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PubMed1982

Coroner's practice in Singapore.

The coroner investigates into sudden, unnatural and violent deaths and cases in which the manner the person came by his death is unknown. In Singapore the coroner is a magistrate and he has all the powers conferred on a magistrate court. Yearly there are about 2,500 cases reported to the coroner and about 74% of these are subjected to postmortem examination. Death by unnatural causes formed about 55% of the postmortem cases. The Forensic Pathologist cooperates closely with the coroner and police in medico-legal investigations into these deaths.

Coroners and Medical Examiners↗
PubMed1982

A study on the prevalence of antibodies to Toxoplasma gondii in Singapore.

The indirect fluorescence antibody technique has been employed to study the prevalence of toxoplasma antibodies in Singapore. 42.5% of clinically suspected cases of toxoplasmosis showed antibody titres. Of these, 17.5% had titres greater than or equal to 1.64. Malays and Indians have higher positive rates compared to the main ethnic group, the Chinese. Antibody titres are found in both males and females and span through the various age groups. The possible mode of transmission is discussed and the importance of congenital toxoplasmosis is indicated.

Adolescent↗
PubMed1982

Tuberculous lymphadenitis in Singapore.

An analysis of patients diagnosed as having tuberculous lymphadenitis (the second commonest form of tuberculosis after respiratory tuberculosis) in 1980, was carried out to ascertain the pattern of disease and methods of diagnosis. Of 114 cases so notified, 97 were available for this purpose. Diagnosis was on lymph node biopsy with histological examination and/or bacteriological culture confirmation. Patients with tuberculous lymphadenitis tended to be young (more than 60% below 31 years old), and to have cervical involvement (88.6% of cases). A female preponderance (as in other studies) and a disproportionate number of Indians and Malays (thrice and twice that expected on the basis of their ethnic proportion of the Singapore population) were noted. Only 25 out of 97 biopsied glands were sent for mycobacterial culture by the surgeons and 16 grew niacin positive Mycobacteria tuberculosis. This 64% culture-positive rate is more sensitive and specific than the histological demonstration of acid-fast bacilli (13.4%) in the diagnosis. It must be stressed that the pathologist can only report a picture consistent with or supportive of a diagnosis of tuberculosis and be more confident if acid-fast bacilli are seen microscopically. The diagnosis cannot be absolute except on a positive culture which also identifies typical or atypical mycobacteria and allows drug sensitivity testing. Surgeons removing lymph nodes in patients suspected to have tuberculous lymphadenitis must send these to both the bacteriologist and pathologist, the tissue to the former not being suspended in formalin but saline.

Adolescent↗
PubMed1980

The Singapore heroin control programme.

In 1975 Singapore experienced a sudden heroin epidemic, and within two years an estimated 3 per cent of the males, 15-24, were involved. In 1977 the Government responded with an all-out enforcement strategy aimed at rapid containment. Demand reduction involved the large scale arrest of suspected users, and the immediate commitment of those with positive urines to Drug Rehabilitation Centres. The primary rehabilitation emphasis is on instilling discipline, social responsibility and sound work habits. Releases are placed on two years of compulsory supervision with a 5-day cycle for reporting and urine specimens. Sixty-three per cent show no detected drug use within the first year of supervision. Supply reduction efforts are equally strong and, while these were not immediately successful in limiting availability, heroin is currently very scarce and expensive. While there is some evidence of the substitution of cannabis, psychotropic drugs and alcohol, the number of new heroin cases is minimal. Overall, the epidemic appears to have been controlled.

Drug and Narcotic Control↗
PubMed1981

A three-year streptococcal survey among Singapore school children. Part I--Carriership of streptococci.

A prospective three years' survey, conducted on a total of 491 children attending four schools in Singapore showed that the throat carrier rates for beta-haemolytic and group A streptococci varied from 15-31 percent and 6.6-15.7 per cent respectively. Malays had the highest streptococcal throat carrier rates followed by Indians/Pakistanis and the Chinese. There was no significant difference in streptococcal throat carrier rates between the sexes. Children from lowest family income of less than $500/- and those living in attap/zinc houses had the highest streptococcal carriage rates. On the other hand, children from households where two or less than two persons shared a room had the lowest beta-haemolytic and group A streptococcal throat carrier rates. No marked variation in the incidences of streptococcal carriage rates was detected during the rainy and dry seasons. Twelve (2.4 percent) of the children haboured beta-haemolytic streptococci on their healthy skin. Ten (2 percent) of these children were colonized by group A streptococci. T5/11/12/27/44 was found to be the most predominant pattern during the period of study. Other common T patterns were T3/13/B3264, T8/25/Imp19 and T4/24/26/28/29/46. 19(17.3 percent) of the throat group A strains were M-typable and 11 M types were differentiated.

Child↗
PubMed1981

The detection of active pulmonary tuberculosis in Singapore.

A prospective study was carried out to identify the services which were responsible for detection of pulmonary tuberculosis in Singapore. It was found that the public health services were the sources of 58.8% of cases. Among them the Tuberculosis Control Department detected the largest proportion (25.8%) of cases. These formed the majority of the asymptomatic and a large proportion of the abacillary cases detected. It was suggested that this reflected the result of the Department's active case-finding programme. The private practitioners identified 30% of patients. More than half of them were bacillary cases and they were a significant proportion of all infectious cases detected. Thus while the Department of Tuberculosis Control detected most of the patients with early tuberculosis disease, the bulk of the infectious cases with extensive disease were diagnosed by the private practitioners. Both sectors complement each other in the detection of tuberculosis cases in the country. An improvement and expansion of the existing case detection programme among patients attending the clinics of private practitioners and the Outpatient Service Department's dispensaries was recommended. The way in which this could be done and some of the problems that might be encountered were discussed.

Bacteriological Techniques↗
PubMed1981

Dengue haemorrhagic fever in Singapore.

The history of dengue haemorrhagic fever as distinct from dengue fever in South-East Asia is traced. The epidemiology of the disease in the various countries is contrasted with that in Singapore since DHF first appeared on the scene in South-East Asia. From this survey, it is concluded that the dengue haemorrhagic fever is a new disease presentation, and its fate in SE Asia depends on the immunological state of the community, attempts at vector control, and probably antigenic variation in the various types of dengue virus. The pathogenetic mechanisms are discussed in detail. Diagnosis is presented with a detailed discussion of diagnosis of the pre-shock stage. Finally, the management of dengue haemorrhagic fever is discussed.

Dengue↗
PubMed1982

Histopathological profile of adult nephrotic syndrome in Singapore.

The renal biopsies of 100 patients presenting with the Nephrotic Syndrome were analysed. Eighty-seven percent were due to primary glomerulonephritis and the other 13% due to secondary glomerulonephritis of which Systemic Lupus Erythematosus was the commonest. Diffuse mesangial proliferative glomerulonephritis (DPGN) formed the largest group (60%). Minimal lesion occurred in 15% of patients and only 5% had Membranous Glomerulonephritis. 63% of patients with DPGN had negative staining on immunofluorescence. Even though Mesangial IgA Nephritis is prevalent in Singapore, it accounted for only 4% of glomerulonephritis causing the Nephrotic Syndrome.

Adolescent↗
PubMed1982

Infant, neonatal and perinatal mortality rates in Singapore.

Infant, neonatal and perinatal mortality rates are reliable indices of the health status and delivery of health care in a country. These rates have been declining in Singapore since World War II, and presently have become comparable to those of many developing countries. The pattern has also changed; postneonatal mortality has fallen markedly, resulting in neonatal mortality accounting for 75% of infant mortality, and first week mortality for 85% of neonatal mortality. Perinatal mortality rates have also declined over the years, due mainly to a decline in the first week mortality rates though a slight fall in stillbirth rates has also occurred. Further improvements can be expected in the perinatal and neonatal mortality rates. As neonatal intensive care improves, the prognosis of the very small and feeble infants will be brighter even though the efforts required might be very much greater. Such a challenge will prove to be very exciting and stimulating, and be an impetus to the raising of neonatal intensive care to a much higher level.

Female↗
PubMed1982

Neurosurgery in Singapore.

Neurosurgery was first done in 1956 by Sir Douglas Miller of Australia in 'A' Surgical Unit, Outram Road General Hospital. A section on neurosurgery was started in 1965 by Dr C F Tham at Thomson Road General Hospital. In September 1972, a new and fully equipped Department of Neurosurgery and Neurology was established. It is fully staffed and serves the whole of Singapore.

Humans↗
PubMed1982

The development of blood services in Singapore.

The Singapore Blood Transfusion Service (BTS) collects, processes and distributes blood and blood components to all hospitals. It also provides clinical and diagnostic haematological services to the hospitals. Blood donation is based on an entirely voluntary system. Blood donor incentives include a scheme of medical benefits for regular blood donors. Major advances in the 1960s include the introduction of disposable plastic blood packs for blood collections which permitted blood components to be prepared in a closed system. The development of a mobile blood collection service has enabled many more donor sources to be tapped. Hepatitis B Surface Antigen (HBsAg) screening of blood donors was introduced in 1973 as local studies showed that HBsAg positive blood was associated with a high risk of hepatitis. HBsAg positive donors are permanently excluded from the donor panel. BTS provides reference services for Immunohaematology, Coagulation problems, a clinical and diagnostic haematology service and a haemophilia centre. A computerized system of blood donor call up and the introduction of automation in the transfusion and haematology laboratories have helped BTS cope with an increasing volume of work and at the same time restrain manpower increases.

Blood Banks↗
PubMed1982

Pathology services in Singapore.

The provision of an adequate Pathology Service is essential for the rational diagnosis, management and control of diseases. In Singapore such a need has long been recognised, and the service has made substantial progress since it started.

Hospital Departments↗
PubMed1982

Clinical biochemistry in Singapore--past and present.

This paper traces the historical development of the practice of clinical biochemistry in Singapore and presents the current status of the special branch of laboratory medicine in the country. The rapid expansion in the field which has taken place over the last three decades, has no parallel in any other medical specialty. This has presented unique problems. The approaches taken to solve these problems are described and the following areas are highlighted: scope of biochemical investigations, research and development, methodology and instrumentation, laboratory workload, automation and computerisation, costing of laboratory service, reference values, quality control, training, education, international relations and professional activities.

Chemistry, Clinical↗
PubMed1982

The development of radiation therapy in Singapore--its present status & future prospects.

X-rays were introduced into Singapore soon after their discovery but their use in therapy did not take place until 1914. Radiation therapy was widely used only after 1949 when the first deep X-ray machine was installed. Since then the number of patients given this treatment has progressively increased, keeping pace with the rising cancer incidence. In 1981, 2533 cases were referred for treatment, out of which 1889 were given radiation treatment. The value of radiotherapy in malignant disease has been established both as a palliative as well as a radical method of treatment. Through improved techniques, better therapy equipment, and greater understanding of malignant disease, results of radical radiotherapy have shown progressive improvement. Further advances can be expected with newer techniques which have been put to clinical trials recently. These are planning with CT Scan, conformation radiotherapy, radiation sensitizers and protectors, hyperfractionation, hyperthermia, intraoperative radiotherapy, heavy particle radiotherapy and isotopic immunoglobulin therapy.

Forecasting↗
PubMed1982

The cardiovascular laboratory at the Singapore General Hospital, 1964-1981.

The invasive cardiac laboratory at the Singapore General Hospital was established in 1964. It was completely renovated and re-equipped in 1975 to cater for all the permutations and combinations that may be required for the safe conduct of cardiac catheterization procedures. A total of 4,849 procedures were done by 33 operators over 18 years. Patients for invasive procedures were usually discussed at the Monday Cardiac Conference prior to a decision being made to study. As such, the selected patients were usually the ill ones and the patients who required cardiac surgery. In the 1807 cardiac catheterizations done between 1975 and 1979, 1137 patients were found to be suffering from congenital heart disease, 586 were found to have acquired heart disease and 46 patients had coronary heart disease. The commonest congenital cardiac defect was atrial septal defect (or patent foramen ovale). Secondary pulmonary hypertension was found in 373 patients with acquired heart disease. Major complications occurred on 149 occasions and these were all in ill patients with severe heart disease.

Cardiac Catheterization↗
PubMed1982

Hydatidiform mole in Singapore.

A five year retrospective analysis of 198 cases of hydatidiform mole recorded in three maternity hospitals in Singapore is presented. The incidence was 1 in 868 deliveries. The number of molar pregnancies in the first half of the year was higher than in the subsequent six months. The incidence of hydatidiform mole and its correlation with possible environmental factors is discussed.

Communicable Diseases↗
PubMed1982

Lead exposure patterns and parameters for monitoring lead absorption among workers in Singapore.

A study was carried out among 1414 workers in 14 industries in Singapore to determine the extent of their exposure to lead and their lead absorption. High-level exposure situations found included secondary lead smelting, followed by mixing of lead salt stabilizers and lead storage battery manufacture. Other exposure situations included those relating to lead welding, print shop, wire splicing, leaded paint manufacture, fire-fighting and soldering. Early cases of lead absorption could not be detected by clinical signs alone. Other parameters such as blood lead and delta-aminolaevulinic acid dehydratase had to be used. There was good correlation between a rise in blood lead and a fall in delta-aminolaevulinic acid dehydratase levels.

Air Pollutants, Occupational↗
PubMed1980

The pattern of maxillo-facial injuries in Singapore.

This is a study of 1,404 patients with maxillo-facial injuries treated at the Dental Clinic, Singapore General Hospital during the period January 1977 to December 1979. The significant features in the pattern of injuries in this group of patients are: 1. the commonest causes of maxillo-facial injuries are falls from height and automobile accidents. 2. the age group most affected is 0 to 39 years. 3. a high incidence in males (72.2%). The various modalities of treatment are also reviewed. Recent trends in the management of complex maxillo-facial fractures have significantly reduced the period of hospitalisation.

Adolescent↗