Objective: This study aims to determine the quality of life (QOL) of Malaysian women based on their physical and mental scores and correlates with age and cervical disease severity. Methods: This is a cross-sectional study from Nov 2006 till Dec 2007 from participating Gynecology-Oncology outpatient and in patient’s wards. QOL interviews used the SF-36 questionnaires. Main domains were the Physical Composite Scores (PCS) and the Mental Composite Scores (MCS). Results: A total of 396 participated in the study. Mean respondents age were 53.31 ± 11.21 years, educated till secondary level (39.4%), Malays (44.2%) with mean marriage duration of 27.73 ± 12.12 years. Among pre-invasive diseases, the cervical intra epithelial neoplasia (CIN) 1 was the highest in percentage of cases (8.1%). Among invasive cancer, stage 1 cancer was highest (31.1%), followed with stage 2 (28.3%), stage 3 (7.3%) and stage 4 cancers (5.8%). PCS scores are highest among the pre-invasive and stage 1 cancer (F=4.357; p<0.0001) and influenced by age and income. MCS were not significantly influenced by age or stage of cervical diseases (F= 1.393; p=0.206) but the regression model showed that amount spent on health care was a significant factor. Conclusion: Cervical diseases posed a substantial cause in reducing QOL with increasing age and disease severity. This disability can be reduced with early screening and intervention to prevent disease progression. Reducing disease burden play a role to improve QOL among at risk women before developing late stages of disease.

Recent epidemics and pandemics have highlighted a number of ethical concerns about the response to the increasing threat of emerging infectious diseases. Some of these ethical concerns are very fundamental. They include why a pandemic was declared, how much clinical information can be collected for public health without threatening patient confidentiality and how to ensure fairness in the distribution of resources. We discuss these issues and suggest approaches to resolve these dilemmas as we anticipate the next pandemic.
Communicable Disease Control ; Communicable Diseases ; epidemiology ; Disease Outbreaks ; ethics ; Ethics, Medical ; Global Health ; Humans ; Pandemics ; ethics ; Public Health Practice ; ethics ; Quarantine ; Sentinel Surveillance ; Singapore ; epidemiology

Fecal occult blood test (FOBT) screening has been shown to decrease the incidence and mortality of colorectal cancer (CRC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the immunochemical fecal occult blood test (i-FOBT) in diagnosing CRC were assessed among the patients in a tertiary referral hospital in Malaysia. A total sample of 814 patients aged 16 to 85 years old who performed i-FOBT and endoscopic screenings was obtained. The patients were recruited for a retrospective investigation. Sensitivity, specificity, PPV, and NPV were derived for the CRC screenees. Out of the 814 patients screened using i-FOBT, half of them were above 59 years old (49.6%), and 36% had positive i-FOBT. Gender distribution was almost equal, where 53.4% of the patients were female, and 46.6% were male. Majority of the patients were Malays (56.6%), followed by Chinese (24.0%), Indians (16.5%), and others (2.9%). Among the 71 patients referred for colonoscopy, 57.7% and 42.3% corresponded to positive and negative i-FOBT cases, respectively. Polyps were found to be most common among the patients (25.6%), 7.0% were found positive for invasive CRC, and 35.2% had normal colonoscopic findings. There was a significant association between colonoscopic finding and positive i-FOBT (p=0.001). The sensitivity, specificity, PPV, and NPV for CRC detection were 66.7%, 43.0%, 9.8%, and 93.3%, respectively. The results indicate that i-FOBT is a useful tool in the detection of abnormalities in the lower gastrointestinal tract and therefore serves as a cornerstone for potential large-scale screening programmes.

INTRODUCTIONThe incidence of cough induced by angiotensin-converting enzyme (ACE) inhibitors has been reported to be 5%-20%, with less than half of affected patients requiring discontinuation due to persistent cough. However, the incidence in the local Asian population has not been studied. This study aimed to objectively evaluate the incidence of discontinuation of ACE inhibitors due to cough, in a primary healthcare centre in Singapore.

METHODSWe retrospectively reviewed the medical records, both electronic and written, of patients who attended Tampines Polyclinic to identify those who were newly prescribed ACE inhibitors. The written medical records were analysed to identify patients who discontinued the use of ACE inhibitors and to find out the reasons for discontinuation.

RESULTSA total of 424 patients were identified during the study period. Out of the 424 patients, 129 (30.4%) discontinued the use of ACE inhibitors due to cough. Overall, 90 (21.2%) patients who were initially started on ACE inhibitors were eventually switched to angiotensin receptor blockers (ARBs).

CONCLUSIONIn our cohort, the incidence of discontinuation of ACE inhibitors due to cough is higher than most other studies. The relationship between ethnicity and tolerance of medications should not be underestimated. As there is a high incidence of discontinuation of ACE inhibitors due to cough in the local population, ARBs may be a reasonable substitute as a first-line medication, if clinically indicated.

Angiotensin-Converting Enzyme Inhibitors ; adverse effects ; Cough ; chemically induced ; Female ; Humans ; Incidence ; Male ; Physicians ; Primary Health Care ; organization & administration ; Retrospective Studies ; Singapore ; Time Factors ; Treatment Outcome

Background: Management of COVID--19 patients during surges have been a challenge as hospitals have to deal with staff, room, and medication shortages. Among these medications is tocilizumab which is given to patients with severe/critical conditions. In Ospital ng Makati, patients are given baricitinib as alternative immunomodulator to prevent possible cytokine storm during tocilizumab shortages. The current recommendation for baricitinib is to give it in addition to dexamethasone and remdesivir for hospitalized COVID-19 patients requiring low to high-flow oxygen, and non-invasive ventilation. However, there is not enough evidence to recommend it as an alternative to tocilizumab in COVID--19 patients. This study aims to find out the real-world efficacy of baricitinib in addition to standard of care among admitted patients with severe COVID-19 pneumonia admitted in Ospital ng Makati. Methods: This is a retrospective, case control study that reviewed records of adult patients admitted at Ospital ng Makati from December 2020 to May 2021 due to severe COVID-19. Patients who were given standard of care was compared to those who were given baricitinib by measuring the duration of clinical improvement, in-hospital all-cause mortality, number of hospital stay, and progression to acute respiratory distress syndrome (ARDS) and need for mechanical ventilator. Results: The use of baricitinib led to a faster improvement time (10 vs 12 days) however did not reach level of significance (p=0.069). There was also no significant difference in the mortality, number of hospital days, and progression to ARDS between the two groups. Conclusion There is not enough evidence to recommend baricitinib as an alternative to tocilizumab in patients with severe COVID--19 infection.
COVID-19 ; Standard of Care

Purpose: To characterize the patterns of demographic data, dermatologic diagnosis, and disposition regarding pediatric dermatological presentations in an emergency department (ED) at Armadale Health Service, a secondary outer metropolitan hospital in Perth, Western Australia. Methods: Retrospective cross-sectional study auditing pediatric dermatological presentations to the ED from December 2022 through November 2023. We analyzed the age group, sex, dermatologic diagnosis, Australasian Triage Scale, ED length of stay, and disposition. The age group comprised infants, preschoolers, schoolers, and adolescents. The diagnosis included anaphylaxis and angioneurotic edema (AAE), allergy-related and urticarial dermatitis (AUD), eczema and other dermatitis (EOD), infective dermatoses, and not elsewhere classified. Results: Of the 540 pediatric patients who presented to the ED with a dermatological complaint, 44.4% were girls with a median age of 4.5 years (interquartile range, 1.5-9.3) and a hospitalization rate of 7.6%. The dermatologic diagnoses consisted of AUD (34.3%), infective dermatoses (29.3%), EOD (23.3%), AAE (8.5%), and not elsewhere classified (4.6%). Most patients were triaged as an Australasian Triage Scale category 3-4, with a median ED length of stay of 2.3 hours (1.5-3.5 hours). Pairwise comparisons showed differences in the diagnoses between infants and preschoolers and between schoolers and adolescents for EOD and infective dermatoses (P < 0.001). The hospitalized patients showed a higher proportion of AAE, EOD, and infective dermatoses than those discharged (P < 0.001). Patients with AUD were hospitalized less (odds ratio, 0.06; 95% confidence interval, 0.12-0.30; compared with AAE). No dermatological emergencies, such as Stevens-Johnson syndrome, were identified. Conclusion Our findings underscore regional differences and support global efforts to reduce non-life-threatening pediatric dermatological presentations to the ED. This study may contribute to the ongoing discourse on effectively managing such presentations in EDs.

Purpose: To characterize the patterns of demographic data, dermatologic diagnosis, and disposition regarding pediatric dermatological presentations in an emergency department (ED) at Armadale Health Service, a secondary outer metropolitan hospital in Perth, Western Australia. Methods: Retrospective cross-sectional study auditing pediatric dermatological presentations to the ED from December 2022 through November 2023. We analyzed the age group, sex, dermatologic diagnosis, Australasian Triage Scale, ED length of stay, and disposition. The age group comprised infants, preschoolers, schoolers, and adolescents. The diagnosis included anaphylaxis and angioneurotic edema (AAE), allergy-related and urticarial dermatitis (AUD), eczema and other dermatitis (EOD), infective dermatoses, and not elsewhere classified. Results: Of the 540 pediatric patients who presented to the ED with a dermatological complaint, 44.4% were girls with a median age of 4.5 years (interquartile range, 1.5-9.3) and a hospitalization rate of 7.6%. The dermatologic diagnoses consisted of AUD (34.3%), infective dermatoses (29.3%), EOD (23.3%), AAE (8.5%), and not elsewhere classified (4.6%). Most patients were triaged as an Australasian Triage Scale category 3-4, with a median ED length of stay of 2.3 hours (1.5-3.5 hours). Pairwise comparisons showed differences in the diagnoses between infants and preschoolers and between schoolers and adolescents for EOD and infective dermatoses (P < 0.001). The hospitalized patients showed a higher proportion of AAE, EOD, and infective dermatoses than those discharged (P < 0.001). Patients with AUD were hospitalized less (odds ratio, 0.06; 95% confidence interval, 0.12-0.30; compared with AAE). No dermatological emergencies, such as Stevens-Johnson syndrome, were identified. Conclusion Our findings underscore regional differences and support global efforts to reduce non-life-threatening pediatric dermatological presentations to the ED. This study may contribute to the ongoing discourse on effectively managing such presentations in EDs.

Purpose: To characterize the patterns of demographic data, dermatologic diagnosis, and disposition regarding pediatric dermatological presentations in an emergency department (ED) at Armadale Health Service, a secondary outer metropolitan hospital in Perth, Western Australia. Methods: Retrospective cross-sectional study auditing pediatric dermatological presentations to the ED from December 2022 through November 2023. We analyzed the age group, sex, dermatologic diagnosis, Australasian Triage Scale, ED length of stay, and disposition. The age group comprised infants, preschoolers, schoolers, and adolescents. The diagnosis included anaphylaxis and angioneurotic edema (AAE), allergy-related and urticarial dermatitis (AUD), eczema and other dermatitis (EOD), infective dermatoses, and not elsewhere classified. Results: Of the 540 pediatric patients who presented to the ED with a dermatological complaint, 44.4% were girls with a median age of 4.5 years (interquartile range, 1.5-9.3) and a hospitalization rate of 7.6%. The dermatologic diagnoses consisted of AUD (34.3%), infective dermatoses (29.3%), EOD (23.3%), AAE (8.5%), and not elsewhere classified (4.6%). Most patients were triaged as an Australasian Triage Scale category 3-4, with a median ED length of stay of 2.3 hours (1.5-3.5 hours). Pairwise comparisons showed differences in the diagnoses between infants and preschoolers and between schoolers and adolescents for EOD and infective dermatoses (P < 0.001). The hospitalized patients showed a higher proportion of AAE, EOD, and infective dermatoses than those discharged (P < 0.001). Patients with AUD were hospitalized less (odds ratio, 0.06; 95% confidence interval, 0.12-0.30; compared with AAE). No dermatological emergencies, such as Stevens-Johnson syndrome, were identified. Conclusion Our findings underscore regional differences and support global efforts to reduce non-life-threatening pediatric dermatological presentations to the ED. This study may contribute to the ongoing discourse on effectively managing such presentations in EDs.

Purpose: To characterize the patterns of demographic data, dermatologic diagnosis, and disposition regarding pediatric dermatological presentations in an emergency department (ED) at Armadale Health Service, a secondary outer metropolitan hospital in Perth, Western Australia. Methods: Retrospective cross-sectional study auditing pediatric dermatological presentations to the ED from December 2022 through November 2023. We analyzed the age group, sex, dermatologic diagnosis, Australasian Triage Scale, ED length of stay, and disposition. The age group comprised infants, preschoolers, schoolers, and adolescents. The diagnosis included anaphylaxis and angioneurotic edema (AAE), allergy-related and urticarial dermatitis (AUD), eczema and other dermatitis (EOD), infective dermatoses, and not elsewhere classified. Results: Of the 540 pediatric patients who presented to the ED with a dermatological complaint, 44.4% were girls with a median age of 4.5 years (interquartile range, 1.5-9.3) and a hospitalization rate of 7.6%. The dermatologic diagnoses consisted of AUD (34.3%), infective dermatoses (29.3%), EOD (23.3%), AAE (8.5%), and not elsewhere classified (4.6%). Most patients were triaged as an Australasian Triage Scale category 3-4, with a median ED length of stay of 2.3 hours (1.5-3.5 hours). Pairwise comparisons showed differences in the diagnoses between infants and preschoolers and between schoolers and adolescents for EOD and infective dermatoses (P < 0.001). The hospitalized patients showed a higher proportion of AAE, EOD, and infective dermatoses than those discharged (P < 0.001). Patients with AUD were hospitalized less (odds ratio, 0.06; 95% confidence interval, 0.12-0.30; compared with AAE). No dermatological emergencies, such as Stevens-Johnson syndrome, were identified. Conclusion Our findings underscore regional differences and support global efforts to reduce non-life-threatening pediatric dermatological presentations to the ED. This study may contribute to the ongoing discourse on effectively managing such presentations in EDs.

Purpose: To characterize the patterns of demographic data, dermatologic diagnosis, and disposition regarding pediatric dermatological presentations in an emergency department (ED) at Armadale Health Service, a secondary outer metropolitan hospital in Perth, Western Australia. Methods: Retrospective cross-sectional study auditing pediatric dermatological presentations to the ED from December 2022 through November 2023. We analyzed the age group, sex, dermatologic diagnosis, Australasian Triage Scale, ED length of stay, and disposition. The age group comprised infants, preschoolers, schoolers, and adolescents. The diagnosis included anaphylaxis and angioneurotic edema (AAE), allergy-related and urticarial dermatitis (AUD), eczema and other dermatitis (EOD), infective dermatoses, and not elsewhere classified. Results: Of the 540 pediatric patients who presented to the ED with a dermatological complaint, 44.4% were girls with a median age of 4.5 years (interquartile range, 1.5-9.3) and a hospitalization rate of 7.6%. The dermatologic diagnoses consisted of AUD (34.3%), infective dermatoses (29.3%), EOD (23.3%), AAE (8.5%), and not elsewhere classified (4.6%). Most patients were triaged as an Australasian Triage Scale category 3-4, with a median ED length of stay of 2.3 hours (1.5-3.5 hours). Pairwise comparisons showed differences in the diagnoses between infants and preschoolers and between schoolers and adolescents for EOD and infective dermatoses (P < 0.001). The hospitalized patients showed a higher proportion of AAE, EOD, and infective dermatoses than those discharged (P < 0.001). Patients with AUD were hospitalized less (odds ratio, 0.06; 95% confidence interval, 0.12-0.30; compared with AAE). No dermatological emergencies, such as Stevens-Johnson syndrome, were identified. Conclusion Our findings underscore regional differences and support global efforts to reduce non-life-threatening pediatric dermatological presentations to the ED. This study may contribute to the ongoing discourse on effectively managing such presentations in EDs.