Aged ; Female ; Humans ; Maxillary Sinus ; parasitology ; Myiasis ; Nasal Cavity ; parasitology

Adaptation, Psychological ; Humans ; Interdisciplinary Communication ; Male ; Muscular Dystrophy, Duchenne ; therapy ; Patients ; psychology ; Singapore

Objective: To analyze the effect of colorectal cancer screening in the general population in Guangzhou, and provide evidence for the for development of colorectal cancer screening policy and strategy. Methods: The data of colorectal cancer screening in Guangzhou during 2015- 2016 were collected. The participation, the positive rate of fecal occult blood test, the detection rate of colonoscopy and screening effect of colonoscopy were evaluated. Results: A total of 220 834 residents aged 50-74 years received the screening, and the positive rate of the screening was 16.77% (37 040 cases). Colonoscopy was performed for 7 821 cases (21.12%). Colorectal lesions were found in 4 126 cases (52.76%), of which 614 (7.85%) and 73 (0.93%) and 230 (2.94%) were identified as advanced adenoma, severe dysplasia lesions and colorectal cancers, respectively. The detection rates of all colorectal lesions were higher in men than in women (all P<0.01). The diagnostic rate of early lesion was 87.24%, and 99 early cancer cases were found, accounting for 46.26% of the total cases. The overall screening detection rate of colorectal cancer was 104.15/100 000, higher than the incidence rate (81.18/100 000) in colorectal cancer surveillance (P<0.001), but age group <70 years had higher detection rate, age group ≥70 years had higher incidence rate. Conclusions: The colorectal cancer screening strategy in Guangzhou is effective in the detection of the population at high risk, increase the detection rate of colorectal lesions, early diagnosis rate of precancerous lesions and diagnosis rate of early colorectal cancer. The benefit in those aged ≤69 years was more obvious than that in those aged 70-74 years. It is necessary to improve the compliancy of colorectal cancer screening in population at high risk.
Adenoma/prevention & control* ; Aged ; China/epidemiology* ; Colonoscopy/statistics & numerical data* ; Colorectal Neoplasms/prevention & control* ; Early Detection of Cancer/methods* ; Female ; Humans ; Immunochemistry ; Male ; Mass Screening/statistics & numerical data* ; Middle Aged ; Occult Blood ; Predictive Value of Tests

Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.
Atrial Fibrillation ; Heart Valve Diseases ; Humans ; Hypertension, Pulmonary ; Mitral Valve Insufficiency ; Ventricular Dysfunction, Left

In response to the demands of an ageing nation, the postgraduate medical education in Singapore is currently in the early stage of transition into the American-styled residency programme. This study assessed the expectations of both radiology trainees and faculty on their ideal clinical learning environment (CLE) which facilitates the programme development. A modified 23-item questionnaire was administered to both trainees and faculty at a local training hospital. All items were scored according to their envisioned level of importance and categorised into 5 main CLE domains-supervision, formal training programme, work-based learning, social atmosphere and workload. 'Supervision' was identified as the most important domain of the CLE by both trainees and faculty, followed by 'formal training programmes', 'work-based learning' and 'social atmosphere'. 'Workload' was rated as the least important domain. For all domains, the reported expectation between both trainees and faculty respondents did not differ significantly. Intragroup comparison also showed no significant difference within each group of respondents. This study has provided valuable insights on both respondents' expectations on their ideal CLE that can best train competency in future radiologists. Various approaches to address these concerns were also discussed. The similarities in findings between ours and previous studies suggest that the 'supervision', 'formal training programmes' and 'work-based learning' domains are crucial for the success of a postgraduate medical training and should be emphasised in future curriculum. 'Workload' remains a challenge in postgraduate medical training, but attempts to address this will have an impact in future radiology training.
Attitude of Health Personnel ; Competency-Based Education ; Curriculum ; Education, Medical, Graduate ; methods ; organization & administration ; Faculty, Medical ; Female ; Humans ; Internship and Residency ; methods ; organization & administration ; Male ; Radiology ; education ; Singapore ; Students, Medical ; psychology ; Surveys and Questionnaires ; Workload

INTRODUCTIONWhile paediatric strokes are fairly uncommon, they are often associated with significant long-term disability. Diagnosis is often delayed because of the need to exclude conditions that mimic stroke. Understanding the outcomes related to stroke in children is important in the development of secondary prevention strategies. The aim of this study was to evaluate the epidemiology of childhood stroke in a tertiary paediatric unit in Singapore and to assess factors influencing outcome in these children.

MATERIALS AND METHODSA retrospective case-note review of all childhood strokes presenting to the Children's Medical Institute (CMI) at the National University Hospital (NUH), Singapore between October 1999 and May 2006. Data collected include demographic factors, clinical presentation, diagnosis, subsequent management and follow-up using specific outcome measures.

RESULTSTwenty-six children with a median age of 8.0 years at presentation were identified, comprising 15 ischaemic strokes (57.7%), 10 haemorrhagic strokes (38.5%) and 1 patient with both ischaemic and haemorrhagic lesions. The most common symptoms at presentation were seizures (15/26, 57.7%), lethargy (11/26, 42.3%), hemiparesis (10/26, 38.5%) and altered levels of consciousness (10/26, 38.5%). Vascular abnormalities accounted for 50% of strokes in our study population. The average length of follow-up was 33.2 months (range, 1 to 120) with only 11 children (11/26, 42.3%) achieving full recovery. Significant prognostic factors include altered consciousness and seizures at presentation, lesions in both cortical and subcortical locations, systemic disease aetiology, neurological deficits at discharge and seizures at the time of discharge.

CONCLUSIONLong-term neurological, neuropsychological and functional impairment are common in survivors of paediatric strokes. Certain clinical features and lesion characteristics are useful indicators of prognosis in these children.

Adolescent ; Age Factors ; Asian Continental Ancestry Group ; Brain Ischemia ; epidemiology ; etiology ; rehabilitation ; Cerebral Hemorrhage ; etiology ; Child ; Child, Preschool ; Developmental Disabilities ; etiology ; Female ; Humans ; Infant ; Intracranial Arteriovenous Malformations ; complications ; Length of Stay ; statistics & numerical data ; Male ; Neuropsychological Tests ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Singapore ; epidemiology ; Stroke ; epidemiology ; etiology ; Stroke Rehabilitation ; Treatment Outcome ; Vascular Diseases ; complications

The United Nations has identified the training and education of healthcare professionals and care providers involved in the care of older persons as a global priority. Singapore is no exception as it faces a rapidly ageing population. Older people have many medical needs of varying dimensions and their care requires a multidisciplinary healthcare team. The current status of geriatric education of health professionals involved in elderly care in Singapore is discussed in this paper. Important issues raised include the disparity between professions in the stages of development of geriatric education, questions on the adequacy of numbers and training of healthcare professionals providing geriatric care, as well as the need for geriatric education of caregivers.
Aged ; Geriatric Nursing ; education ; Health Personnel ; education ; Humans ; Singapore

No abstract available.
Diastole

Nonalcoholic fatty liver disease (NAFLD) affects about a third of the world’s adult population and is a major public health concern. NAFLD is defined by the presence of hepatic steatosis and the absence of other causes of liver disease. As NAFLD is closely associated with the presence of the metabolic syndrome, several experts have called for a change in nomenclature from NAFLD to metabolic-associated fatty liver disease (MAFLD) to better reflect the underlying pathophysiology of NAFLD as a metabolically driven disease and shift to a “positive” diagnostic criteria rather than one of exclusion. Recent studies have suggested that the global prevalence of MAFLD is higher than that of NAFLD, and patients with MAFLD have more metabolic comorbidities compared to those with NAFLD. Emerging data also suggest that all-cause and cardiovascular mortality may be higher in MAFLD compared with NAFLD. In this synopsis, we discuss differences in clinical features, prevalence and clinical outcomes between NAFLD and MAFLD. In addition, we highlight the advantages and disadvantages of a name change from NAFLD to MAFLD from the perspective of the scientific community, care providers and patients.

Objective: Low-density lipoprotein-cholesterol (LDL-C) remains a clinically important cholesterol target in primary prevention of atherosclerotic cardiovascular disease. The present study aimed to assess the practical differences among three equations utilized for the estimation of LDL-C: the Friedewald, the Martin/Hopkins, and the NIH equation 2. Methods: Blood lipid measurements from 4,556 noninstitutionalized participants, aged 12 to 80, were obtained from the 2017-2020 National Health and Nutrition Examination Survey study. We 1) assessed the differences between three calculated LDL-C estimates, 2) examined the correlations between LDL-C estimates using correlation coefficients and regression, and 3) investigated the degree of agreement in classifying individuals into the LDL-C category using weighted Kappa and percentage of agreement. Results: The differences in LDL-C estimates between equations varied by sex and triglyceride levels (p<0.001). Overall, the mean of absolute differences between Friedewald and Martin/ Hopkins was 3.17 mg/dL (median=2.0, 95% confidence interval [CI] [3.07–3.27]). The mean of absolute differences between Friedewald and NIH Equation 2 was 2.08 mg/dL (median=2.0, 95% CI [2.03–2.14]). Friedewald correlated highly with Martin/Hopkins (r=0.991, rho=0.989) and NIH Equation 2 (r=0.998, rho=0.997). Cohen’s weighted Kappa=0.92 between Friedewald and Martin/Hopkins, and 0.95 between Friedewald and NIH equation 2. The percentage of agreement in classifying individuals into the same LDL-C category was 93.0% between Friedewald and Martin/Hopkins, and 95.4% between Friedewald and NIH equation 2. Conclusion Understanding the practical differences in LDL-C calculations can be helpful in facilitating decision-making during a paradigm shift.