Adolescent ; Adult ; Aged ; Aged, 80 and over ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Singapore ; Skin Diseases ; diagnosis ; Tertiary Care Centers ; Young Adult

Introduction: Biomedical research has traditionally been the domain of developed countries. We aim to study the effects of the increased focus on biomedical and medical research on level 1-4 publications in several industrialised and newly industrialised countries endowed with petroleum and gas resources. Methods: We identified all level 1-4 publications from 01/01/1994 to 31/12/2013 via PubMed using advanced options. The population and GDP (current US$) data from 1994-2013 were obtained through data provided by the World Bank and the raw data was normalised based on these two indicators. Results: From 1994-2013, Saudi Arabia and Malaysia were responsible for the highest absolute number of level 1 to 4 biomedical and medical research publications with 2551 and 1951 publications respectively. When normalised to population, Kuwait and Qatar had the highest publication rates, with 7.84 and 3.99 publications per 100,000 inhabitants respectively in a five yearly average. Kuwait produced the largest number of publications per billion (current US$) of GDP, at 2.92 publications, followed by Malaysia at 2.82 publications in a five yearly average. Conclusion: The population size of a country as well as GDP can influence the number of level 1-4 publications in some countries. More importantly, effective government policy which stimulates research as well as a culture which actively promotes research as shown by Malaysia have proven to have a larger influence on the amount of level 1-4 biomedical and medical publications.
Biomedical Research

The aim of this study was to determine whether testicular volume is correlated with clinical and biochemical markers of hypothalamic-pituitary-testicular (HPT) axis function. This was a cross-sectional substudy of a larger randomized controlled trial including obese men, body mass index (BMI) ≥30 kg m-2, with a total testosterone level <12 nmol l-1. Testicular volume was measured by orchidometer, testosterone by liquid chromatography/tandem mass spectrometry, and body composition by dual-energy X-ray absorptiometry. Men completed the Aging Males' Symptoms (AMS) score, International Index of Erectile Function-5 (IIEF-5), physical function, and handgrip dynamometer testing. Eighty-nine men participated with a median (interquartile range [IQR]) age of 53.1 (47.6, 59.2) years, BMI of 37.0 (34.6, 40.5) kg m-2, and a total testosterone of 7.0 (6.1, 7.9) nmol l-1. Median testicular volume was 18 (IQR: 10, 20) ml. Testicular volume was negatively correlated with BMI (τ =-0.1952, P = 0.010) and total fat mass (τ =-0.2115, P = 0.005) independent of age and testosterone. When BMI, testosterone, sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were present in a multivariable model, only BMI (-0.38 ml change in testicular volume per 1 kg m-2BMI; 95% CI:-0.74,-0.02; P = 0.04) and LH (-0.92 ml change in testicular volume per 1 IU l-1 LH; 95% CI:-1.75,-0.095; P = 0.03) remained independent significant predictors of testicular volume. Testicular volume was positively correlated with IIEF-5 (τ = 0.2092, P = 0.021), but not related to handgrip strength, physical function tests, or AMS. In obese men, testicular volume is inversely and independently associated with measures of adiposity, but not with most clinical or biochemical markers of HPT axis action. From a clinical perspective, this suggests that obesity might compromise the reliability of reduced testicular volume as a sign of androgen deficiency in men.

Aged ; Eccrine Porocarcinoma ; pathology ; Female ; Humans ; Sweat Gland Neoplasms ; pathology

INTRODUCTION: Pemphigus is a chronic, relapsing immunobullous disease. There is limited data on the clinical course and prognostic factors of pemphigus in Asian patients. MATERIALS AND METHODS: We conducted a retrospective cohort study of all newly diagnosed pemphigus vulgaris (PV) and pemphigus foliaceus (PF) patients seen at the National Skin Centre from 1 January 2004 to 31 December 2009. Demographic and clinical data on comorbidities, treatment and remission were recorded. Mortality information was obtained from the National Registry of Diseases. Prognostic endpoint was overall remission at last visit. RESULTS: Sixty- one patients (36 PV and 25 PF) were recruited. Among PV patients, higher initial prednisolone dose ( = 0.017) and the use of azathioprine ( = 0.028) were significantly associated with overall remission at last visit. However, higher desmoglein 1 antibody titres at diagnosis ( = 0.024) and the use of dapsone ( = 0.008) were negatively associated with overall remission at last visit. Among PF patients, only higher desmoglein 1 antibody titre at diagnosis ( = 0.041) was found to be associated with lower overall remission at last visit. There was no mortality during the 3-year follow-up period in both PV and PF. CONCLUSION Higher initial prednisolone dose and the use of azathioprine in PV desmoglein 1 antibody titre at diagnosis in PV and PF might be prognostic markers for achieving remission. Use of dapsone was associated with lower overall remission in PV, but this might be confounded because dapsone was used as an adjuvant therapy in recalcitrant cases. Owing to study methodology and limitations, further evaluation is needed for better prognostication of pemphigus.

INTRODUCTIONAtopic dermatitis is a common, chronic pruritic condition affecting both children and adults, which has a negative impact on the quality of life. These guidelines were developed by an expert workgroup appointed by the Dermatological Society of Singapore, to provide doctors with information to assist in the management of their patients with atopic dermatitis. The workgroup members are experienced dermatologists with interest and expertise in eczemas.

MATERIALS AND METHODSWorkgroup members arrived at a consensus on the topics to be included. Relevant studies from the literature were assessed for best evidence, supplemented by the collective experience of the workgroup.

RESULTSFor mild atopic dermatitis, emollients, mild potency topical steroids and topical calcineurin inhibitors are recommended. For moderate-to-severe atopic dermatitis, the use of emollients, moderate-to-potent topical steroids, topical calcineurin inhibitors, wet dressings, antimicrobials for secondary skin infection, phototherapy, and systemic therapy (e.g. prednisolone, cyclosporine, azathioprine or methotrexate) may be warranted. Patients with moderate-to-severe atopic dermatitis should be managed in conjunction with a dermatologist.

CONCLUSIONGood outcomes can be achieved with an individualised therapeutic approach combined with adequate patient and parental education.

Administration, Cutaneous ; Adrenal Cortex Hormones ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Azathioprine ; therapeutic use ; Calcineurin Inhibitors ; therapeutic use ; Coinfection ; complications ; drug therapy ; Cyclosporine ; therapeutic use ; Dermatitis, Atopic ; complications ; immunology ; therapy ; Dermatology ; Disease Management ; Emollients ; therapeutic use ; Food Hypersensitivity ; immunology ; Humans ; Immunosuppressive Agents ; therapeutic use ; Methotrexate ; therapeutic use ; Patient Education as Topic ; Phototherapy ; Practice Guidelines as Topic ; Referral and Consultation ; Severity of Illness Index ; Singapore

Livedoid vasculopathy is a rare chronic relapsing disorder characterised by recurrent painful thrombotic and vasculitic ulcers on the legs. We present the cases of two Indian women with livedoid vasculopathy that were found to be associated with an underlying factor V Leiden heterozygous mutation. There were no other thrombotic manifestations, and livedoid vasculopathy was the sole presenting feature of the factor V Leiden mutation, although this could also be coincidental. Initial treatment with high-dose immunosuppressive therapy was suboptimal, and the addition of pentoxifylline and antiplatelet therapy was crucial in achieving disease control and remission. These cases highlight the possible association with an underlying prothrombotic disorder, such as factor V Leiden mutation, in patients with livedoid vasculopathy. Although this association is relatively uncommon, it is more relevant to Indian patients, as the presence of factor V Leiden mutation is highest in this ethnicity as compared to the local Malay and Chinese populations.
Adult ; Blood Vessels ; pathology ; DNA ; genetics ; Factor V ; genetics ; metabolism ; Female ; Humans ; Leg Ulcer ; blood ; genetics ; pathology ; Livedo Reticularis ; blood ; diagnosis ; genetics ; Point Mutation ; Polymerase Chain Reaction ; Skin ; blood supply ; Skin Diseases, Vascular ; blood ; genetics ; pathology

INTRODUCTIONLeg ulcers are a chronic condition affecting the older population. In Singapore, the use of topical traditional Chinese medicaments (TTCM) is common amongst those older than 65 years of age. We study the role of TTCM as contact sensitisers in patients with chronic venous leg ulcers and its impact in the clinical management of these patients.

MATERIALS AND METHODSPatients with chronic leg ulcers attending the Wound and Ulcer Clinic at the National Skin Centre (NSC) between October 2005 and April 2006 were patch-tested to the NSC TTCM series. They were also patch-tested for other allergens from the NSC Standard Series, Medicament Series, Steroid Series and wound dressings.

RESULTSA total of 44 patients were patch-tested. Seventeen of the 44 (38.7%) patients were using or had used at least 1 TTCM. Seven patients (15.9%) had at least 1 positive patch test (PT) reading to TTCM, giving a sensitisation rate of 41% (7 of 17). A significantly high proportion of the patients, 94.1% (16 of 17) with a positive history of TTCM usage had at least 1 positive PT reading compared to those without a history of TTCM usage, 45.8% (11 of 24).

CONCLUSIONTTCM play an important role as contact sensitisers in our patients with chronic venous leg ulcers and may be a significant factor in non- or poor-healing leg ulcers. In such patients, a history of TTCM usage should be sought for and patch testing should include the commonly used TTCM where relevant.

Administration, Topical ; Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Dermatitis, Allergic Contact ; epidemiology ; Female ; Humans ; Leg Ulcer ; drug therapy ; Male ; Medicine, Chinese Traditional ; adverse effects ; Middle Aged ; Singapore ; epidemiology ; Varicose Ulcer ; drug therapy

INTRODUCTIONCutaneous melanoma is rare in Asia and the clinical presentation and outcome of melanoma is not well described in Southeast Asia. In addition, it is unclear if ethnic variations exist between the various racial groups. The objective of our study is to present the clinical characteristics of melanoma in Singapore and to highlight ethnical differences between Asians and Caucasians living in Singapore.

MATERIALS AND METHODSData were retrospectively collected from 48 patients with histological confirmation of melanoma who were seen in both the National Skin Centre and National Cancer Centre of Singapore.

RESULTSAcral lentiginous melanoma (ALM) was the most common subtype of melanoma in Singapore (50%). A higher proportion of non-ALM subtypes of melanoma compared to ALM were diagnosed at stage 1 (48% vs. 25%). The delay in diagnosis of ALM was 27 months compared to 12 months in other subtypes. Compared to Caucasians, there was a trend towards Asian patients being older, having a higher proportion of ALM and a longer delay to diagnosis.

CONCLUSIONGeographical and ethnic variations in the clinical presentation of melanoma exist. Specially adapted programmes are necessary to increase awareness of the different clinical presentation of melanoma in Asia and to encourage examination of the palms and soles in order to reduce the delay in diagnosis.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; European Continental Ancestry Group ; Female ; Humans ; Male ; Melanoma ; diagnosis ; epidemiology ; ethnology ; pathology ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Skin Neoplasms ; diagnosis ; epidemiology ; ethnology ; pathology

Objective: To determine physical activity, sleep, and nutrition patterns in individuals with cerebral palsy (CP) and investigate the association of Gross Motor Function Classification System (GMFCS) and age with these health behaviors. Methods: A cross-sectional study was conducted in an outpatient setting. Participants included adolescents and adults with CP (n=28; GMFCS level I–V; mean age 35.1±14.4 years). An Exercise Questionnaire or Leisure Time Physical Activity Questionnaire was used to measure physical activity in adolescents and adults, respectively. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). An adapted version of the PrimeScreen questionnaire was used to assess nutrition. Linear regression analyses were performed to investigate the association between GMFCS and age with physical activity, sleep, and nutrition. Results: The average total physical activity was 29.2±30.0 min/day. Seventy-five percent of the participants had poor sleep quality (PSQI score >5). Seventy-one percent reported “fair” eating behaviors; none reported “excellent” eating behaviors. Neither GMFCS nor age were significantly associated with PSQI score, PrimeScreen score, or total physical activity. A negative correlation existed between sleep quantity (hright) and PSQI score (r=-0.66, p=0.01). Conclusion The triad of health components, consisting of physical activity, sleep, and nutrition, was not associated with GMFCS or age in our sample of 28 individuals with CP, suggesting that these three health behaviors should be assessed during clinical encounters of CP in adolescents and adults at all levels of the GMFCS.