In March 2012, an article in The Straits Times entitled 'Freezing eggs could reverse falling birth rate' suggested that employing the latest oocyte cryopreservation techniques could both foster individual women's reproductive autonomy and impact Singapore's fertility rate, which in recent years has consistently been among the world's lowest. The article cited both local and international fertility specialists' approval of elective oocyte cryopreservation for young women wishing to protect their reproductive potential against ageing and as a potential antidote to the contemporary 'delay and defer' model of family-building. Later in 2012, the Ministry of Health announced a review of oocyte cryopreservation policy taking into account related medical, scientific and ethical issues, while the Singapore College of Obstetricians and Gynaecologists endorsed oocyte cryopreservation as an "important, safe and efficient technology". This paper outlines and analyses the arguments and empirical evidence used both to support and oppose offering elective oocyte cryopreservation as a routine fertility service, before concluding that this remains unjustifiable on the basis of insufficient evidence of its clinical efficacy and safety as regards either pregnancy rates or birth outcomes. If it is to be made available at all for these reasons in Singapore, it should be subjected to rigorous clinic-specific evaluation in accordance with accepted clinical and ethical norms.
Birth Rate ; Cryopreservation ; methods ; Female ; Fertility Preservation ; methods ; Humans ; Oocyte Retrieval ; methods ; Oocytes ; Personal Autonomy ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Reproductive Techniques, Assisted ; Singapore

The cytochrome oxidase subunit I (COXI) gene sequences of three recent (2007- 2008) clinical Plasmodium knowlesi isolates from Klang Valley, peninsular Malaysia, were determined and compared with those of older (1960’s) peninsular Malaysia, recent isolates from Sarawak (on Borneo Island), and an isolate from Thailand. Multiple alignment of the sequences showed that the three clinical isolates were more similar to the older peninsular Malaysia isolates than to those from Sarawak and Thailand. Phylogenetic tree based on the COXI sequences revealed three distinct clusters of P. knowlesi. The first cluster consisted of isolates from peninsular Malaysia, the second consisted of Sarawak isolates and the third composed of the Thailand isolate. The findings of this study highlight the usefulness of mitochondrial COXI gene as a suitable marker for phylogeographic studies of P. knowlesi.

INTRODUCTION: Head injuries occur commonly in children and can lead to concussion injuries. We aim to describe the epidemiology of head injuries among school-going children and identify predictors of brain concussions in Singapore. METHODS: This is a retrospective study of children 7-16 years old who presented to the Emergency Department (ED) of KK Women's and Children's Hospital in Singapore with minor head injury between June 2017 and August 2018. Data including demographics, clinical presentation, ED and hospital management were collected using a standardised electronic template. Multivariable logistic regression analysis was performed to identify early predictors for brain concussion. Concussion symptoms were defined as persistent symptoms after admission, need for inpatient intervention, or physician concerns necessitating neuroimaging. RESULTS: Among 1,233 children (mean age, 6.6 years; 72.6% boys) analysed, the commonest mechanism was falls (64.6%). Headache and vomiting were the most common presenting symptoms. A total of 395 (32.0%) patients required admission, and 277 (22.5%) had symptoms of concussion. Older age (13-16 years old) (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.12-2.08), children involved in road traffic accidents (aOR 2.12, CI 1.17-3.85) and a presenting complaint of headache (aOR 2.64, CI 1.99-3.50) were significantly associated with symptoms of concussion. CONCLUSION This study provides a detailed description of the pattern of head injuries among school-going children in Singapore. High risk patients may require closer monitoring to detect post-concussion syndrome early.

OBJECTIVES: Diagnosis of Turner syndrome in Malaysia is often late. This may be due to a lack of awareness of the wide clinical variability in this condition. In our study, we aim to examine the clinical features of all our Turner patients during the study period and at presentation.

METHODOLOGY: This was a cross-sectional study. Thirty-four (34) Turner patients were examined for Turner-specific clinical features. The karyotype, clinical features at presentation, age at diagnosis and physiologic features were retrieved from their medical records.

RESULTS: Patients with 45,X presented at a median age of 1 month old with predominantly lymphoedema and webbed neck. Patients with chromosome mosaicism or structural X abnormalities presented at a median age of 11 years old with a broader clinical spectrum, short stature being the most common presenting clinical feature. Cubitus valgus deformity, nail dysplasia and short 4th/5th metacarpals or metatarsals were common clinical features occurring in 85.3%-94.1% of all Turner patients. Almost all patients aged ?2 years were short irrespective of karyotype.

CONCLUSION: Although short stature is a universal finding in Turner patients, it is usually unrecognised till late. Unlike the 45,X karyotype, non-classic Turner syndrome has clinical features which may be subtle and difficult to discern. Our findings underscore the importance of proper serial anthropometric measurements in children. Awareness for the wide spectrum of presenting features and careful examination for Turner specific clinical features is crucial in all short girls to prevent a delay in diagnosis.

Human ; Turner Syndrome ; Karyotype

Background: Ribosomal proteins are traditionally associated with protein biosynthesis until recent studies that implicated their extraribosomal functions in human diseases and cancers. Our previous studies using GeneFishingTM DEG method and microarray revealed underexpression of three ribosomal protein genes, RPS26, RPS27, and RPL32 in cancer of the nasopharynx. Herein, we investigated the expression pattern and nucleotide sequence integrity of these genes in nasopharyngeal carcinoma to further delineate their involvement in tumourigenesis. The relationship of expression level with clinicopathologic factors was also statistically studied. Methods: Quantitative Polymerase Chain Reaction was performed on nasopharyngeal carcinoma and their paired normal tissues. Expression and sequence of these three genes were analysed. Results: All three ribosomal protein genes showed no significant difference in transcript expressions and no association could be established with clinicopathologic factors studied. No nucleotide aberrancy was detected in the coding regions of these genes. Conclusion: There is no early evidence to substantiate possible involvement of RPS26, RPS27, and RPL32 genes in NPC tumourigenesis.

Sarcocystosis was diagnosed worldwide by serodiagnostic tests utilising the whole parasite, for which the protozoa were maintained in vitro are more costly. In this study, antigenicity of Sarcocystis falcatula recombinant protein (rSfSAG4) was investigated towards the local communities of Pangkor and Tioman Islands and its seroprevalence was surveyed in these islands. A total of 348 human sera were tested using rSfSAG4 by Western blot and ELISA. High prevalence of sarcocystosis was observed in Tioman Island (80.6%) than in Pangkor Island (50.0%) by Western blot. In ELISA, the seroprevalence observed in Tioman Island was 45.9%, whereas in Pangkor Island 63.0%. In other parasitic infections, the prevalence was 34.0% by Western blot and 46.0% by ELISA. In healthy control group, 7% by Western blot and 8% by ELISA showed positivity to rSfSAG4. It is suggested SfSAG4 is a candidate antigen to measure seroprevalence of sarcocystosis.

Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rarevariant of hepatocellular carcinoma. It is commonly reportedin the younger population with no underlying chronic liverdisease and free of viral Hepatitis B and C. Local recurrenceand distant metastasis are common despite betterprognosis compared to conventional hepatocellularcarcinoma. Complete surgical resection is associated withhigher median survival and is the mainstay treatment optionfor localized FL-HCC. Multi-modality therapies such as TACEcan be used to downstage upfront unresectable FL-HCC.Complete response with GEMOX chemotherapy has beenreported in advanced metastatic FL-HCC and should beconsidered in upfront unresectable or metastatic disease.We present a case of biopsied proven relapse FL-HCC witholigo- left lung metastasis who successfully underwent a leftlung lobectomy after neo-adjuvant GEMOX chemotherapy,and is disease free at 24 months follow up.

Humans ; Infant ; Prevalence ; Risk Factors ; Vitamin D Deficiency/epidemiology*

INTRODUCTIONThis study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore.

MATERIALS AND METHODSAdult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey.

RESULTSA total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149).

CONCLUSIONThe results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.

Adult ; Caregivers ; psychology ; Cost of Illness ; Dementia ; nursing ; Female ; Humans ; Interview, Psychological ; methods ; standards ; Male ; Middle Aged ; Psychiatric Status Rating Scales ; standards ; Stress, Psychological ; diagnosis ; ethnology