Seventy-seven Streptococcus pyogenes strains isolated of children of three elementary schools located in Kangwon-do in spring, 1992 were serotyped with M, opacity factor (OF) and T typing antisera. In the M/OF typing results, M-78 (46.8%) and M-28 (22.1%) were most frequently encountered, while M-4 (6.5%), M-12 (5.2%), M-3 (1.3%), M-5 (1.3%) and M-6 (1.3%) were rarely observed. Twelve strains (15.6%) were not typable with M or OF typing system. In the T typing results, T-11 (35.1%) and T-28 (27.3%) were most common. We were able to identify 77.9% of S. pyogenes strains by T typing, 94.8% with T typing and OF typing. With the addition of M typing, 97.4% were typable. Through the serotypings, we could know the basic distribution of serotypes of S. pyogenes of healthy children which could be comparable to those of rheumatic fever, poststreptococcal glomerulonephritis and other severe streptococcal disease.
Adolescent ; Bacterial Typing Techniques ; Child ; Female ; Humans ; Korea ; Male ; Pharynx/microbiology ; Rheumatic Fever/microbiology ; Serotyping ; Streptococcus pyogenes/*classification/isolation & purification

Serotypings have been used as markers for epidemiological surveys of Streptococcus pyogenes infections. Seventy-seven strains of S. pyogenes isolated from the throats of elementary school children in Kangwon Province in Korea in March and April 1992 were serotyped with M and/or opacity factor (OF) antisera. Sixty-eight strains of S. pyogenes from healthy school children in Chungnam Province in March 1993 were also serotyped and the distribution of serotype was compared with the isolates from those living in Kangwon Province. The distributions of M types were quite different between the two areas. M-78 (46.8%) and M-28 (22.1%) were most frequently encountered in Kangwon Province, while M-5 (20.6%), M-12 (16.2%), M-3 (13.2%), M-1 (11.8%) and M-62 (11.8%) were frequently isolated in Chungnam Province. Eighty-seven percent of strains in Kangwon produced OF while 33.2% of those in Chungnam produced OF (p< 0.0001). The difference in the distribution of serotypes and of OF production in the isolates from the children in the two provinces may be responsible for differences in the epidemiology of group A streptococcal infections and their sequelae.
Child ; Comparative Study ; Human ; Korea/epidemiology ; Residence Characteristics ; Rural Population ; Serotyping ; Streptococcal Infections/epidemiology/*microbiology ; Streptococcus pyogenes/*classification/pathogenicity ; Virulence

INTRODUCTIONHand surgery is a subspecialty with a dedicated training programme in Singapore. Currently, Singapore is one of two countries in the world that still provides dedicated advanced hand specialty training. As hand surgeons depend on referrals from institutions and general practitioners, appropriate hand surgical referral requires the referring physician to have knowledge and understanding of common hand conditions as well as less common but more urgent surgical conditions, and their available surgical treatments. This study aimed to determine the knowledge of hand surgery and hand surgical conditions among general practitioners.

METHODSA questionnaire survey was conducted during a continuing medical education symposium on hand surgery in Singapore. Participants responded to 12 questions on hand trauma by keying the answers into a computer database system. The results were then analysed.

RESULTSA total of 35 general practitioners responded to our survey, and they were able to answer 53% of the questions correctly. We found knowledge gaps among the participants regarding hand surgical conditions, and identified areas where increased education during medical school, postgraduate training and continuing medical education may be beneficial. Areas that were found to be weak included recognising injuries that pose a high risk for developing wound infection, complications of topical steroid injection in trigger finger treatment and hand tumours.

CONCLUSIONImproving hand surgery knowledge among general practitioners not only leads to improved primary care, but it can also facilitate prompt recognition of surgical problems and subsequent referral to appropriate hand surgeons for treatment. This may possibly reduce the load of tertiary institutions in treating non-urgent hand conditions.

Clinical Competence ; Education, Medical, Continuing ; methods ; General Practitioners ; education ; Hand ; surgery ; Humans ; Primary Health Care ; Singapore ; Surveys and Questionnaires

INTRODUCTION: We developed a Clinical Frailty Scale algorithm (CFS-A) to minimise inter-rater variability and to facilitate wider application across clinical settings. We compared the agreement, diagnostic performance and predictive utility of CFS-A against standard CFS. MATERIALS AND METHODS: We retrospectively analysed data of 210 hospitalised older adults (mean age, 89.4 years). Two independent raters assessed frailty using CFS-A. Agreement between CFS-A raters and with previously completed CFS was determined using Cohen's Kappa. Area under receiver operator characteristic curves (AUC) for both measures were compared against the Frailty Index (FI). Independent associations between these measures and adverse outcomes were examined using logistic regression. RESULTS: Frailty prevalence were 81% in CFS and 96% in CFS-A. Inter-rater agreement between CFS-A raters was excellent (kappa 0.90, <0.001) and there was moderate agreement between CFS-A and standard CFS (kappa 0.42, <0.001). We found no difference in AUC against FI between CFS (0.91; 95% CI, 0.86-0.95) and CFS-A (0.89; 95% CI, 0.84-0.95; <0.001). Both CFS (OR, 3.59; 95% CI, 2.28-5.67; <0.001) and CFS-A (OR, 4.31; 95% CI, 2.41-7.69; <0.001) were good predictors of mortality at 12 months. Similarly, CFS (OR, 2.59; 95% CI, 1.81-3.69; <0.001) and CFS-A (OR, 3.58; 95% CI, 2.13-6.02; <0.001) were also good predictors of institutionalisation and/or mortality after adjusting for age, sex and illness severity. CONCLUSION Our study corroborated the results on inter-rater reliability, diagnostic performance and predictive validity of CFS-A which has the potential for consistent and efficient administration of CFS in acute care settings.

BACKGROUND AND PURPOSE: The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States. METHODS: Arizona Medicaid claims data from January 1, 2008 to December 31, 2010 were used for this analysis. Subjects who were aged > or =65 years and were continuously enrolled in any Arizona Medicaid health plans (eligible to patients with low income) for > or =12 months between January 1, 2008 and December 31, 2009 were considered eligible for inclusion in the study cohort. In addition to meeting the aforementioned criteria, incident and prevalent cases must have had epilepsy-related healthcare claims. Furthermore, incident cases were required to have a 1-year "clean" period immediately preceding the index date. Negative binomial and logistic regression models were used to assess the factors associated with epilepsy incidence and prevalence. RESULTS: The estimated epilepsy incidence and prevalence for this population in 2009 were 7.9 and 19.3 per 1,000 person-years, respectively. The incidence and prevalence rates were significantly higher for patients with comorbid conditions that were potential risk factors for epilepsy and were of younger age than for their non-comorbid and older counterparts (p<0.05). The prevalence rates were significantly higher for non-Hispanic Blacks and male beneficiaries than for non-Hispanic Whites and female beneficiaries, respectively (p<0.05). CONCLUSIONS: This patient population had higher epilepsy incidence and prevalence compared with the general US population. These differences may be at least in part attributable to their low socioeconomic status.
African Continental Ancestry Group ; Aged* ; Arizona ; Cohort Studies ; Delivery of Health Care ; Epilepsy* ; Female ; Humans ; Incidence* ; Logistic Models ; Male ; Medicaid ; Poverty* ; Prevalence* ; Risk Factors ; Social Class ; United States*

INTRODUCTION: Endovenous cyanoacrylate glue (CAG) ablation for the treatment of chronic venous insufficiency (CVI) and varicose veins has shown non-inferior outcomes with an excellent safety profile, high patient satisfaction rate, and excellent efficacy when compared to the gold standard of endothermal ablation. A review of the current literature for CAG use in CVI showed that most studies and longer-term data are from Caucasian-based populations, which are subject to different anatomical venous variations and socio-economical contexts. This review aimed to gather the current evidence for CAG use in Asian CVI patients. METHODS: Asian studies for the use of CAG in CVI were included in this review. Successful ablation rates, quality of life improvement and novel complications such as glue hypersensitivity reactions are described, along with anatomical descriptions of superficial venous anatomy in study patients. Use of CAG in Singapore and Asia was addressed. RESULTS: CAG has been gaining traction as an option for CVI treatment in Asians. In Singapore, it has been adopted with comparable low complication rates and significant improvement of quality of life after treatment. As we increase our understanding of the variations in venous anatomy in the Asian population, new techniques such as retrograde deployment of the device and use of CAG ablation for venous leg ulcers have been developed. CONCLUSION Further robust evidence in terms of large randomised control trials along with cost effectiveness studies are needed to determine the true value of CAG ablation in the Asian setting.

INTRODUCTION: Percutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore. METHODS: Patients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months. RESULTS: A total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status. CONCLUSION PTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.
Amputation ; Chronic Disease ; Chronic Limb-Threatening Ischemia ; Humans ; Ischemia/surgery* ; Limb Salvage/methods* ; Lower Extremity/surgery* ; Peripheral Arterial Disease/surgery* ; Retrospective Studies ; Risk Factors ; Singapore ; Treatment Outcome