No abstract available.
Hernia, Hiatal

Adult ; Aged ; Aged, 80 and over ; COVID-19/transmission* ; Cross-Sectional Studies ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Perception ; Singapore ; Surveys and Questionnaires

Introduction: There has been a paradigm shift in the treatment of AAA with the advent of endovascular aneurysm repair (EVAR). Rapid progress and evolution of endovascular technology has brought forth smaller profile devices and closure devices. Total percutaneous endovascular aneurysm repair (pEVAR) involves the usage of suture-mediated closure devices (SMCDs) at vascular access sites to avoid a traditional surgical cutdown. Materials And Methods: We retrospectively reviewed our experience of pEVAR between April 2013 and July 2014. Primary success of the procedure was defined as closure of a common femoral artery (CFA) arteriotomy without the need for any secondary surgical or endovascular procedure within 30 days. Results: In total there were 10 pEVAR cases performed in the study period, one case in Queen Elizabeth Hospital during visiting vascular service. Patients have a mean age of 73.4 year old (66-77 year old) The mean abdominal aortic size was 7.2 cm (5.6-10.0cm). Mean femoral artery diameter was 9.0 mm on the right and 8.9 mm on the left. Mean duration of surgery was 119 minutes (98- 153 minutes). 50% of patients were discharged at post-operative day one, 30%- day two and 20%- day three. Primary success was achieved in 9 patients (90%) or in 19 CFA closures (95%). No major complication was reported. Discussion: We believe that with proper selection of patients undergoing EVAR, pEVAR offers a better option of vascular access with shorter operative time, less post- operative pain, shorter hospital stay and minimises the potential complications of a conventional femoral cutdown.

Global Health ; Humans ; Singapore

INTRODUCTIONThe Multiple Sclerosis International Quality of Life questionnaire (MusiQoL) is a self-administered, multi-dimensional, patient-based health-related quality of life (HRQoL) instrument. With increasing prevalence of multiple sclerosis (MS) in Asian countries, a valid tool to assess HRQoL in those patients is needed. The aim of this study was to evaluate patient acceptability, content validity and psychometric properties of an Asian version of the English MusiQoL in Singapore, Malaysia and India.

MATERIALS AND METHODSEnglish speaking patients older than 18 years of age with a defi nite diagnosis of MS were included. The self-administered survey material included the adapted HRQoL questionnaire, a validated generic HRQoL questionnaire: the short-form 36 (SF-36), as well as a checklist of 14 symptoms. We assessed the internal and external validity of the adapted MusiQoL.

RESULTSA total of 81 patients with MS were included in the study. The questionnaire was generally well accepted. In the samples from Malaysia and Singapore, all scales exhibited good internal consistency (Cronbach's alpha >0.70). Correlation to SF-36 was generally good, demonstrating high construct validity (P <0.001) in some aspects of the MusiQoL.

CONCLUSIONThe Asian adaptation of the English version of the MusiQoL in evaluating HRQoL seems to be a valid, reliable tool with adequate patient acceptability and internal consistency.

Activities of Daily Living ; Asia ; Female ; Health Surveys ; Humans ; India ; Language ; Malaysia ; Male ; Multiple Sclerosis ; drug therapy ; psychology ; Outcome Assessment (Health Care) ; Psychometrics ; standards ; Quality of Life ; psychology ; Singapore ; Statistics, Nonparametric ; Surveys and Questionnaires

Objective To determine the prevalence and the risk factors for childhood obesity in Changsha and Shenzhen, China.Methods A case-control study was conducted in 209 obese children (the cases) identified in the investigation on childhood obesity in 6 288 children aged 6 to 9 years in Changsha and Shenzhen in China and 209 children with normal weight (the controls). The cases and controls were matched by gender, age, and school. Adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the risk factors were measured.Results The prevalence rate of overweight and obese children was 9.28% and 3.30% in Changsha, and 12.17% and 4.22% in Shenzhen, respectively. The rate of overweight children is significantly higher in Shenzhen than in Changsha. No statistical difference was observed in the rate of obesity between the children in both cities. Paternal obesity (OR 1.78, 95% CI 1.01 to 3.16), maternal weight gain during pregnancy ≥15.0 kg (OR 5.22, 95% CI 2.78 to 9.80), birth weight ≥4.00 kg (OR 2.55, 95% CI 1.24 to 5.26), unhealthy snacks ≥1 per week (OR 3.94, 95% CI 1.11 to 13.99), and watching television ≥2 hours per day(OR 2.35, 95% CI 1.01 to 5.47) were associated with childhood obesity when potential confounding factors were adjusted by multi-variable logistic regression analysis. Conclusion Paternal obesity, gestational weight gain, high birth weight, and unhealthy life-style are important risk factors for obesity in urban children in south China.

INTRODUCTIONThe near terminal patient with skeletal metastasis may suitably be palliated with an intramedullary nail whereas another patient with good survival potential may benefit from a more extensive resection and reconstructive procedure. In a previous study by the senior author (Nathan et al, 2005), life expectancy in patients operated on for bone metastases correlated with clinical and haematological parameters in a normogram. We performed a cross-cultural comparison to validate this normogram.

MATERIALS AND METHODSWe randomly selected 73 patients who had undergone surgery for metastatic bone disease between 28 December 2000 and 11 March 2009. The time to deaths was recorded from hospital records and telephone interviews. Multiple parameters including clinical, radiological and haematological were evaluated for significant prognostic value using Kaplan-Meier survivorship analysis. Statistically significant parameters were entered into a Cox regression model for statistically independent significance. A multi-tier prediction of survival was performed by workers from various levels of seniority.

RESULTSAt the time of analysis, there were 40 deaths (55%). Median survival was 15.8 (95% CI, 7.9 to 23.7) months. Kaplan-Meier analysis showed that low haemoglobin (P = 0.0000005), presence of lymph node metastases (P = 0.00008), multiple bone metastases (P = 0.003), presence of visceral metastases, (P = 0.007), low lymphocyte count (P = 0.02) and low serum albumin (P = 0.02) were significantly associated with poor survival. By Cox regression analysis, presence of visceral metastases (P = 0.002), presence of lymph node metastases (P = 0.0002) and low haemoglobin (P = 0.01) were shown to be independent factors in the prediction of survival. Survivorship readings were superimposed onto the previous normogram and found to be similar. Independent blinded use of the normogram allowed good prediction of survival. There was a tendency to underestimate survival when patients survived beyond 1 year of skeletal metastasis.

CONCLUSIONOur findings are similar to that of the previous study in showing a relationship between the above-mentioned parameters and survival. This is despite differences in patient demographic characteristics and management protocols. Use of the tools may allow better siting of most appropriate surgery in metastatic bony disease.

Bone Neoplasms ; mortality ; surgery ; Decision Support Systems, Clinical ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Survival Analysis ; Terminal Care

INTRODUCTION: Hip fractures in patients with end-stage renal disease (ESRD) are associated with frequent complications and poorer outcomes. Patients on chronic dialysis are at additional risk of dialysis-related complications such as myocardial infarction and early osteolysis. We analysed the complications and implant survivorship of hemiarthroplasty in patients with femoral neck fractures with late-stage chronic kidney disease with and without pre-existing dialysis. METHODS: We conducted a retrospective case-control study of 28 patients with ESRD and 31 patients with chronic kidney disease (CKD) Stages 3-5, who had a total of 62 fractures treated with hemiarthroplasty between 2005 and 2015. The mean age of the patients was 68.33 (50.21-86.45) years. The mean follow-up time of the group was 39 months. Patient demographics, complications, outcomes and follow-up radiographs were analysed for differences. RESULTS: Patient in both groups had statistically similar demographics and comorbidity scores except for a higher incidence of hyperparathyroidism in ESRD patients on chronic dialysis (nine patients vs. zero patients; p = 0.001). These patients were more likely to develop cardiopulmonary complications in the perioperative period (odds ratio [OR] 5.04; p = 0.04) and implant loosening on radiographic analysis (OR 8.75; p = 0.02). The incidence of loosening was higher in patients with hyperparathyroidism (OR 9.80; p = 0.002). Cemented techniques, however, did not appear to be significantly associated with intraoperative fractures or loosening. CONCLUSION Patients with ESRD on chronic dialysis were more likely to develop cardiopulmonary complications and implant loosening after hemiarthroplasty for femoral neck fractures. Hyperparathyroidism should be optimised, as it may prevent loosening. Our study did not show any difference in complications or outcomes for cemented fixation.