UNLABELLEDThe prevalence of chronic pain is well described in various parts of the world; primarily in Western societies such as Europe, America and Australia. Little is known of the prevalence of chronic pain within Asia or Southeast Asia. In view of the cultural and genetic variation in pain causation, manifestation and reporting, the findings of previous studies cannot be translated to Asian countries. Prevalence studies needed to be carried out to quantify the magnitude and impact of chronic pain within Asian countries to properly allocate precious health funds to deal with this important healthcare issue. We report the findings of the prevalence study within one Asian country: Singapore.

OBJECTIVETo determine the prevalence and impact of chronic pain in adult Singaporeans.

MATERIALS AND METHODSTwo sets of questionnaires were designed. The first, a screening questionnaire, to identify the prevalence of chronic pain, and should there be chronic pain; the second, a detailed questionnaire was administered, to characterise the features and the impact of pain. A cross-sectional sampling of Singapore adults were achieved using a computer-based multi-step random sampling of listed telephones numbers. The questionnaires were administered via telephone by a trained interviewer with the aid of a computer-assisted telephone interview system.

RESULTSA total of 4141 screening and 400 detailed questionnaires were completed. The prevalence of chronic pain, defined as pain of at least 3 months' duration over the last 6 months was 8.7% (n = 359). There was a higher prevalence in females (10.9%) and with increasing age. In particular, pain prevalence increased steeply beyond the age of 65 years old. There was a significant impact on work and daily function of those with chronic pain.

CONCLUSIONThough the prevalence of chronic pain was marginally lower compared other studies, the impact of pain was just as significant. In a rapidly ageing population such as Singapore, chronic pain is an important emerging healthcare problem which will likely exert increasing toll on the existing social infrastructure within the next 5 to 10 years.

Absenteeism ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Humans ; Income ; Male ; Middle Aged ; Pain, Intractable ; epidemiology ; physiopathology ; Singapore ; epidemiology ; Surveys and Questionnaires ; Young Adult

Eurycoma longifolia, locally known as 'Tongkat Ali' is a popular local medicinal plant that possess a lot of medicinal properties as claimed traditionally, especially in the treatment of malaria. The claims have been proven scientifically on isolated compounds from the plant. The present study is to investigate the anti malaria properties of Eurycoma longifolia standardized extract (root) (TA164) alone and in combination with artemisinin in vivo. Combination treatment of the standardized extract (TA164) with artemisinin suppressed P. yoelii infection in the experimental mice. The 4 day suppressive test showed that TA164 suppressed the parasitemia of P. yoelii-infected mice as dose dependent manner (10, 30 and 60 mg/kg BW) by oral and subcutaneous treatment. By oral administration, combination of TA164 at 10, 30 and 60 mg/kg BW each with artemisinin respectively showed a significant increase in the parasitemia suppression to 63, 67 and 80 percent as compared to artemisinin single treatment (31%). Using subcutaneous administration, at 10 mg/kg BW of TA164 in combination with 1.7 mg/kg BW of artemisinin gave a suppression of 80% of infection. This study showed that combination treatment of TA164 with artemisinin gives a promising potential anti malaria candidate using both oral and subcutaneous route, the later being the most potent.
artemisinine ; therapeutic aspects ; Psychological suppression ; Laboratory mice ; Subcutaneous

Introduction: Hepatitis B virus (HBV) infection is one of the major public health problems in Malaysia. It remains the most common permanent deferral among blood donors. In Malaysia, the national vaccination programme has been introduced since 1989 to prevent HBV transmission. The objective of this study is to determine the prevalence and associated risk factors of HBV infection among first-time blood donors after the implementation of the national hepatitis B vaccination programme. Methods: This is a retrospective cohort study involving tracing of the database of National Blood Centre Malaysia. The record of first-time blood donors who had donated between 1st January 2010 and 31st December 2015 and were screened HBV positive was reviewed and analysed. Results: There were 376,737 first-time donors who had donated blood and 575 of them screened positive for HBV. The overall prevalence of seropositive for hepatitis B was 0.15%. The prevalence was higher at 0.23% among donors born before the year 1989 (pre-vaccination era) compared to 0.05% among donors born in and after the year 1989 (post-vaccination era). Perinatal transmission was found to have 15 times higher odds of developing HBV infection as compared to those who had the combination of risk factors among those born after the year 1989 (adjusted OR=14.95, 95% CI 1.80=124.01). Conclusion: The implementation of the national vaccination programme reduced the prevalence of hepatitis B among donors who received vaccination at birth compared to those who did not.
Vaccination

Complex regional pain syndrome secondary to brachial plexus injury is often severe, debilitating and difficult to manage. Percuteneous radiofrequency sympathectomy is a relatively new technique, which has shown promising results in various chronic pain disorders. We present four consecutive patients with complex regional pain syndrome secondary to brachial plexus injury for more than 6 months duration, who had undergone percutaneous T2 and T3 radiofrequency sympathectomy after a diagnostic block. All four patients experienced minimal pain relief with conservative treatment and stellate ganglion blockade. An acceptable 6 month pain relief was achieved in all 4 patients where pain score remained less than 50% than that of initial score and all oral analgesics were able to be tapered down. There were no complications attributed to this procedure were reported. From this case series, percutaneous T2 and T3 radiofrequency sympathectomy might play a significant role in multi-modal approach of CRPS management.
Analgesics ; Brachial Plexus ; Brachial Plexus Neuropathies ; Chronic Pain ; Humans ; Stellate Ganglion ; Sympathectomy

PURPOSE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD) uses the post-bronchodilator spirometry for diagnosis and severity staging. We evaluated differences in the severity classification of COPD, based on pre- and post-bronchodilator spirometry. MATERIALS AND METHODS: From 2000 to 2004, 207 COPD patients who underwent spirometry before and after inhalation of 400 microg of fenoterol were analyzed. A responder to the bronchodilator test (BDT) was defined by the American Thoracic Society (ATS) as an increase in forced expiratory volume in one second (FEV1) or forced vital capacity > or = 12% and > or = 200 mL, and by the European Respiratory Society (ERS) as an increase in FEV1 > or = 10% of the predicted value. COPD severity was classified according to the 2008 GOLD guidelines. RESULTS: For the entire study population, the FEV1 increased by 11.8 +/- 12.5% of baseline after BDT and 41.1% and 27.1% of subjects were classified as responders using the ATS and ERS criteria, respectively. Based on pre-BDT spirometry, 55, 85, 58, and 9 patients were classified as Stage I-IV COPD, respectively. Sixty-seven (32.4%) patients changed severity staging after BDT, including 20.0%, 28.2%, 44.8%, and 66.7% of pre-BDT patients Stages I through IV, respectively. More ATS or ERS BDT-responders had a change in severity staging than non-responders (52.9% vs. 18.9% and 62.5% vs. 21.2%, both p < 0.001). CONCLUSION: Our data suggest that the severity staging of COPD using pre-BDT spirometry might lead to significant differences as compared to staging, based on post-BDT spirometry, as recommended by the current GOLD guidelines.
Bronchodilator Agents/*diagnostic use ; Fenoterol/diagnostic use ; Forced Expiratory Volume/drug effects ; Humans ; Practice Guidelines as Topic ; Prognosis ; Pulmonary Disease, Chronic Obstructive/*diagnosis ; Spirometry/methods

INTRODUCTIONThe aim of this study is to report normative data for the Short-Form 36 version 2 (SF-36v2) for assessing health-related quality of life, in the Singapore general population.

MATERIALS AND METHODSData for English and Chinese-speaking participants of the Singapore Prospective Study Programme were analysed. The SF-36v2 scores were norm-based with the English-speaking Singapore general population as reference and reported by age (in decades), gender and ethnicity as well as for the 5 most prevalent chronic medical conditions. Scores were reported separately for the English and Chinese language versions.

RESULTSA total of 6151 English-speaking (61.5% Chinese and 19.2% Malay) and 1194 Chinese-speaking participants provided complete data. Mean (SD) age of all participants was 49.6 (12.58) years with 52.4% being women. In both languages, women reported lower scores than men on all scales. Among the chronic medical conditions, stroke had the largest impact on all English SF-36v2 scales and on 3 Chinese SF-36v2 scales (role-physical, general health and social functioning).

CONCLUSIONWe have provided detailed normative data for the Singapore English and Chinese SF-36v2, which would be valuable in furthering HRQoL research in Singapore and possibly the region.

Adult ; Female ; Health Surveys ; standards ; statistics & numerical data ; Humans ; Language ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Singapore ; Young Adult

Introduction: Endoscopic sinus surgery (ESS) is themainstay for treatment of chronic rhinosinusitis versusmaximal medical therapy. We propose a more economicaloption, by using steroid-impregnated Gelfoam instead ofNasopore post ESS, as it is less expensive and has showedeffectiveness in preventing post-operative bleeding.Materials and methods: A randomised, double-blinded,placebo-controlled trial was carried out in eight patients with chronic rhinosinusitis or nasal polyposis who were planned for bilateral endoscopic sinus surgery. A Peri-operative Sinus Endoscopy (POSE) Score and Lund-KennedyEndoscopic Score (LKES) were recorded. The use ofhydrocortisone-impregnated Gelfoam dressing versusnormal saline-impregnated Gelfoam dressing werecompared. Scores were repeated post-operatively at oneweek, three weeks and three months interval.Results: For LKES, at the end of three months, 50% of thepatients had the same score difference, 37.5% had betterresults on the study side while 12.5% had better results onthe control side. Meanwhile, for POSE Score, at the end ofthree months, 75% of the patients had better scoredifference on the study side while 12.5% had better resultson the control side.Conclusion: Gelfoam can be used as nasal packing materialto deliver topical steroid after endoscopic sinus surgery.Steroid-impregnated nasal dressing after endoscopic sinussurgery may not provide better long-term outcome.

INTRODUCTIONWhile opioids are effective in carefully selected patients with chronic non-cancer pain (CNCP), they are associated with potential risks. Therefore, treatment recommendations for the safe and effective use of opioids in this patient population are needed.

MATERIALS AND METHODSA multidisciplinary expert panel was convened by the Pain Association of Singapore to develop practical evidence-based recommendations on the use of opioids in the management of CNCP in the local population. This article discusses specific recommendations for various common CNCP conditions.

RESULTSAvailable data demonstrate weak evidence for the long-term use of opioids. There is moderate evidence for the short-term benefit of opioids in certain CNCP conditions. Patients should be carefully screened and assessed prior to starting opioids. An opioid treatment agreement must be established, and urine drug testing may form part of this agreement. A trial duration of up to 2 months is necessary to determine efficacy, not only in terms of pain relief, but also to document improvement in function and quality of life. Regular reviews are essential with appropriate dose adjustments, if necessary, and routine assessment of analgesic efficacy, aberrant behaviour and adverse effects. The reasons for discontinuation of opioid therapy include side effects, lack of efficacy and aberrant drug behaviour.

CONCLUSIONDue to insufficient evidence, the task force does not recommend the use of opioids as first-line treatment for various CNCP. They can be used as secondor third-line treatment, preferably as part of a multimodal approach. Additional studies conducted over extended periods are required.

Analgesics, Opioid ; therapeutic use ; Chronic Pain ; drug therapy ; etiology ; Evidence-Based Medicine ; Humans

Refugees worldwide have been a challenge to many countries. Threats of preventable immunisable diseases amongst children that disrupt the herd immunity have been a concern as many countries lack a structured national policy to administer full vaccines to these refugees. Full immunisation coverage not only protected the refugees but also safeguarded the children of the home country. We designed a collaborative university-based community service partnership with UNHCR and International-Organisation-for-Migration, implemented a practice-integrated immunisation service initiative with the local community. This paper described the implementation process of an immunisation project for the refugees using the evaluative Logic Model. This model diagrammatically shows the relationships between the program's objectives, program activities, process indicators, outcomes, and resources used. It applies to program planning, operation, evaluation and address questions for decision making. The aim was to provide refugees' children below 18-years the complete doses of the national scheduled immunisation. The immunisation was given in six refugees-learning-centres in a total of 31 visits. The workflow includes administering the immunisation, health education, triaging, data collection, and monitoring the children immunised. A total of 1116 children received full immunisation within a period of eighteen months. Vaccines given were Pentavalent, Hepatitis B, Tetanus-Diphtheria, and Mumps-Measles-Rubella. This project has achieved more than 80% immunisation coverage for all the vaccines except Pentavalent (<50%). The Logic Model is useful for developing, implementing, and evaluating knowledge co-production partnerships in the context of a community delivery system in this project.

COVID-19/transmission* ; COVID-19 Testing ; Humans ; Infection Control ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Intraoperative Care ; Pandemics ; Personal Protective Equipment ; Postoperative Care ; Preoperative Care ; Tracheostomy/methods*