Humans ; Infant ; Infant, Newborn ; Male ; Mutation ; Thyroid Hormone Receptors beta ; genetics ; Thyroid Hormone Resistance Syndrome ; genetics

Adult ; Aged ; Bronchoscopy ; methods ; Endosonography ; Feasibility Studies ; Female ; Humans ; Lung Diseases ; diagnosis ; Male ; Middle Aged ; Respiration, Artificial

China ; ethnology ; Female ; Health Literacy ; Humans ; International Normalized Ratio ; Language ; Male ; Middle Aged ; Patient Preference ; Pharmacogenetics ; Research Design ; Singapore ; Warfarin ; therapeutic use

Bariatric Surgery ; adverse effects ; Diabetes Mellitus, Type 2 ; complications ; prevention & control ; Humans ; Obesity, Morbid ; complications ; surgery ; Treatment Outcome ; Weight Loss

INTRODUCTIONSuperovulation-intrauterine insemination (SO-IUI) is the most common assisted reproductive technique (ART) in the world, with good evidence of efficacy and cost-effectiveness. However, parameters affecting its success have not been consistently reported. So in this study, we aim at determining the parameters influencing the success rate of SO-IUI.

MATERIALS AND METHODSWe conducted a retrospective cohort study of 797 SO-IUI cycles from 606 patients, performed between 2007 and 2009 in a single centre. These women received clomiphene citrate (CC), recombinant FSH (rFSH) or both.

RESULTSThere were 127 clinical pregnancies with a pregnancy rate (PR) of 15.9% (127/797) per treatment cycle. Factors associated with higher PR included maternal age <38 (P = 0.02), subfertility diagnoses of ovulatory disorders, unexplained infertility, sexual dysfunction and unilateral tubal obstruction (P = 0.02), an endometrial thickness ≥8 mm (P = 0.03), total number motile spermatozoa (TNMS) of ≥1 million (P = 0.03), and spermatozoa normal forms (NF) ≥4% (P <0.01) on bivariate analysis. When CC is used, the endometrial thickness is more likely to be suboptimal (<8 mm). All the above parameters remained significant except the subfertility diagnoses on multivariate analysis.

CONCLUSIONPatients' selection with women <38 years old and preferably with ovulation disorders and unexplained infertility is associated with the highest PR in SO-IUI. Cycle parameters such as the use of rFSH alone, with the avoidance of CC, TNMS ≥1 million and NF ≥4% is likely to result in the best outcomes and reduce the high order multiple pregnancy risk.

Adult ; Age Factors ; Clomiphene ; therapeutic use ; Cohort Studies ; Female ; Fertility Agents, Female ; therapeutic use ; Humans ; Infertility, Female ; etiology ; Insemination, Artificial ; methods ; Pregnancy ; Pregnancy Rate ; Prognosis ; Retrospective Studies ; Superovulation

INTRODUCTIONPaediatric laparoscopic choledochal cyst excision has increasingly gained acceptance as an alternative to open excision. Laparoscopic excision is feasible and safe in the short term, but long-term outcomes are not as well established. KK Women's and Children's Hospital started performing laparoscopic choledochal cyst excision in children since 2007. In this paper, we report our experience with the laparoscopic approach, and the early and mid-term outcomes in comparison with the conventional open approach.

MATERIALS AND METHODSThirty-five consecutive cases by a single surgeon between May 2006 and April 2012 were retrospectively reviewed. Patient characteristics and surgical outcomes were analysed.

RESULTSThere were 13 laparoscopic and 22 open cases. Baseline patient characteristics were similar. Operative time was longer in the laparoscopic group. Three cases in the laparoscopic group were converted to open in our early experience. There were no differences in time to feeds or length of hospitalisation. One laparoscopic case developed minor bile leak that resolved on conservative management. There were no complications in the laparoscopic group on median follow-up of 35 months. In the open group, there was 1 case of pancreatitis, cholangitis, and hypertrophic scarring respectively. There were 3 cases of suspected adhesive colic that resolved without surgery.

CONCLUSIONLaparoscopic choledochal cyst excision enjoys excellent early and mid-term outcomes compared to open excision, even in centres with smaller patient volume. It should be the approach of choice where technical expertise is available.

Child, Preschool ; Choledochal Cyst ; surgery ; Digestive System Surgical Procedures ; methods ; Female ; Hospitals, Pediatric ; Humans ; Laparoscopy ; Male ; Retrospective Studies ; Tertiary Care Centers ; Time Factors ; Treatment Outcome

INTRODUCTIONGamma-glutamyltransferase (GGT), bilirubin (Bil) and small dense low-density lipoprotein (sdLDL) particles are each known to be risk markers for cardiometabolic diseases which are characterised by oxidative stress conditions. These markers are connected with the oxidative milieu; however, the association between GGT, Bil, and sdLDL has been hardly examined. This hospital-based study investigated the association between GGT and sdLDL, as well as the association between Bil and sdLDL, in asymptomatic subjects.

MATERIALS AND METHODSCardiometabolic variables, GGT, Bil and the mean LDL particle size were measured in 100 asymptomatic subjects attending a clinic for screening dyslipidaemias (36 men and 64 women, mean age 64 years). Correlation analyses of the association between the mean LDL particle size and other variables, such as GGT and Bil, were performed.

RESULTSThe mean (standard deviation) levels of GGT, Bil, and the mean LDL particle size were found to be 21.7 (8.3) IU/L, 14.0 (4.3) μmol/L, and 26.7 (0.6) nm, respectively. An univariate correlation test showed both a significant inverse correlation between the mean LDL particle size and GGT (r = - 0.33, P <0.01) and a significant positive correlation between the mean LDL particle size and Bil (r = 0.32, P <0.01). A multiple regression analysis revealed similarly significant results of their correlations, independent of the other cardiometabolic variables.

CONCLUSIONThese results suggest that the correlation of GGT and sdLDL, as well as that of Bil and sdLDL, may be cooperatively associated with cardiometabolic processes. Further research is warranted in order to confirm the observed association.

Asymptomatic Diseases ; Bilirubin ; blood ; Biomarkers ; blood ; Cross-Sectional Studies ; Dyslipidemias ; blood ; diagnosis ; Female ; Humans ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; gamma-Glutamyltransferase ; blood

INTRODUCTIONThis study aims to determine the inpatient rehabilitation effectiveness (REs) and rehabilitation efficiency (REy) of hip fracture in a Singapore community hospital (CH), its association with socio-demographic variables, medical comorbidities and admission Shah-modified Barthel Index (BI) score as well as change in independent ambulation from discharge to 4 months later.

MATERIALS AND METHODSA retrospective cohort study using data manually extracted from medical records of all patients who had hip fracture within 90 days and admitted to a CH after the operation for rehabilitation. Multiple linear regressions are used to identify independent predictors of REs and REy.

RESULTSThe mean REs was 40.4% (95% Confidence Interval (CI), 36.7 to 44.0). The independent predictors of poorer REs on multivariate analysis were older age, Malay (vs non-Malay) patients, fewer numbers of rehabilitative therapy sessions and dementia. The mean REy was 0.41 units per day [CI, 0.36 to 0.46]. The independent predictors of poorer REy on multivariate analysis were higher admission BI and being non-hypertensive patient. The prevalence of independent ambulation improved from 78.9% at the discharge to 88.3% 4 months later.

CONCLUSIONCH inpatient rehabilitative therapy showed REs 40.4% and REy of 0.41 units per day and the optimum number of rehabilitative therapy session was from 28 to 41 in terms of rehabilitation effectiveness and the maximum rehabilitation efficiency was seen in those doing 14 to 27 sessions of rehabilitative therapy. The study also showed improvement in BI at discharge and improvement in the independent ambulation 4 months after discharge from the CH.

Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Hip Fractures ; rehabilitation ; Hospitalization ; Hospitals, Community ; Humans ; Male ; Middle Aged ; Postoperative Complications ; rehabilitation ; Retrospective Studies ; Treatment Outcome

INTRODUCTIONThe precise burden of movement disorder conditions in our movement disorders centre is unclear. This study investigated the clinical burden of the Movement Disorders Clinic (MDC) in National Neuroscience Institute (NNI) over 10 years, aiming to identify the burden and spectrum of movement disorders conditions, to facilitate future resource allocation.

MATERIALS AND METHODSWe identified all patient visits from January 2002 to December 2011 at MDC from the Movement Disorders (MD) database using a standardised data collection form.

RESULTSThere was a linear increase in the clinical burden of MDC during this period. Parkinsonism comprised 71.6% of this clinical burden of which 84.8% were Parkinson's disease (PD) patients. Dividing the incident cases of MD conditions into two 5 years' blocks, the proportion of PD cases had not changed. There was significant increase in time to diagnosis for PD, hemifacial spasm and dystonia.

CONCLUSIONThere was nearly 4-fold increase in the burden of movement disorders conditions in our tertiary condition within a decade. However, we did not find increasing proportion of PD cases which would be in line with an ageing population. This could be due to the fact that we are still in the early stages of an ageing population and we postulate that this proportion will go up in the future. The increased time to diagnosis may indicate increasing waiting time to see a movement disorders specialist and that current outreach effort to promote awareness may not be reaching its target audience. The upward trend of clinical burden indicates a need for increased resource allocation to cope with demand for movement disorders services.

Aged ; Cost of Illness ; Female ; Humans ; Male ; Middle Aged ; Movement Disorders ; epidemiology ; Retrospective Studies ; Tertiary Care Centers ; Time Factors

Crohn Disease ; diagnosis ; drug therapy ; Humans ; Remission Induction