INTRODUCTIONAlthough Singapore national guidelines recommend influenza vaccination for individuals with comorbidities, the vaccine uptake remains relatively low. This study examines the rates of influenza vaccine prescriptions in a clinic population, and patient, doctor and clinic factors that could affect the vaccine prescribing rates.

MATERIALS AND METHODSThis retrospective review utilised electronic medical records from HIV-infected patients seen in an infectious disease (ID) specialist clinic. Data from 40 randomly selected patients per physician were analysed for the outcome of influenza vaccine prescriptions from 1 January to 31 December 2007. All 7 consultants and the 6 ID registrars who had spent at least 4 months in the Department during 2007 were included. Data analysed included patient, physician, and clinic characteristics, and clinically relevant outcomes of admission within a year, and the length of hospital stay.

RESULTSOf the 461 HIV-infected patients analysed for this study, only 107 (23%) were prescribed influenza vaccine in 2007. Vaccine prescribing rates by individual physicians ranged from 0% to 77%. The outcome of vaccine prescribing was analysed by patient demographics (age >40 years, gender, race), physician characteristics (doctor grade, gender and training), and clinic volumes (number of patients per clinic session). Multivariate analysis demonstrated that patients with female doctors (OR 1.8, 95% CI, 1.1 to 3.0, P = 0.017), and doctors with overseas medical training (OR 11.6, 95% CI, 6.0 to 22.2, P <0.001) were significantly more likely to have influenza vaccine prescribed. On univariate analysis, patients were more likely to be admitted if they were male (OR 2.1, 95% CI, 1.0 to 5.1, P = 0.041), and over 40 years old (OR 2.1, 95% CI, 1.1 to 4.5, P = 0.024). Patients prescribed influenza vaccine showed a non-significant trend for protection against admission (OR 0.7, P = 0.288), and shorter length of stay (median 5 vs 9 days, P = 0.344).

CONCLUSIONInfluenza vaccine prescribing for HIV-infected outpatients in 2007 was only 23%, even in an ID specialist clinic. There was substantial variability in prescribing rates by individual physicians. Neither patient demographics nor patient volumes per clinic session had an impact on the prescribing rates, but significant predictors included physician gender and medical school training. Patients prescribed influenza vaccine had fewer admissions and shorter hospital lengths of stay, although these trends were non-significant.

Adult ; Drug Prescriptions ; statistics & numerical data ; Female ; HIV Infections ; complications ; Humans ; Influenza A virus ; immunology ; Influenza Vaccines ; pharmacology ; Influenza, Human ; prevention & control ; Male ; Prescription Drugs ; Retrospective Studies ; Singapore ; Vaccination ; trends

INTRODUCTION: Current international consensus confirms that certain histopathologic factors such as tumor morphology, histologic grade and presence of lymphovascular invasion are correlated with prognosis. This retrospective cohort study evaluated the correlation between histopathologic profile and time to disease progression (UP) within the first 1-2 years follow-up of Filipino Stage I-Ill early breast cancer patients.
METHODS: This is a retrospective cohort study which included breast cancer patients enrolled in the Department of Health¬Breast Cancer Medicine Access Program (DOH-BCMAP) at the medical oncology clinics of two tertiary hospitals in Manila. Clinical and histopathologic factors were gathered from patient records, and the patients were grouped according to the modified St. Gallen definition of risk categories for patients with breast cancer. Kaplan-Meier survival analysis determined the average UP as well as progression-free survival (PFS). Multivariate logistic regression determined factors contributing to disease progression.
RESULTS AND CONCLUSION: Of the 326 patients enrolled in this study, 18% showed progression, with a median HP of 14 months. UP was comparable among the low-, intermediate- and high-risk groups. PFS during the 1st 1-2 years follow-up was estimated to be at 78% for the high-risk group, 83% for the intermediate-risk group, and 86% for the low-risk group. During this 1st 1-2 years follow-up, no studied factors of interest were shown to be significantly correlated with outcome among this predominantly intermediate to high risk for recurrence breast cancer patients. Follow-up of this patients up to 5 or more years would define sustained gains from the DOH-BCMAP.

Human ; Male ; Female ; Breast ; Breast Neoplasms ; Consensus ; Neoplasms ; Prognosis ; Medical Oncology

There is a lack of representative samples to provide reliable and accurate seroprevalence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) as well as behavioural information among men who have sex with men (MSM) in Singapore. We used respondent driven sampling (RDS) to recruit MSM. Participants completed a survey used by Asian Internet MSM Sex Survey (AIMSS) and were tested for HIV and syphilis. We compared the characteristics of the RDS participants with STI diagnosis against those who did not have any STI diagnosis in the past 6 months. We compared RDS participants with AIMSS participants. Of 72 MSM recruited, 1 was positive for HIV (1.3%) and 4 (5.5%) tested positive for syphilis. Median age was 30 years and majority was Chinese (69.4%). RDS participants who had any STI diagnosis reported to have more use of recreational drugs (P = 0.006), and lower condom use (P = 0.054). Comparing RDS participants (n = 72) with the AIMSS participants (n = 2075), RDS respondents had ≥1 male partner in the past 6 months (P = 0.003), more casual sex partners (P = 0.012) and more STI symptoms (P = 0.019). There was no difference in terms of HIV testing and recreational drug use. The HIV and syphilis seroprevalence rates from our study are similar to previous reports conducted in high-risk MSM. In contrast to other settings, RDS did not work well among MSM in Singapore. The public health implications of our study highlight the challenges in obtaining data for HIV surveillance in assessing prevalence and risk behaviours among MSM.
Adult ; HIV Infections ; diagnosis ; epidemiology ; psychology ; Health Literacy ; methods ; Health Surveys ; Homosexuality, Male ; psychology ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Prevalence ; Risk-Taking ; Seroepidemiologic Studies ; Sexual Behavior ; Sexual Partners ; psychology ; Singapore ; epidemiology ; Syphilis ; diagnosis ; epidemiology ; psychology

Objective: This study aims to identify the epidemiological characteristics and co-morbidities of eyelid injuries among Filipino patients seen at the Emergency and Out-patient Clinics of a single, tertiary, government, urbanbased hospital from June 2014 to June 2015. Methods: This is a retrospective, cross-sectional, descriptive single-center study. Medical records of 85 patients who consulted at the Emergency or Out-Patient Clinics of the Department of Ophthalmology and Visual Sciences of the Philippine General Hospital, Manila due to eyelid injuries that resulted to skin breaks with or without tissue loss or other ocular co-morbidities were reviewed. Information collected included: demographic data of the patient; the offending object; mechanism, place, date and time of injury; date and time of consult; possible risk factors and predisposing conditions such as alcohol intoxication and lack of use of protective gears. Complications associated with eyelid injuries were also noted. Descriptive statistics was used for analysis of patient demographics, epidemiologic characteristics of eyelid injuries and its associated complications. Results: Of the 85 cases, 78% were males. Most of the patients were below 50 years of age with a range of 1-79 and a mean age of 25 years old. There is male preponderance across all age groups except in the pediatric group below 10 years of age. The right eye was involved in 58% of cases. The most common area affected was the right lower lid as seen in 36 cases. Most of the eyelid injuries were severe: 21 (25%) were margin-involving, 17 (20%) had canalicular transection and 34 (40%) had both. Other co-morbidities included some degree of tissue loss or avulsion (16%) and globe involvement (29%). Majority were accidental (36%). Public places (33%) and the home (33%) were the most common places of injury. Most of the injuries that happened at home were accidents (82%) while those that occurred in public places were mostly assault cases (71%). The most common offending objects that caused the eyelid injuries included metal (33%), pavement/cement (18%), and wood (16%). The most common mechanism of injury was blunt trauma (67%). There were 18 cases of vehicular crash, 89% of the patients were not wearing helmets. All work-related injuries reported absence of protective gear. Alcohol intoxication was reported in 30% of assault cases and 72% of vehicular crash. Conclusion Eyelid injuries continue to pose as a public health concern. Campaigns organized toward educating the public can stress on the importance of increased vigilance regarding safety especially in children and young adults. Use of protective gear and eyewear while driving or working in hazardous environments should also be emphasized. Monitoring of public places for any disturbance can prevent violent acts from escalating. The AntiDrunk and Drugged Driving Act of 2013 should also be strictly enforced.
Accidents ; Driving Under the Influence

INTRODUCTION: Infantile haemangiomas (IH) are the most common vascular tumours in childhood. Over the past decade, treatment of IH has been revolutionised by the discovery of the effectiveness of beta-blockers in its treatment. We review our hospital's experience with oral propranolol in the treatment of IH in an Asian population. METHODS: We performed a retrospective review of the medical records and clinical photos of paediatric patients with IH treated with propranolol in a tertiary paediatric hospital in Singapore from January 2010 to February 2015. RESULTS: A total of 88 patients with IH treated with propranolol were identified over a five-year period, with 79 patients included in the final analysis. There was a predominance of female patients (75.9%) and preterm infants (41.8%) in our study population. The head and neck (65.8%), especially the orbital or preorbital region (45.6%), were the most common lesion sites in our cohort of patients. Mean age of onset was 2.3 ± 4.5 weeks of age, and mean age of starting propranolol treatment was 7.7 ± 10.5 weeks of age. 44.3% of patients experienced > 75% improvement, while 29.1% experienced improvement of 50%-75%. Response to treatment was influenced by the age of starting treatment. CONCLUSION Our study provides further evidence of the efficacy and safety of propranolol in the treatment of IH in an Asian population. Early treatment is recommended for optimal results.

Humans ; Pharmaceutical Preparations ; Singapore

INTRODUCTIONAs the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control.

METHODSA retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded. Dysglycaemia prevalence was calculated as proportions of BG-monitored days with at least one reading exceeding the cut points of 8, 10 and 15 mmol/L for hyperglycaemia, and below the cut point of 4 mmol/L for hypoglycaemia.

RESULTSAmong the 288 patients recruited, hyperglycaemia was highly prevalent (90.3%, 81.3% and 47.6% for the respective cut points), while hypoglycaemia was the least prevalent (18.8%). Dysglycaemic patients were more likely than normoglycaemic patients to have poorer glycated haemoglobin (HbA1c) levels (8.4% ± 2.6% vs. 7.3% ± 1.9%; p = 0.002 for BG > 10 mmol/L) and longer lengths of stay (10.1 ± 8.2 days vs. 6.8 ± 4.7 days; p = 0.007 for BG < 4 mmol/L). Hyperglycaemia was more prevalent in patients on more intensive treatment regimens, such as basal-bolus combination therapy and the use of both insulin and oral hypoglycaemic agents (100.0% and 96.0%, respectively; p < 0.001 for BG > 10 mmol/L).

CONCLUSIONInpatient glycaemic control is suboptimal. Factors (e.g. type of treatment regimen, discipline and baseline HbA1c) associated with greater prevalence of dysglycaemia should be given due consideration in patient management.

Aged ; Blood Glucose ; analysis ; Diabetes Mellitus ; drug therapy ; Female ; Hospitals ; Humans ; Hyperglycemia ; complications ; drug therapy ; Hypoglycemia ; complications ; drug therapy ; Hypoglycemic Agents ; therapeutic use ; Inpatients ; Insulin ; therapeutic use ; Male ; Middle Aged ; Point-of-Care Systems ; Prevalence ; Retrospective Studies ; Singapore ; Treatment Outcome