids analysis using a Hewlett- Packard gas chromatography and mass spectrometry, mucopolysaccharides quantitative assay and high-resolution electrophoresis, sugars by thin-layer chromatography. RESULTS: Of the 3656 patients studied from 1992 to 2005, IMDs were found in 127 (77 males; 50 females; age range, 1 day to 56 years). Their ethnic distribution was: 55.1% Chinese, 19.7% Malays, 11.0% Indians, 11.0% other races and 3.2% unknown. IMD diagnosed comprised 41 (32.3%) organic acidurias, 34 (26.8%) amino acidaemias/acidurias, 14 (11.0%) urea cycle defects, 15 (11.8%) mucopolysaccharidoses, 6 (4.7%) carbohydrate disorders and 17 (13.4%) others. Twenty-three (18.1%) cases were diagnosed during the neonatal period and 36 (28.3%) after the age of 13. CONCLUSION: Positive detection rate was 3.5% and 48 IMDs were found. Significant proportion of cases had late-onset IMDs. Early identification of IMDs permits timely management, genetic counselling and prenatal diagnosis.

Adolescent↗
PubMed1991

A radiological survey of diverticulosis in Singapore.

Three hundred and sixty one consecutive barium enemas done at a general hospital were reviewed prospectively to determine the frequency and anatomic distribution of diverticulosis in Singapore. The frequency of 28% is comparable to previous American and European studies and higher than previous Asian studies. There was also a predominance of purely right-sided disease with the caecum and/or ascending colon involved in 71% of patients. This anatomic distribution of diverticulosis is quite different from that seen in Caucasian populations where the disease mainly involves the left side of the colon and is probably a function of genetic and racial factors.

Adult↗
PubMed1991

Cost-effectiveness analysis of medical and surgical treatment for duodenal ulcer in Singapore.

A mathematical model involving transitions between possible states of duodenal ulcer was used to calculate the costs of various treatments, medical and surgical, which are available for the long-term management of duodenal ulcer. Costs of medical and surgical treatment were based on costs incurred at the National University Hospital, Singapore as at 1990. Elective surgery incurs a high cost, both financial and in terms of mortality, at the outset with minimal additional costs subsequently. The various medical options cost less initially but their costs are cumulative and eventually overtake the costs of surgical treatment. These calculations are based on the use of a proprietary preparation of a histamine-2-blocker. If a generic preparation is used, medical treatment becomes considerably cheaper over a 15 year period.

Cost-Benefit Analysis↗
PubMed1991

Management of the hearing-impaired adults in Singapore.

A preliminary study to investigate that the pure-tone air-conduction hearing threshold level which is not an accurate index of amplification need profile applies to the hearing-impaired population in Singapore. Results obtained from a sample of twenty users of monaural amplification indicate that the hearing-impaired patients showed a significant reduction in communication difficulties with their hearing aids and are overall satisfied with their monaural amplification despite certain problems with background noise, regardless of the severity of their hearing losses.

Adult↗
PubMed1991

Otorhinolaryngology--head and neck surgery--its beginnings and development in Singapore.

Otolaryngology which had a modest beginning in Singapore as part of general surgery in the late twenties, developed into a full-fledged independent unit by 1957. From the provision of simple basic emergency and secondary patient care during the early period, the speciality has progressed steadily to its present advanced state where its area has been enlarged from the traditional Ear, Nose and Throat to extend from the Skull Base down to the Neck. Microsurgery was introduced in 1958 and this enabled widening of the scope of work. Increased traineeship programmes along with subspecialisation in various fields in Otolaryngology have significantly enlarged the pool of available specialists. This, together with advanced diagnostic and supportive facilities have contributed to much better patient management.

History, 20th Century↗