The objective was to estimate the prevalence of intestinal protozoa among the aborigines and to determine the problems regarding the infection. The study was carried out in January 2006 in Pos Senderut, Pahang, Malaysia. Samples of faeces were collected from children and adults and these were fixed in PVA and trichrome staining was carried out. From the 130 individuals studied, 94 (72.3%) were positive with at least one intestinal protozoa. Nine intestinal protozoa namely Blastocystis hominis, Giardia lamblia, Entamoeba histolytica, Entamoeba coli, Endolimax nana, Entamoeba hartmani, Entamoeba polecki, Iodamoeba butschlii and Chilomastix mesnili were detected. The prevalent species were B. hominis (52.3%), followed by G. lamblia (29.2%), E. coli (26.2%) and E. histolytica (18.5%). The other species ranged from 1.5 to 10.8%. Among the positive samples, mixed infection with E. histolytica and G. lamblia was 3.8%, E. histolytica and B. hominis was 15.4%, G. lamblia and B. hominis was 17.7%. Triple infection of E. histolytica, G. lamblia and B. hominis was 3.1%. The infection was more prevalent in children below 10 years age group (45.4%) and lowest in the age above 60 years (3.8%). The high prevalence was attributable to poor environmental management, poor personal hygiene and lack of health education.
Protozoal ; upper case gee ; Upper case ee ; Upper case Bee ; Infection as complication of medical care

INTRODUCTIONDengue fever remains a significant public health concern in Singapore. Appropriate, timely diagnosis and risk stratification for severe disease are crucial in the optimal management of this illness. In the outpatient setting, the primary care physician plays a key role in dengue diagnosis, management, and triage. We present a descriptive analysis of the variations in dengue knowledge, attitudes, and practices among primary care physicians (PCPs) in Singapore.

MATERIALS AND METHODSA survey of 25 multiple-choice questions was mailed to 2000 PCPs in Singapore. Responses were analysed by physician age group (21-40, 41-60, and >61) and practice setting (government subsidised polyclinic or private practice).

RESULTSOf the 3 questions assessing dengue knowledge, 89.9% chose 2 or 3 of the preferred responses. Half of the respondents utilised dengue diagnostic tests at least 50% of the time, and 75% used serology when doing so. Older respondents and those from private practices used diagnostic tests more often than their counterparts, and both groups favoured non-serology tests. About 85% of surveyed PCPs monitored confirmed or suspected cases daily, and one-third referred patients to a hospital always or often.

CONCLUSIONSWhile no major gaps in knowledge about dengue were identified in PCPs in Singapore, there were significant variations in clinical practice by physician age group and practice setting. The results of this survey provide a useful opportunity to identify strengths and areas in need of improved awareness in primary care management of dengue.

Adult ; Dengue ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Physicians, Primary Care ; Public Health ; Singapore ; Surveys and Questionnaires

While non-alcoholic fatty liver disease (NAFLD) is highly prevalent (15% to 45%) in modern societies, only 10% to 25% of cases develop hepatic fibrosis leading to cirrhosis, end-stage liver disease or hepatocellular carcinoma. Apart from pre-existing fibrosis, the strongest predictor of fibrotic progression in NAFLD is steatohepatitis or non-alcoholic steatohepatitis (NASH). The critical features other than steatosis are hepatocellular degeneration (ballooning, Mallory hyaline) and mixed inflammatory cell infiltration. While much is understood about the relationship of steatosis to metabolic factors (over-nutrition, insulin resistance, hyperglycemia, metabolic syndrome, hypoadiponectinemia), less is known about inflammatory recruitment, despite its importance for the perpetuation of liver injury and fibrogenesis. In this review, we present evidence that liver inflammation has prognostic significance in NAFLD. We then consider the origins and components of liver inflammation in NASH. Hepatocytes injured by toxic lipid molecules (lipotoxicity) play a central role in the recruitment of innate immunity involving Toll-like receptors (TLRs), Kupffer cells (KCs), lymphocytes and neutrophils and possibly inflammasome. The key pro-inflammatory signaling pathways in NASH are nuclear factor-kappa B (NF-kappaB) and c-Jun N-terminal kinase (JNK). The downstream effectors include adhesion molecules, chemokines, cytokines and the activation of cell death pathways leading to apoptosis. The upstream activators of NF-kappaB and JNK are more contentious and may depend on the experimental model used. TLRs are strong contenders. It remains possible that inflammation in NASH originates outside the liver and in the gut microbiota that prime KC/TLR responses, inflamed adipose tissue and circulating inflammatory cells. We briefly review these mechanistic considerations and project their implications for the effective treatment of NASH.
Adipose Tissue ; Apoptosis ; Carcinoma, Hepatocellular ; Cell Death ; Chemokines ; Cytokines ; Fatty Liver ; Fibrosis ; Hepatocytes ; Hyperglycemia ; Immunity, Innate ; Inflammation ; Insulin Resistance ; JNK Mitogen-Activated Protein Kinases ; Kupffer Cells ; Liver ; Liver Diseases ; Lymphocytes ; Metagenome ; Models, Theoretical ; Neutrophils ; NF-kappa B ; Toll-Like Receptors

INTRODUCTIONPeriprostatic nerve block (PPNB) is a common local anaesthetic technique in transrectal ultrasound-guided (TRUS) prostate biopsy, but concerns remain over the increased theoretical risks of urinary tract infection (UTI) and sepsis from the additional transrectal needle punctures. This study reviewed our biopsy data to assess this risk.

MATERIALS AND METHODSRetrospective data collected from 177 men who underwent TRUS biopsy between July 2007 and December 2009 in a single institution were analysed. PPNB was administered using 1% xylocaine at the prostatic base and apex and repeated on the contralateral side under ultrasound guidance. Complications, including UTI sepsis, bleeding per rectum and acute retention of urine (ARU) were noted. Every patient was tracked for the first 2 weeks for complications until his clinic review. Demographic profi le, biopsy parameters and histological fi ndings were reviewed. Univariate and multivariate analysis of possible risk factors for development of sepsis after TRUS biopsy were performed. Statistical analysis was performed using SPSS 17.0.

RESULTSNinety (51%) men received PPNB and 87 (49%) did not. The groups were matched in age (PPNB: mean 62.7 ± 5.8 years; without PPNB: mean 64.4 ± 5.7 years) and prebiopsy prostate specific antigen (PSA) levels (PPNB: mean 8.2 ± 3.9 ng/mL; without PPNB: mean 8.3 ± 3.7 ng/mL). The PPNB group had a larger prostate volume, with more cores taken (P <0.05). On univariate and multivariate analysis controlling for age, PSA, prostate volume, number of cores taken and histological prostatitis, PPNB was not a significant risk factor for sepsis. Sepsis rates were 5.6% in the PPNB group and 5.7% in the other group (P = 0.956). Overall prostate cancer detection rate was 33.3%.

CONCLUSIONThe risk of sepsis was not increased in patients who received PPNB, even though this group had larger gland volumes and more biopsy cores taken.

Aged ; Biopsy, Needle ; adverse effects ; methods ; Endosonography ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Nerve Block ; adverse effects ; methods ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; diagnosis ; Retrospective Studies ; Risk Factors ; Sepsis ; blood ; epidemiology ; etiology ; Singapore ; epidemiology

Purpose: One of the most common ileostomy-related complications is high output stoma (HOS) which causes significant fluids and electrolytes disturbances. We aimed to analyze the incidence, severity, and risk factors for readmission for HOS. Methods: We reviewed all patients who underwent loop ileostomy closure in a single institution between 2010 and 2020. Patients that were readmitted for dehydration due to HOS during the time interval between the creation and the closure of the stoma were identified and divided into a study (HOS) group. The remaining patients constructed the control group. Results: A total of 307 patients were included in this study, out of which, 41 patients were readmitted 73 times (23.7% readmission rate) for the HOS group, and the remaining 266 patients constructed the control group. Multivariate analysis identified; advanced American Society of Anesthesiologists (ASA) physical status (PS) classification, elevated baseline creatinine, and open surgery as risk factors for HOS. Renal function worsened among the entire cohort between the construction of the stoma to its closure (mean creatinine of 0.82 vs. 0.96, P<0.0001). Conclusion Loop ileostomy formation is associated with a substantial readmission rate for dehydration as a result of HOS, and increasing the risk for renal impairment during the duration of the diversion. We identified advanced ASA PS classification, open surgery, and elevated baseline creatinine as predictors for HOS.

INTRODUCTIONPrompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore.

MATERIALS AND METHODSThis is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied.

RESULTSEighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%).

CONCLUSIONWe found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use.

Aged ; Aged, 80 and over ; Ambulances ; Cardiopulmonary Resuscitation ; standards ; Electric Countershock ; standards ; Emergency Medical Services ; standards ; Female ; Humans ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest ; diagnosis ; therapy ; Retrospective Studies ; Singapore ; Transportation of Patients ; standards

BACKGROUND/AIMS: Acute pancreatitis complicated by walled-off necrosis (WON) is associated with high morbidity and mortality, and if infected, typically necessitates intervention. Clinical outcomes of infected WON have been described as poorer than those of symptomatic sterile WON. With the evolution of minimally invasive therapy, we sought to compare outcomes of infected to symptomatic sterile WON. METHODS: We performed a retrospective cohort study examining patients who were undergoing dual-modality drainage as minimally invasive therapy for WON at a high-volume tertiary pancreatic center. The main outcome measures included mortality with a drain in place, length of hospital stay, admission to intensive care unit, and development of pancreatic fistulae. RESULTS: Of the 211 patients in our analysis, 98 had infected WON. The overall mortality rate was 2.4%. Patients with infected WON trended toward higher mortality although not statistically significant (4.1% vs 0.9%, p=0.19). Patients with infected WON had longer length of hospitalization (29.8 days vs 17.3 days, p<0.01), and developed more spontaneous pancreatic fistulae (23.5% vs 7.8%, p<0.01). Multivariate analysis showed that infected WON was associated with higher odds of spontaneous pancreatic fistula formation (odds ratio, 2.65; 95% confidence interval, 1.20 to 5.85). CONCLUSIONS: This study confirms that infected WON has worse outcomes than sterile WON but also demonstrates that WON, once considered a significant cause of death, can be treated with good outcomes using minimally invasive therapy.
Cause of Death ; Cohort Studies ; Drainage ; Hospitalization ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Multivariate Analysis ; Necrosis ; Outcome Assessment (Health Care) ; Pancreatic Fistula ; Pancreatitis ; Pancreatitis, Acute Necrotizing ; Retrospective Studies

Bacterial Infections ; Humans ; Lymphoma, Large B-Cell, Diffuse/diagnosis* ; Mucormycosis/diagnosis* ; Respiratory Sounds ; Thyroid Gland

The neuronal ceroid lipofuscinoses correspond to a group of disorders characterized by neurodegeneration and intracellular buildup of auto-flourescent lipopigment (ceroid lipofuscin). They are classified by age of onset into infantile, late infantile, juvenile and adult forms. Among these, the late infantile type is caused by mutations in tripeptidyl peptidase 1 (TPP1) gene and is characterized by age of onset between 2-4 years, seizures, early progressive cognitive impairment and visual loss. Our patient is a 4-year-old girl who presented at 2 years and 10 months old with seizures followed by ataxia, regression of skills and eventual visual decline. TPP1 enzyme activity was below normal for age. This report aims to increase the awareness of physicians on the cluster of symptoms characteristic of this disorder which will help facilitate early diagnosis and prompt institution of appropriate management.
Neuronal Ceroid-Lipofuscinoses ; Cognitive Dysfunction

Introduction: Patient education is integral in the management of gestational diabetes mellitus (GDM), a common pregnancy complication that may cause adverse perinatal outcomes. This study evaluated the effect of diabetes education on the knowledge and attitude among patients with GDM, comparing pre- vs post-diabetes session scores and determining pregnancy outcomes. Methodology: A one-group pre-test and post-test experimental design study was conducted on 75 patients after one- session diabetes counseling using the Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) and the third version of the Diabetes Attitude Scale (DAS-3). Results: Of the 75 subjects, 84% exhibited adequate knowledge of diabetes. Post-education, a significant increase in the total scores was seen among those less than 35 years of age (p-value: 0.003), both employed and unemployed (p-value: 0.0.026, 0.047, respectively), with a secondary level of education (p-value: 0.014) and multigravid (p-value: 0.015). An overall median positive attitude score of 3.6 was documented. For neonatal outcomes, no adverse events existed. For maternal outcomes, 17.9% had elevated fasting blood glucose while 7.1% had elevated 2-hour post-glucose tolerance test. Conclusion Diabetes education improves patient’s knowledge but not their attitude. Hence, improvement in attitude interventions should be incorporated into the current diabetes education program.
Diabetes, Gestational ; Knowledge ; Attitude