Background: Withdrawal response was used to explain extensor plantar response in population without pyramidal dysfunction but there is lack of data characterizing this response in normal population. Objective: To characterize withdrawal response from pain and tickle sensation in population without any neurological defi cit. Methods: The study was carried out using four different stimuli, namely heat-induced pain, cold-induced pain, electric-induced pain using electromyography stimulator and ticklish sensation using superworm (Zophobas morio), applied to normal subjects in University Malaya Medical Centre, Kuala Lumpur. Results: Heat-induced pain resulted in fl exion of the big toe (61.1%), other toes (62.3%), ankle dorsifl exion (82.6%), knee fl exion (83.9%) and hip fl exion (83.9%). Electric-induced pain showed fl exion of the big toe (27.7%), other toes (28.3%), ankle dorsifl exion (51.0%), knee fl exion (76.0%) and hip fl exion (76.0%). Ticklish sensation showed fl exion of the big toe (14.8%), other toes (14.8%), ankle dorsifl exion (22.7%), knee fl exion (21.9%), and hip fl exion (21.9%). There was signifi cant correlation between fear and ticklish sensation induced withdrawal responses and extension of big toe. Cold induced pain resulting in big toe fl exion (6.4%), other toes (6.9%), dorsifl exion of ankle (7.1%), fl exion of knee (6.9%), and hip fl exion (6.9%). Females were more responsive to heat, males to electrical stimulation. The prevalence of big toe extension ranged from 11.0% (electrical), 6.3% (ticklish), 4.8 (heat), to 0% (cold), a mean of 5.2% overall. Conclusion: Withdrawal response caused by nociceptive and ticklish sensation consists mostly of big toe fl exion and of other toes, ankle dorsifl exion and fl exion of the knee and hip. Extension of the big toe is seen in about 5% of all the stimulation.

Background: There are extensive studies indicating that deep venous thrombosis and pulmonary embolism contributes to significant morbidity and mortality after acute ischaemic stroke in the West, with established guidelines for prophylaxis. The situation is less clear in Asia. Accordingly, a literature search was performed to review the available evidence. Methods: A search was performed with all published materials in PubMed, Directory of Open Access Journals and BioMed Central, using the following keywords “venous thromboembolism”, “Asia”, “stroke”, “deep venous thrombosis” and “pulmonary embolism”. Systematic and non-systematic studies, previous review articles with their related references were also reviewed. Results: Wide ranging prevalence of venous thromboembolism has been reported after acute ischaemic stroke in Asia, 1% or less in clinical studies, 4.8% to 45% with imaging studies. The prevalence is lower as compared to Caucasian populations, 1.5% to 5.6% in clinical studies, 11% to 80% with imaging studies. Conclusion: The problem of venous thromboembolism is not negligible in Asia. There is a need for future studies in Asia with larger sample sizes. Antiplatelet drugs should be routinely used as prophylaxis while compression stockings applied for those with significant limb weakness. Prophylactic anticoagulation may be considered in those with additional risk factors.

Objective The T-Spot.TB is an interferon-gamma release assay (IGRA) which is increasingly used in dermatology as a screen for latent TB before initiation of biologics and for confirming diagnosis of tuberculids. This study aims to explore its concordance with tuberculin skin tests (TST) and eventual diagnosis of latent TB. Study design This is a retrospective review of all patients in NSC who had a TB T-spot test done between 2008 and 2010. We looked at the dermatological diagnosis, results of T-Spot.TB and TST, chest radiograph findings, tuberculosis status and treatment of TB. Result 51 TB T spot tests were ordered in National Skin Centre between 1 January 2008 and 9 June 2010. 31 tests were for patients with psoriasis with the intention of initiating biologics; 5 were for patients with suspected tuberculids and tuberculosis verrucosa cutis; 3 were done as part of work-up for possible erythema nodosum; 3 tests were part of screening for latent TB in hospital staff and 9 tests were performed for other reasons. There were a total of 13 patients eventually diagnosed with latent or active TB infection. All of whom had a positive T-Spot.TB result except for 1 patient with an indeterminate result. On the other hand, out of these 13 patients, only 5 showed a positive TST, 2 had negative TST and 4 patients did not have a TST done. There were a total of 14 positive T-Spot.TB results for which 12 eventually received antituberculous therapy. All patients with erythema induratum had a positive test result. Six patients’ T-Spot.TB tests were borderline, indeterminate or could not be interpreted due to insufficient lymphocyte yield. Conclusion Our study shows the utility of T-Spot. TB test in various conditions seen in dermatology clinics in a local setting. We suggest that the T-spot test can supplant the tuberculin skin test in screening latent TB for psoriasis patients for whom biologics are intended and in erythema induratum. The high incidence of borderline and indeterminate results should not be ignored. This should be taken into account when interpreting the IGRA especially if patients are on immunosuppressive therapy.

INTRODUCTION: Diabetes mellitus is a major public health issue in Singapore. To shape healthcare policies for the primary prevention of diabetes, it is crucial to understand Singaporeans' knowledge, attitudes and practices related to diabetes and its prevention. This study aimed to assess the knowledge, attitudes and lifestyles of individuals without diabetes. MATERIALS AND METHODS: A cross-sectional household survey was performed between 31 January to 3 February 2019 to examine knowledge, attitudes and practices related to diabetes. Inclusion criteria of the participants included: 1) Singaporeans/permanent residents, 2) between 30 to 64 years old, and 3) who did not have a diagnosis of diabetes. Logistic and linear regression models were used to analyse the association of knowledge and attitudes with physical activity and diet habits, respectively. RESULTS: Among 806 participants, 72.2% did not meet the Health Promotion Board's physical activity recommendation. Physical activity was associated with better diabetes knowledge (odds ratio [OR] 5.38, 95% confidence interval [CI] = 1.65-17.53, = 0.049), stronger beliefs in diabetes prevention (OR 3.36, 95% CI = 1.02-11.12, = 0.047) and lower levels of worry about diabetes (OR 0.41, 95% CI 0.17-1.00, = 0.049). Neither knowledge nor beliefs or worries about diabetes was associated with diet. CONCLUSION There is a need to reinforce the importance of physical activity and healthy diet in preventing diabetes. Although improving the knowledge level of diabetes may increase physical activity of the population, it is unlikely to improve dietary choices without effective behavior change interventions.