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PubMed1990

Nuclear cardiology in the detection of coronary artery disease--an overview of its role in the Singapore General Hospital.

Nuclear cardiology at the Singapore General Hospital (SGH) had a humble beginning in 1983 when it was carried out by the joint staff of the departments of cardiology and nuclear medicine. At the onset the bulk of the scans were blood pool studies. In 1984, qualitative tomographic myocardial perfusion studies replaced the less accurate planar scans and this was carried out on a routine basis. Its superiority to conventional exercise electrocardiography in the detection, management and prognostication of coronary artery disease (CAD) has since been validated locally. We have since progressed to the fields of research involving pharmacological stress testing with intravenous dipyridamole and use of technetium-based isonitrile as an alternative to the conventional myocardial perfusion agent, thallous chloride. Our results mirror those from other research centres. On this encouraging note we are looking into newer areas such as the role of diastolic function for early detection of cardiac disease. In under a decade we are in a position to provide scintigraphic service expected of an established nuclear cardiac laboratory. This article provides an overview of our work in the management of CAD.

Coronary Disease↗
PubMed1990

The pattern of diabetes in a primary health care setting in Singapore.

This is a study of Diabetes mellitus and its treatment in a single doctor government primary health care clinic in Singapore. Data was collected on the entire 349 patients with diabetes attending this clinic over a three month period in 1987. We found there was an increasing number of diabetics with age and a substantial proportion was above 70 years of age. Only 7% had their diabetes treated with diet alone and 9.6% were treated with insulin. Most (61%) patients were on tolbutamide, with 17.6% on glibenclamide and 5.9% on chlorpropamide. Hypertension was found in 38% of the diabetic patients but was not associated with increase in age of the patient. The duration of diabetes, but not the age of the patient, was positively associated with the number of drugs taken by the patient (chi-squared, p less than 0.05).

Adolescent↗
PubMed1990

Diabetic retinopathy--results of a two year screening programme in two medical units in Singapore.

Three hundred patients with Diabetes Mellitus from 2 medical units in Singapore were screened for retinopathy over a 24 month period. Prevalence of retinopathy in this population was 38% with sight-threatening retinopathy in 17%. Risk factors associated with retinopathy included a longer duration of disease, the presence of hypertension, nephropathy and poor glycaemic control. Prevalence of retinopathy was higher in females. Malays and Indians had higher prevalence of retinopathy than Chinese.

Diabetic Nephropathies↗
PubMed1990

Melioidosis: epidemiology and antibiogram of cases in Singapore.

There has been an increased incidence of melioidosis in Singapore. The disease affects mainly males, older patients and a disproportionately higher number of Indians and Malays. Possible predisposing illness include diabetes mellitus. Most patients are bacteraemic. Mortality rate is 72% for bacteraemic patients, as compared to 32% for non-bacteraemic patients. Local strains of Pseudomonas pseudomallei have been consistently sensitive to ceftazidime, chloramphenicol and piperacillin, and nearly always sensitive to tetracycline.

Adolescent↗
PubMed1979

The pattern of liver diseases in Singapore. An autopsy study.

This study is based on an analysis of 1839 consecutive necropsies. Liver diseases are common in Singapore. Of particular importance are cholelithiasis, cirrhosis and primary carcinoma of the liver. Gallstones are mainly of the pigment variety and a significant proportion are present in the bile ducts. The multiracial composition of the population is reflected in a difference in the pattern of liver diseases among the different ethnic groups. Indians are found to have more alcoholic hepatitis and cirrhosis which are often of the micronodular type, while the Chinese have significantly more macronodular cirrhosis and hepatocellular carcinoma. Clonorchiasis and schistosomiasis are confined to the immigrant Chinese. The pattern of liver diseases is changing. Cholangitis and cholangitic abscesses as a result of cholelithiasis are becoming more common while amoebic abscesses and hepatic ascariasis are definitely on the decline. This is attributable to improved sanitary conditions.

Adenoma, Bile Duct↗
PubMed1990

Refractive errors in Singapore medical students.

The refraction of 128 third-year medical students aged 20-22 was studied using a Topcon autorefractometer. The population was predominantly Chinese and comprised 44% females and 56% males. The mean refractive error was -3.75 D for males and -4.76D for females. In all, 82% of the students were myopic, 72% were found to have astigmatism. This study confirms clinical impressions that Singapore students have one of the highest prevalence rates of myopia and astigmatism in the world.

Adult↗
PubMed1990

Singapore--an ageing society.

Singapore is undergoing a rapid transition into an ageing society. This is due to a dramatic fall in the birth rate combining with a fall in infant and early childhood mortality rate as well as an improvement in the life expectancy. Other changes in the society such as the breaking up of the extended family structure, the changing role of women as well as the increasing expectations of elderly and their families are taking place at the same time. These changes will place increasing demands on the families of the elderly, social services, community and health services. There will have to be a rethinking on how we care for our elderly and the measuring required in meeting this challenge.

Aged↗
PubMed1990

New waves, new problems--use of CD-ROM MEDLINE in the Medical Library of the National University of Singapore.

In the rapid development of optical disc technology, compact disc read-only-memory (CD-ROM) is gaining popularity as a reference tool. The National University of Singapore Medical Library (NUSML) is the first special library of the University Library System to introduce CD-ROM technology by setting up of the MEDLINE on CD-ROM system to complement its reference and information services since February 1989. The experiences of the Library is setting up the system and feedback obtained from end users through a questionnaire survey are presented in this paper. The success of the implementation of the new services has also given rise to new problems which have implications on library user education programmes, manpower planning, collection development and system security.

Attitude to Computers↗
PubMed1990

Application of computers in clinics in Singapore: status and doctors' perceptions.

A survey of 67 private clinics in Singapore indicates a positive trend towards use of computer-based information systems for administrative and medical applications. The computerised clinics are generally large in terms of number of staff and number of patients, and have been in operation for 3 to 15 years. Specialist clinics have a greater tendency to use computers. The widely used applications in clinics with computers are word processing, accounting, database, medical billing, drugs inventory, laboratory billing and reporting, medical records tracking, and prescription processing. Clinics with computers find: (1) software are generally suitable, (2) objectives of computerisation have been generally achieved, (3) a slight increase in operating costs, (4) a slight increase in staff productivity, and (5) satisfactory vendor support. The responding doctors rate their knowledge of computers from average to poor. Doctors with computers in their clinics hold the perception that: (1) computers can adequately support clinic operations, (2) computer systems are reliable, (3) a genuine need exists for computers in clinics, (4) computers are useful as research tools, and (5) legal and ethical constraints may inhibit use of computers in medical applications. Further analysis of the data has identified some interesting correlations among clinic variables and among doctors' perception variables.

Attitude to Computers↗
PubMed1990

MediNet: Singapore's nationwide medical network.

MediNet is Singapore's nationwide computer network for the medical and health care community. This paper presents the case for MediNet and discusses the five high-priority applications which would be implemented by 1993. These 5 pilot applications focus on the processing of claims in hospital bills, electronic procurement of medical and surgical supplies, the transmission of notifications to government agencies, a national patient master index and access to local and foreign databases. MediNet will be able to link the computer systems of all participants in the healthcare delivery system. These include the Ministry of Health, Central Provident Fund (CPF) Board, government, restructured and private hospitals and general practice clinics. By connecting their computers (personal computers, minicomputers and mainframes) to MediNet, these organisations will be able to communicate, exchange data and access common applications on the network.

Computer Communication Networks↗
PubMed1990

Decompression sickness in the Singapore Mass Rapid Transit Project.

In the Singapore Mass Rapid Transit Project (MRT), 11 km of underground tunnels were built using compressed air. 1,737 compressed air workers (CAWs) were employed in the project. They underwent 188,538 man decompressions at the various compressed air worksites. 160 CAWs developed Type I decompression sickness (DCS) and 4 developed Type II DCS. This gave an overall incidence of 0.087%. The adoption of strict medical selection, strict adherence to decompression procedures and the provision for acclimatization of newstarters contributed greatly to this low incidence. Prompt treatment of DCS accounted for the low relapse rate. The clinical presentation of DCS is discussed here. Prevention of DCS by worksite environmental and work-practice monitoring are advocated.

Decompression Sickness↗
PubMed1990

A short history of Kandang Kerbau Hospital and the maternity services of Singapore.

This article traces the history of Kandang Kerbau Hospital ("the hospital beside the Bukit Timah Canal") and the maternity and infant welfare services of Singapore from 1858 to the present. This includes the development of teaching of Obstetrics and Gynaecology to medical undergraduates and postgraduates, and the training and registration of midwives, and the resulting saving of maternal and infant lives. Why was Kandang Kerbau Hospital converted into a Maternity Hospital in 1924?

History, 20th Century↗
PubMed1990

Permanent pacemaker trends in Singapore General Hospital in the eighties.

This is a ten year survey of all the pacemakers implanted in the Department of Cardiology, Singapore General Hospital, from January 1980 to July 1989. There were 331 (164 male and 167 female) patients with pulse generators and leads implanted. The ages of the subjects ranged from 8 to 91 years (mean 63 years). Two-thirds of the patients were greater than 60 years. The indications for pacemaker implants were high grade atrioventricular block in 199 (60%) patients, sick sinus syndrome in 112 (34%) patients and in the remaining 20 (6%) of patients, no data was available, 298 (90%) patients had VVI pacing (133 were non-programmable and 165 were programmable pacemakers), 8 (2%) had AAI, 16 (5%) had DDD and the remaining 9 (3%) had VVIR mode of pacing. 282 (85%) of the patients had new pacemakers implanted while the remaining 49 (15%) patients had pacemaker replacements. At the time of replacement of pacemakers, 23 patients had upgrade of their non-programmable to programmable VVI pacemakers and 4 to DDD and VVIR pacing modes respectively. Furthermore, 293 (88%) patients had endocardial leads as compared to 38 (12%) with epicardial leads. In conclusion, most of the patients who require pacemaker implants will continue to have single chamber system. However, to improve longevity of the pacemakers, one should consider using low pacing threshold leads and programmable pacemakers.

Adolescent↗
PubMed1990

Monitoring cancer incidence and risk factors in Singapore.

In the development of a national cancer control programme, the cancer registry can play a pivotal role by providing useful data for planning and evaluation of curative and preventive services. Having produced information on cancer incidence patterns, the Singapore registry is now able to analyse incidence trends among the Chinese population based on the first 15 years of data (1968-1982). Increases in incidence are reported for all sites (at average annual rate of 0.4%), lung (2.2%), colon (3.0%), rectum (3.1%), skin (3.2%), prostate (4.9%) and bladder (2.3%) in males; for all sites (1.3%), lung (2.4%), colon (5.0%), rectum (4.1%), skin (3.9%), breast (3.2%) and ovary (3.4%) in females. Marked decreases are reported for oesophagus (3.9% in males, 5.8% in females) and stomach (2.2%) in males and 1.4% in females). No significant changes are seen in nasopharynx, liver (both sexes) and cervix. Some of the associated changes in risk factor prevalence are discussed in relation to the main cancer sites.

China↗
PubMed1990

Acute decompression sickness in compressed air workers exposed to pressures below 1 bar in the Singapore Mass Rapid Transit project.

The Singapore Mass Rapid Transit (MRT) project started compressed air work in Oct 1984. Eleven km of underground tunnels out of 20 km were built using this method. Cases of decompression sickness (DCS) arising from compressed air work are rare with working pressures less than 1 bar gauge. However, there were 10 cases of DCS in the MRT project who were exposed to less than 1 bar pressure. The authors present their clinical features and attempt to explain the observations in relation to theories of bubble nuclei formation, gas loading and rate of decompression. The formation of bubble micronuclei are correlated with physical factors like heavy exertion, and the use of vibrating tools. The concept of extremely long tissue half-times in the absorption of nitrogen in the body is discussed as a contributory factor to the development of DCS under 1 bar.

Acute Disease↗
PubMed1990

The dexamethasone suppression test in depression--a Singapore study.

The Dexamethasone Suppression Test (DST) has been evaluated as a biological marker in psychiatry especially in depressive illness. A study on the DST involving 20 patients in Tan Tock Seng Hospital, Singapore, who fulfilled the Research Diagnostic Criteria for major depressive disorder and with 21 healthy controls was carried out. Two out of the 20 patients had abnormal DST responses.

Adult↗
PubMed1990

Experience with endoscopic biliary drainage in Singapore.

In several overseas centres endoscopic biliary drainage is now a standard procedure in the initial or definitive management of biliary tract obstruction. We report the first nine patients in whom this procedure was carried out in our unit. Four patients presented with acute cholangitis due to cholelithiasis. Urgent endoscopic biliary drainage improved the general condition in three patients prior to subsequent elective surgery. In one other patient with huge common bile duct calculi a biliary stent prevented recurrent episodes of cholangitis. Endoscopic endoprostheses were used in three patients with malignant biliary tract obstruction. Two had terminal metastatic disease and endoscopic drainage provided adequate palliation of jaundice and pruritus in one. Endoprosthesis blockage necessitated percutaneous drainage in the other patient. The third patient with carcinoma of the head of the pancreas was improved by endoscopic drainage prior to an open surgical bypass procedure. Another patient with obstructive jaundice due to terminal gall bladder carcinoma experienced relief of jaundice and pruritus following endoscopic insertion of a nasobiliary drain. We anticipate that endoscopic biliary drainage will become increasingly used in Singapore.

Aged↗
PubMed1990

Obesity and body mass indices in Chinese, Malays and Indians in Singapore.

A population based cross-sectional survey has measured body mass indices (BMIs) in Singapore and compared their means and the proportions who are overweight and obese amongst Chinese, Malays and Indians. For males there was little ethnic differences; for the 18-69 age group, the age-adjusted mean BMIs being Chinese 22.3, Malays 23.1 and Indians 22.5. However for females, Malays and Indians were considerably more obese than Chinese; for the 18-69 age group the age-adjusted mean BMIs in Malays (25.1) and Indians (24.6) were significantly greater (p less than 0.001) than in Chinese (22.2). The proportions categorised as overweight or obese (BMI equal to or more than 26 in males and 25 in females) were males (Chinese 16.7%, Malays 22.4%, and Indians 14.0%) and females (Chinese 21.2%, Malays 51.5%, and Indians 42.0%). Health education on the harmful effects of obesity should be targeted especially on Malay and Indian females.

Adolescent↗