Diagnostic Errors ; prevention & control ; Emergency Service, Hospital ; Humans ; Severe Acute Respiratory Syndrome ; diagnosis ; World Health Organization

Amphotericin B ; therapeutic use ; Antifungal Agents ; therapeutic use ; Fever ; Histoplasma ; Histoplasmosis ; diagnosis ; drug therapy ; microbiology ; pathology ; Humans ; Jaundice ; Male ; Middle Aged

INTRODUCTIONThis study objectively evaluates the effectiveness of a 6-week Preparatory Training Phase (PTP) programme prior to Basic Military Training (BMT) for less physically conditioned conscripts in the Singapore Armed Forces.

MATERIALS AND METHODSWe compared exercise test results of a group of less fi t recruits who underwent a 16-week modified-BMT (mBMT) programme (consisting of a 6-week PTP and 10-week BMT phase) with their 'fitter' counterparts enlisted in the traditional 10-week direct-intake BMT (dBMT) programme in this prospective cohort study consisting of 36 subjects. The main outcome measures included cardiopulmonary responses parameters (VO(2)max and V(O2AT)) with clinical exercise testing and distance run timings.

RESULTSAlthough starting off at a lower baseline in terms of physical fitness [VO(2)max 1.73 +/- 0.27 L/min (mBMT group) vs 1.97 +/- 0.43 L/min (dBMT), P = 0.032; V(O2AT) 1.02 +/- 0.19 vs 1.14 +/- 0.32 L/min respectively, P = 0.147], the mBMT group had greater improvement in cardiopulmonary indices and physical performance profiles than the dBMT cohort as determined by cardiopulmonary exercise testing [VO(2)max 2.34 +/- 0.24 (mBMT) vs 2.36 +/- 0.36 L/min (dBMT), P = 0.085; V(O2AT) 1.22 +/- 0.17 vs 1.21 +/- 0.24 L/min respectively, P = 0.303] and 2.4 kilometres timed-run [mBMT group 816.1 sec (pre-BMT) vs 611.1 sec (post-BMT), dBMT group 703.8 sec vs 577.7 sec, respectively; overall P value 0.613] at the end of the training period. Initial mean difference in fitness between mBMT and dBMT groups on enlistment was negated upon graduation from BMT.

CONCLUSIONPre-enlistment fitness stratification with training modification in a progressive albeit longer BMT programme for less-conditioned conscripts appears efficacious when measured by resultant physical fitness.

Adolescent ; Asian Continental Ancestry Group ; Body Mass Index ; Cohort Studies ; Exercise Test ; statistics & numerical data ; Humans ; Male ; Military Personnel ; statistics & numerical data ; Oxygen Consumption ; Physical Education and Training ; methods ; standards ; Physical Fitness ; Program Evaluation ; Prospective Studies ; Risk Assessment ; Running ; physiology ; Singapore ; Time Factors ; Young Adult

INTRODUCTIONSingapore saw a resurgence of dengue infections in 2005. Concurrent bacterial co-infections in dengue is rare.

CLINICAL PICTUREWe report a cluster of serious methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia or severe soft tissue infection in 5 epidemiologically linked construction workers presenting with dengue and non-resolving fever.

TREATMENTSurgical intervention was indicated in 4 of the 5 patients despite appropriate antistaphylococcal therapy.

OUTCOMEAll but 1 patient were eventually discharged. Clonality and Panton-Valentine leucocidin genes were not demonstrated. Epidemiological investigations suggested that occupational contact dermatitis could have predisposed the patients to this opportunistic co-infection.

CONCLUSIONClinicians need to be vigilant to unusual manifestations of dengue which may signal a concomitant aetiology.

Adult ; Cluster Analysis ; Dengue ; complications ; epidemiology ; Humans ; Male ; Methicillin ; pharmacology ; Occupations ; Singapore ; epidemiology ; Soft Tissue Infections ; transmission ; Staphylococcal Infections ; complications ; epidemiology ; therapy ; transmission ; Staphylococcal Skin Infections ; transmission ; Staphylococcus aureus ; drug effects

INTRODUCTION: We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity. METHODS: We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January 2020 and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded. RESULTS: 169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum. CONCLUSION Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement; and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.
Humans ; Asian People ; COVID-19/complications* ; Inflammation/complications* ; SARS-CoV-2 ; Thrombosis