INTRODUCTIONMany alcohol-related problems often go undetected and untreated. In Singapore, no epidemiological studies have been done in general hospitals on alcohol use disorders (AUD), i.e. alcohol dependence and abuse (DSM-IV-TR). Such findings are useful in planning AUD liaison services. In this study, we aim to estimate the prevalence of AUD among non-psychiatric inpatients and to determine the rates of identification and intervention rendered by medical staff.

MATERIALS AND METHODSNon-psychiatric medical and surgical wards inpatients aged 21 years and above were recruited over a 3-month period. The Alcohol Use Disorders Identification Test (AUDIT) was used to screen for AUD and the MINI International Neuropsychiatric Interview (MINI English Version 5.0.0) was administered to diagnose AUD if the AUDIT score was 8 or above. Case notes were independently reviewed for AUD identification and if interventions were offered during admissions.

RESULTSA total of 5599 inpatients were screened, of which 673 (12%) completed the screening using the AUDIT, and of these, 154 (2.8% of total sample) were positive for AUDIT. In this group, 107 were diagnosed with AUD. The estimated prevalence was 1.9% (approximately 400 cases per year per hospital). The medical staff identified only 25 (23.4%) cases of AUD, out of which, majority of them (76%) were rendered interventions.

CONCLUSIONThe rate of AUD identification by medical staff was low. Of those identified, majority were given interventions. Thus, the training of health care staff to identify AUD together with the implementation of brief interventions should be considered.

Adult ; Aged ; Alcoholism ; diagnosis ; epidemiology ; therapy ; Female ; Hospitalization ; Hospitals, General ; Humans ; Male ; Mass Screening ; utilization ; Mental Health Services ; Middle Aged ; Prevalence ; Referral and Consultation ; Singapore ; epidemiology ; Young Adult

Approximately 5% of breast cancer patients develop leptomeningeal metastases over the course of their disease. Though several treatments options are available for these patients, their prognosis is typically considered to be poor. We report a case of leptomeningeal failure after a patient underwent prior radiotherapy, radiosurgery, surgery, chemotherapy, and biologic therapy. This patient experienced a prolonged response after receiving bevacizumab and capecitabine. The literature currently contains several reports regarding the use of systemic therapy to manage leptomeningeal metastases from breast cancer, which we summarize. Finally, we review the relevant effects of the patient's treatment modalities and provide a rationale for the mechanism that led to her prolonged response.
Antibodies, Monoclonal, Humanized ; Biological Therapy ; Breast ; Breast Neoplasms ; Deoxycytidine ; Fluorouracil ; Humans ; Meningeal Neoplasms ; Neoplasm Metastasis ; Prognosis ; Radiosurgery ; Bevacizumab ; Capecitabine

To study if Solanum nigrum hairy roots can be used for phytoremediation of Cd contamination, we investigated the effects of cadmium (Cd) alone, and in combination with different concentrations of CaCl2, on growth, activities of superoxide dismutase (SOD) and peroxidase (POD) and Cd absorption by hairy roots of S. nigrum L. var pauciflorum. The results showed that Cd concentrations of lower than 50 micromol/L enhanced the growth of hairy roots, while higher than 100 micromol/L inhibited growth and decreased the number of branched roots, also causing the root tips to become brown and shorter in length. In comparison with a control, the soluble protein content, the activities of SOD and POD in hairy roots cultures showed a trend of first increased and then gradually decreased, while the malondialdehyde (MDA) content significantly increased, when increasing the Cd concentrations. Cd concentration of 100 micromol/L or 300 micromol/L in combination with 10-30 mmol/L CaCl2 resulted in a decreased content of soluble protein and MDA in the hairy roots, but an enhanced SOD activity. The increased POD activities were observed when cultured in 100 micromol/L Cd and 10-30 mmol/L CaCl2 but decreased when cultured in 300 micromol/L Cd and 10-30 mmol/L CaCl2. Atomic Absorption Spectrometry determination showed that the Cd absorbed and adsorbed by the hairy roots increased along with the increase of Cd concentration. The exogenous addition of 10-30 mmol/L CaCl2 could reduce the toxicity of Cd. This was achieved on one hand by reducing the absorption of Cd, on the other hand by decreasing the lipid peroxidation through regulating the activities of antioxidant enzymes SOD and POD in the hairy roots.
Absorption ; Biodegradation, Environmental ; Cadmium ; isolation & purification ; metabolism ; Calcium Chloride ; metabolism ; Peroxidase ; metabolism ; Plant Roots ; growth & development ; physiology ; Soil Pollutants ; isolation & purification ; metabolism ; Solanum nigrum ; enzymology ; growth & development ; physiology ; Superoxide Dismutase ; metabolism

INTRODUCTION: Patient-centred medical care has been rising in importance since the turn of the century. It entails treating patients in relation to their biopsychosocial outlook so as to support the management of their conditions. The extent to which a patient is enabled to acquire skills and knowledge can be measured with the Patient Enablement Instrument (PEI) proposed by Howie and colleagues, and it has been noted to be more reflective of a good consultation compared to patient satisfaction scores. This study aimed to determine the level of patient enablement in the Singaporean context and the factors facilitating it. METHODS: We conducted an embedded mixed method study with primary care patients in two phases: (a) a PEI questionnaire was completed by 150 patients; and (b) a qualitative approach using focused group discussions and individual interviews was used to explore factors associated with high enablement. RESULTS: The mean PEI score was 4.5 ± 4.4, with significantly higher scores among patients attending specialised primary care clinics. Important physician factors were doctors' advice, attitude and relationship with the patient. Critical system factors included good continuity of care, workload and financial support, while patient factors included their beliefs, preparedness, inquisitiveness and trust, with considerable impact from the influence of community. CONCLUSION The PEI score in the Singaporean context is similar to that of other Asian contexts, but slightly higher than that reported in Western studies. Good doctor-patient relationships, efficient systems facilitating continuity of care, and motivated and informed patients all contribute to increased enablement.

BACKGROUND AND PURPOSE: The aim of this study was to elucidate the role of therapy-related cardiotoxicity in multiple sclerosis (MS) patients treated with mitoxantrone and to identify potential predictors for individual risk assessment. METHODS: Within a multicenter retrospective cohort design, cardiac side effects attributed to mitoxantrone were analyzed in 639 MS patients at 2 MS centers in Germany. Demographic, disease, treatment, and follow-up data were collected from hospital records. Patients regularly received cardiac monitoring during the treatment phase. RESULTS: None of the patients developed symptomatic congestive heart failure. However, the frequency of patients experiencing cardiac dysfunction of milder forms after mitoxantrone therapy was 4.1% (26 patients) among all patients. Analyses of the risk for cardiotoxicity revealed that cumulative dose exposure was the only statistically relevant risk factor associated with cardiac dysfunction. CONCLUSIONS: The number of patients developing subclinical cardiac dysfunction below the maximum recommended cumulative dose is higher than was initially assumed. Interestingly, a subgroup of patients was identified who experienced cardiac dysfunction shortly after initiation of mitoxantrone and who received a low cumulative dose. Therefore, each administration of mitoxantrone should include monitoring of cardiac function to enhance the treatment safety for patients and to allow for early detection of any side effects, especially in potential high-risk subgroups (as determined genetically).
Cohort Studies* ; Follow-Up Studies ; Germany ; Heart Failure ; Hospital Records ; Humans ; Mitoxantrone* ; Multiple Sclerosis* ; Retrospective Studies ; Risk Assessment ; Risk Factors

In order to study the physiological mechanism of exogenous calcium on the toxicity of heavy metal cadmium (Cd) to Wedelia trilobata hairy roots, the effects of Cd alone, and in combination with different concentrations of Ca on growth, contents of soluble protein and malondialdehyde (MDA), activities of superoxide dismutase (SOD) and peroxidase (POD), Cd2+ absorption in W. trilobata hairy roots were investigated. Cd concentrations lower than 50 micromol/L enhanced the growth of hairy roots, while concentrations higher than 100 micromol/L inhibited growth, making the branched roots short and small, and also turning the root tips brown, even black. In comparison with the control (0 micromol/L Cd), the soluble protein content in hairy roots was found to increase when cultured with 10-50 micromol/L Cd, and decrease when exposed to a cadmium concentration higher than 100 micromol/L Cd. In addition, the activities of POD and SOD activity and MDA content were significantly higher than the control. Compared to the control (hairy roots cultured without 10-30 mmol/L Ca), 100 micromol/L Cd or 300 micromol/L Cd in combination with 10-30 mmol/L Ca resulted in increased growth, causing the main root and secondary roots thicker and also an increase in soluble protein content. On the contrary, MDA content and POD and SOD activities decreased. Quantitative analysis by Atomic Absorption Spectrophotometry showed that W. trilobata hairy roots can absorb and adsorb heavy metal Cd in the ionic form of Cd2+. The maximum content of Cd2+ absorbed by the hairy roots was obtained with a concentration 100 micromol/L Cd2+ while that of Cd2+ adsorbed by hairy roots was achieved with a concentration of 300 micromol/L Cd2+. The exogenous addition of 10-30 mmol/L Ca2+ was found to reduce the absorption, adsorption of Cd2+ and the toxicity of Cd significantly. This reduction in toxicity was caused by the reduction in the absorption of Cd and decreasing the lipid peroxidation through regulating the activities of antioxidant enzymes SOD and POD in the hairy roots.
Absorption ; Adsorption ; Cadmium ; toxicity ; Calcium Chloride ; pharmacology ; Peroxidase ; metabolism ; Plant Roots ; drug effects ; enzymology ; growth & development ; Stress, Physiological ; drug effects ; Superoxide Dismutase ; metabolism ; Wedelia ; drug effects ; enzymology ; growth & development ; metabolism

INTRODUCTIONVancomycin-resistant enterococci (VRE) have emerged as one of the major nosocomial antimicrobial-resistant pathogens globally. In this article, we describe the epidemiology of VRE in Singaporean public hospitals in the 5 years following the major local VRE outbreak in 2005.

MATERIALS AND METHODSA passive laboratory surveillance programme identified non-duplicate VRE isolates from 7 hospitals from 2006 to 2010. Descriptive statistics and time-series analysis was performed on all clinical VRE isolates for each individual hospital as well as for the combined dataset.

RESULTSThere were a total of 418 VRE isolates over 5 years, of which 102 isolates (24.4%) were from clinical cultures. Between 0.4% and 0.7% of all clinical enterococcal isolates were resistant to vancomycin. The overall incidence-density of VRE did not change over time in Singapore despite 2 separate outbreaks in tertiary hospitals in 2009 and 2010. Incidence-density of clinical VRE cases fell in 2 secondary hospitals, while another 2 hospitals experienced no significant VRE infections after 2008.

CONCLUSIONThe prevalence of VRE clinical isolates remains low in Singaporean public sector hospitals. However, the presence of at least 2 outbreaks in separate hospitals over the past 5 years indicates the need for continued vigilance in order to prevent any further increase in VRE prevalence locally.

Anti-Bacterial Agents ; pharmacology ; Cross Infection ; epidemiology ; Enterococcus ; drug effects ; isolation & purification ; Gram-Positive Bacterial Infections ; drug therapy ; Hospitals, Public ; Humans ; Population Surveillance ; Singapore ; epidemiology ; Vancomycin ; therapeutic use ; Vancomycin Resistance ; drug effects

BACKGROUND/AIMS: Endoscopic resection is a standard treatment for stage T1a esophageal cancer, with esophagectomy or radical radiation therapy (RT) performed for stage T1b lesions. This study aimed to compare treatment outcomes of each modality for clinical stage T1 esophageal cancer. METHODS: In total, 179 patients with clinical T1N0M0-stage esophageal cancer treated from 2006 to 2016 were retrospectively evaluated. Sixty-two patients with clinical T1a-stage cancer underwent endoscopic resection. Among 117 patients with clinical T1b-stage cancer, 82 underwent esophagectomy, and 35 received chemoradiotherapy or RT. We compared overall survival (OS) and recurrence-free survival (RFS) rates for each treatment modality. RESULTS: The median follow-up time was 32 months (range, 1 to 120 months). The 5-year OS and RFS rates for patients with stage T1a cancer receiving endoscopic resection were 100% and 85%, respectively. For patients with stage T1b, the 5-year OS and RFS rates were 78% and 77%, respectively, for the esophagectomy group; 80% and 44%, respectively, for the RT alone group; and 96% and 80%, respectively, for the chemoradiation group. The esophagectomy group showed significantly higher RFS than the RT alone group (p=0.04). There was no significant difference in RFS between the esophagectomy and chemoradiation groups (p=0.922). Grade 4 or higher treatment-related complications occurred in four patients who underwent esophagectomy. CONCLUSIONS: Endoscopic resection appeared to be an adequate treatment for patients with T1a-stage esophageal cancer. The multidisciplinary approach involving chemoradiation was comparable to esophagectomy in terms of survival outcome without serious complications for T1b-stage esophageal cancer.
Chemoradiotherapy ; Esophageal Neoplasms ; Esophagectomy ; Follow-Up Studies ; Humans ; Radiotherapy ; Retrospective Studies

Approximately 25% to 40% of patients with chronic obstructive pulmonary disease (COPD) have the eosinophilic endotype. It is important to identify this group accurately because they are more symptomatic and are at increased risk for exacerbations and accelerated decline in forced expiratory volume in the 1st second. Importantly, this endotype is a marker of treat ment responsiveness to inhaled corticosteroid (ICS), resulting in decreased mortality risk. In this review, we highlight differences in the biology of eosinophils in COPD compared to asthma and the different definitions of the COPD eosinophilic endotype based on sputum and blood eosinophil count (BEC) with the corresponding limitations. Although BEC is useful as a biomarker for eosinophilic COPD endotype, optimal BEC cut-offs can be combined with clinical characteristics to improve its sensitivity and specificity. A targeted approach comprising airway eosinophilia and appropriate clinical and physiological features may improve identification of subgroups of patients who would benefit from biologic therapy or early use of ICS for disease modification.

Objective: Familial hypercholesterolaemia (FH) variant positive subjects have over double the cardiovascular risk of low-density-lipoprotein-cholesterol (LDL-C) matched controls. It is desirable to optimise FH variant detection. Methods: We identified 213 subjects with FH gene panel reports (LDLR, APOB, PCSK9, and APOE) based on total cholesterol >310 mg/dL; excluding triglycerides >400 mg/dL, cascade screening, and patients without pre-treatment LDL-C recorded. Demographic, clinical and lipid parameters were recorded. Results: A 31/213 (14.6%) patients had pathogenic or likely pathogenic FH variants. 10/213 (4.7%) had variants of uncertain significance. Compared with patients without FH variants, patients with FH variants were younger (median age, 39 years vs. 48 years), had more tendon xanthomata (25.0% vs. 11.4%), greater proportion of first degree relatives with total cholesterol >95th percentile (40.6% vs. 16.5%), higher LDL-C (median, 271 mg/dL vs. 236 mg/dL), and lower triglycerides (median, 115 mg/dL vs. 159 mg/dL). The Besseling et al. model (c-statistic 0.798) improved FH variant discrimination over Friedewald LDL-C (c-statistic 0.724), however, Dutch Lipid Clinic Network Score (DLCNS) did not (c-statistic 0.665). Sampson LDL-C (c-statistic 0.734) had similar discrimination to Friedewald. Conclusion Although tendon xanthomata and first degree relatives with high total cholesterol >95th percentile were associated with FH variants, DLCNS or Simon Broome criteria did not improve FH detection over LDL-C. Sampson LDL-C did not significantly improve discrimination over Friedewald. Although lower triglycerides and younger age of presentation are positively associated with presence of FH variants, this information is not commonly used in FH detection algorithms apart from Besseling et al.