Adsorption ; Child ; Child, Preschool ; Female ; Humans ; Liver Failure, Acute ; therapy ; Liver, Artificial ; Male ; Membranes, Artificial ; Retrospective Studies ; Sorption Detoxification

Delivery of Health Care ; economics ; organization & administration ; General Surgery ; Health Care Rationing ; Humans ; Quality of Life ; Singapore ; United Kingdom ; United States

INTRODUCTIONPositron emission tomography (PET) using 18F-2-fluoro-2 deoxy-D-glucose (FDG) has been widely investigated and used in the non-invasive imaging of malignancy. Non-small cell lung carcinoma (NSCLC) is one of the most common and best validated indications for an FDG-PET scan. This review examines the roles of FDG-PET in the management of NSCLC and attempts to identify emerging uses and possible future developments.

MATERIALS AND METHODSLiterature review of English language literature indexed on Medline.

RESULTSThere is strong evidence to support the clinical efficacy and cost effectiveness of FDG-PET in the characterisation of solitary pulmonary nodules and in the staging of NSCLC. In addition, there are emerging uses in radiotherapy planning, monitoring of treatment response and prognostication.

CONCLUSIONSFDG-PET plays an integral role in the management of NSCLC and it is likely to expand as evidence supporting additional roles in the management of NSCLC becomes available.

Algorithms ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; therapy ; Fluorodeoxyglucose F18 ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; therapy ; Neoplasm Staging ; Radiopharmaceuticals ; Radiotherapy Planning, Computer-Assisted ; Tomography, Emission-Computed ; trends

In 26 patients with severe factor infertility (total spermatozoa per ejaculate 0.8-6.3 million) in vitro fertilisation was performed using a capillary tube culture system. Spermatozoa were concentrated and incubated with oocytes in a very small volume (10-20 microliters) within capillary tubes. In seven out of 26 patients (27%) at least one oocyte could be successfully fertilised (overall fertilisation rate 11.6%, 22/190 oocytes) and in two patients a pregnancy with the birth of a healthy child could be observed. If sperm progression was only of grade 2 or less no fertilisation could be observed in 10 patients with a total of 75 oocytes. The described capillary technique for in vitro fertilisation using very small volumes for sperm-oocyte culture may be useful in cases of severe oligozoospermia or before considering extreme therapies such as donor insemination of sperm microinjection.
Fertilization in Vitro ; instrumentation ; methods ; Humans ; Infertility, Male ; etiology ; therapy ; Male ; Oligospermia ; complications

INTRODUCTIONWe sought to determine the opinions of patients, their visitors and healthcare workers regarding Influenza A (H1N1) response measures instituted within a tertiary hospital in Singapore.

MATERIALS AND METHODSThis questionnaire study was undertaken from 21 May 2009 to 31 August 2009.

RESULTSThere were 92 respondents, ranging in age from 15 to 77 years. Of the 90 who identified their role, 35.6% were patients, 12.2% visitors and 52.2% health care professionals. About 23% of respondents disagreed that one could have H1N1 without fever or fl u-like symptoms, while 14.3% thought influenza could not be caught from an asymptomatic infected person. About 30% perceived the H1N1 death rate as high. From this study, 82.2% of respondents agreed or strongly agreed that Singapore's H1N1 responses were essential, while 14.6% found it overdone. In particular, healthcare workers and doctors found their professional work to be inconvenienced. Although more than two-thirds of doctors held this view, an equal proportion agreed the outbreak response was essential.

CONCLUSIONSThere was a high level of acceptance of response measures as essential, despite the perceived inconvenience. We propose that the success of containment measures requires unity of purpose and understanding among stakeholders at all levels.

Adolescent ; Adult ; Aged ; Attitude to Health ; Communicable Disease Control ; organization & administration ; Disease Outbreaks ; Female ; Hospitals, Public ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; prevention & control ; Male ; Middle Aged ; Patient Satisfaction ; Personnel, Hospital ; psychology ; Public Health ; Singapore ; epidemiology ; Surveys and Questionnaires ; Visitors to Patients ; psychology ; Young Adult

INTRODUCTIONThis paper describes the epidemiology and control of a community outbreak of novel influenza A (H1N1-2009) originating from a dance club in Singapore between June and July 2009.

MATERIALS AND METHODSCases of novel influenza A (H1N1-2009) were confirmed using in-house probe-based real-time polymerase chain reaction (PCR). Contact tracing teams from the Singapore Ministry of Health obtained epidemiological information from all cases via telephone.

RESULTSA total of 48 cases were identified in this outbreak, of which 36 (75%) cases were patrons and dance club staff, and 12 (25%) cases were household members and social contacts. Mathematical modelling showed that this outbreak had a reproductive number of 1.9 to 2.1, which was similar to values calculated from outbreaks in naïve populations in other countries.

CONCLUSIONThis transmission risk occurred within an enclosed space with patrons engaged in intimate social activities, suggesting that dance clubs are places conducive for the spread of the virus.

Adolescent ; Adult ; Commerce ; Contact Tracing ; methods ; Dancing ; Disease Outbreaks ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; epidemiology ; Interviews as Topic ; Male ; Models, Statistical ; Polymerase Chain Reaction ; Singapore ; epidemiology ; Travel ; Young Adult

INTRODUCTIONInfluenza A H1N1 (2009) pandemic has affected countries worldwide including Singapore. Data on obstetric outcomes of women with H1N1 (2009) in pregnancy are lacking.

MATERIALS AND METHODSThis was an observational study analysing the obstetric outcomes of pregnant women with influenza A H1N1 (2009) infection who had delivered at a viable gestation (24 weeks or more) in our centre.

RESULTSBetween 23 June 2009 and 30 September 2009, 235 pregnant women were diagnosed with influenza A H1N1 (2009) at our centre, with 42 having delivered and comprising the study cohort. Median age was 27.5 years (range, 16 to 42). Multiparous women comprised 59.5% (25/42) whilst 40.5% (17/42) were primiparous. In terms of ethnicity, 61.9% were Malays, 26.2% Chinese, 4.8% Indians and 7.1% Others. All women received oseltamivir. All had shown recovery from the acute influenza infection. There were no respiratory complications. Twenty-nine women (69.0%) delivered at term. Twenty-fi ve women (59.5%) had spontaneous labour whilst 15 (35.7%) had labour induction. Two women (4.8%) did not labour. Thirty-six women (85.7%) had vaginal delivery, of whom 3 were instrumental deliveries. Apgar scores of greater than 8 at 1 min and 5 min were documented in babies of 95.2% (40/42) women, respectively. Thirty-two women (76.2%) delivered babies with birthweights greater than 2500 g. Compared with historical data from 2008, the H1N1 cohort had comparable mean birthweight and average gestational age at delivery of 38 weeks.

CONCLUSIONOur study suggested that obstetric outcomes were not adversely affected by influenza A H1N1 (2009) infection.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Apgar Score ; Birth Weight ; Female ; Gestational Age ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; drug therapy ; epidemiology ; Obstetrics and Gynecology Department, Hospital ; Oseltamivir ; therapeutic use ; Outcome Assessment (Health Care) ; Pregnancy ; Pregnancy Complications ; Singapore ; Young Adult

INTRODUCTIONSince the emergence of the pandemic influenza A/H1N1/2009 virus in April 2009, diagnostic testing in many countries has revealed the rapid displacement and then replacement of circulating seasonal influenza viruses by this novel virus.

MATERIALS AND METHODSIn-house seasonal and pandemic influenza-specific polymerase chain reaction assays were introduced and/or developed at the Molecular Diagnosis Centre (MDC) at the National University Hospital (NUH), Singapore. These assays have been used to test all samples received from in-patients, out-patients, staff and visitors for suspected pandemic influenza A/H1N1/2009 infection.

RESULTSPrior to the arrival of the pandemic A/H1N1/2009 virus in Singapore at the end of May 2009, seasonal influenza A/H3N2 predominated in this population, with very little seasonal influenza A/H1N1 and B viruses detected. Within about 1 month of its arrival in Singapore (mainly during June to July 2009), this pandemic virus rapidly displaced seasonal influenza A/H3N2 to become the predominant strain in the Singaporean population served by MDC/NUH.

CONCLUSIONSRealtime molecular techniques have allowed the prompt detection of different influenza subtypes during this current pandemic, which has revealed the displacement/replacement of previously circulating seasonal subtypes with A/H1N1/2009. Although some of this may be explained by immunological cross-reactivity between influenza subtypes, more studies are required.

Communicable Diseases, Emerging ; Cross Reactions ; Disease Outbreaks ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza B virus ; isolation & purification ; Influenza, Human ; classification ; diagnosis ; epidemiology ; Influenzavirus C ; isolation & purification ; Molecular Diagnostic Techniques ; Polymerase Chain Reaction ; Singapore ; epidemiology

INTRODUCTIONWe reviewed the epidemiological features of 1348 hospitalised cases of influenza A (H1N1-2009) [pandemic H1N1] infection in Singapore reported between 15 July and 28 September 2009.

MATERIALS AND METHODSData on the demographic and epidemiological characteristics of hospitalised patients with confirmed pandemic H1N1 infection were collected from all restructured and private hospitals in Singapore using a standard template and were analysed retrospectively.

RESULTSOf the 1348 cases, 92 were classified as severely ill (i.e. were admitted to an intensive care unit and/or who died). Of these severely ill cases, 50 (54.3%) required mechanical ventilation. While overall hospitalisation rates were highest in the 0 to 11 months age group, the incidence of severely ill cases was highest in patients aged 65 years and older. Fifty per cent of all hospitalised cases and 28% of all severely ill cases did not have any underlying medical conditions. The following factors were found to be independently associated with a higher likelihood of severe illness: older age and the presence of the following comorbidities: neuromuscular disorders, epilepsy and obesity.

CONCLUSIONBetween 15 July and 28 September 2009, pandemic H1N1 infection caused significant illness requiring hospitalisation, as well as intensive care and mechanical ventilation in some cases. There were 18 deaths from pandemic H1N1 during this period, which corresponded to a case-fatality rate of 7 deaths for every 100,000 cases of pandemic H1N1.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Disease Outbreaks ; Epidemiologic Studies ; Female ; Hospitalization ; statistics & numerical data ; trends ; Humans ; Infant ; Infant, Newborn ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; epidemiology ; Male ; Middle Aged ; Respiration, Artificial ; utilization ; Retrospective Studies ; Severity of Illness Index ; Singapore ; epidemiology ; Young Adult

INTRODUCTIONThe fi rst case of pandemic influenza A(H1N1) was detected in Singapore on 26 May 2009, 1 month after the fi rst cases of novel influenza A(H1N1) was reported in California and Texas in the United States. The World Health Organization declared the fi rst influenza pandemic of the 21st century on 11 June 2009.

MATERIALS AND METHODSConfirmed cases notified to the Ministry of Health between 27 May and 9 July 2009 were analysed. Various indicators of influenza activity were monitored throughout the study period. Estimates of the number of cases of H1N1-2009 were made using the number of polyclinic attendances for acute respiratory infection and influenza-like illness and the weekly prevalence of H1N1-2009.

RESULTSCases in Singapore affected mainly young adults, youths and children. By the end of September 2009, it was estimated that at least 270,000 persons had been infected by pandemic influenza A (H1N1) in Singapore. The peak number of cases occurred during E-week 30 (26 July-1 August) when an estimated 45,000 cases were seen in polyclinics and GP clinics. The hospitalisation, severe illness and mortality rates were estimated at 6 per 1000 cases, 0.3 per 1000 cases and 6.7 per 100,000 cases, respectively. The most common risk factors among hospitalised adult cases were asthma and diabetes. For hospitalised children, the most common risk factors were being under 5 years of age and asthma. The most common risk factors among persons with severe illness were diabetes in adults and epilepsy and being under 5 years of age in children. About half of cases with severe illness required mechanical ventilation. In addition, one-fifth of cases with severe illness had acute respiratory distress syndrome.

CONCLUSIONSThe fi rst wave of the influenza pandemic lasted about 10 weeks. Morbidity and mortality resulting from pandemic influenza were low.

Adolescent ; Adult ; Child ; Child, Preschool ; Comorbidity ; Disease Outbreaks ; Female ; Hospitalization ; Humans ; Infant ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; epidemiology ; mortality ; Male ; Middle Aged ; Risk Factors ; Singapore ; epidemiology ; Young Adult