Sleep deprivation is not uncommon among children in Singapore. Children with deprived sleep may present with poor academic performance, learning disabilities and behavioural disorders. As a result of sleep deprivation, performance in complex tasks involving higher brain functions is affected more than simple memory tasks. Sleep quality rather than sleep quantity is associated with good cognitive learning and memory function. Regular sleep-wake patterns with good sleep schedules will reinforce this. Causes of sleep deprivation include insufficient sleep, fragmentation of sleep and increased need for sleep. The BEARS questionnaire is a useful screening tool for sleep deprivation. A clinical approach to exclude medical conditions that may cause excessive daytime sleepiness should be conducted and focused physical examination be performed. A two-week sleep log about the child's sleep habits and sleep-wake cycles should be recorded. Referrals to a sleep specialist should be made if any sleep disorders is suspected.

Mr Tan, 60, a smoker with diabetes mellitus (DM), hypertension and chronic kidney disease (CKD) Stage 3, and recurrent gout flares last five weeks of increasing intensity and duration. He assumes it is due to frequent travel and lack of exercise. He comes today for routine review of his chronic diseases. Current laboratory results are creatinine 106, eGFR 56, uric acid 490, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is on glipizide 5mg bd, Metformin 250mg BD, Amlodipine 5mg OM. He complains of severe gout pain. He had always been reluctant to start definitive treatment which you had previously mentioned. What will you do next?

Mr Tan, 60, a smoker with diabetes mellitus (DM), hypertension and chronic kidney disease (CKD) Stage 3, and recurrent gout flares last five weeks of increasing intensity and duration. He assumes it is due to frequent travel and lack of exercise. He comes today for routine review of his chronic diseases. Current laboratory results are creatinine 106, eGFR 56, uric acid 490, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is on glipizide 5mg bd, Metformin 250mg BD, Amlodipine 5mg OM. He complains of severe gout pain. He had always been reluctant to start definitive treatment which you had previously mentioned. What will you do next?

More people are traveling to remote places for leisure and business. It is not uncommon for patients to get medication and advice for travel to high altitudes. Although high altitude cerebral and pulmonary oedemas are more frequent at very high and extreme altitudes, they may sometimes occur at lower altitudes and lead to fatalities. Even though acute mountain sickness (AMS) is generally deemed benign, it can easily wreck a holiday. The Lake Louise Score Questionnaire is a useful screening tool for AMS and it can be self-administered during travel. Non-pharmacological means in the prevention and treatment of AMS, especially acclimatisation, are the most important. Pharmacological prevention and treatment strategies should be used as a useful adjunct. This paper provides an approach to the provision of education and advice for high altitude travel in the primary care setting.

BACKGROUND:Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.METHODS:In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.RESULTS:Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work.CONCLUSION:This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

PURPOSE: The aim of this pilot study was to investigate the effect of etched microgrooves on the hydrophilicity of Ti and osteoblast responses. MATERIAL AND METHODS: Microgrooves were applied on Ti to have 15 and 60 micrometer width, and 3.5 and 10 micrometer depth by photolithography, respectively. Further acid etching was applied to create Ti surfaces with etched microgrooves. Both smooth- and acid-etched Ti were used as the controls. The hydrophilicity of Ti was analyzed by determining contact angles. Cell proliferation and osteogenic activity of MC3T3 mouse preosteoblasts were analyzed by bromodeoxyuridine assay and alkaline phosphatase (ALP) activity test, respectively. One-way ANOVA, Pearson's correlation analysis and multiple regression analysis were used for statistics. RESULTS: Etched microgrooves significantly increased the hydrophilicity of Ti compared to the smooth Ti. 60 micrometer-wide etched microgrooves significantly enhanced cell proliferation, whereas the osteogenic activity showed statistically non-significant differences between groups. Result of the osteogenic activity significantly correlated with those of hydrophilicity and cell proliferation. Hydrophilicity was determined to be an influential factor on osteogenic activity. CONCLUSION: This study indicates that increase in hydrophilicity of Ti caused by etched microgrooves acts as an influential factor on osteogenic activity. However, statistically non-significant increase in the ALP activity suggests further investigation.
Alkaline Phosphatase ; Animals ; Bromodeoxyuridine ; Cell Proliferation ; Durapatite ; Hydrophobic and Hydrophilic Interactions ; Mice ; Osteoblasts ; Pilot Projects ; Titanium

Male infertility microsurgery represents the fastest growing sub-specialty in urology and clinical andrology over the past two decades. The importance of microsurgery for male infertility has risen as a part of the urologist's armamentarium in the medical and surgical management of male infertility. Despite the advances in male infertility microsurgery in China, the lack of standardized and well-organized training programs for male infertility microsurgery remains a serious problem affecting its development. In this article, Zhao and Peng have shared their experience with the learning curve of male infertility microsurgery at the Center for Male Reproductive Medicine and Microsurgery, Weill Medical College of Cornell University, which centers on how to pay attention to the details and basic principles of microsurgery. Male infertility microsurgery is physically, technically and mentally challenging, and must be first learned in the laboratory. Clinical success depends heavily upon appropriate training in a microsurgical laboratory. Good training can significantly reduce operation time and surgical errors as well as improve the quality of outcomes.
Andrology ; education ; Humans ; Infertility, Male ; surgery ; Male ; Microsurgery ; education

The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the tradeoff is an increased risk for bleeding while on DAPT. The addition of a novel oral anticoagulant (NOAC) further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on NOAC must be assessed and therapy individualized to ensure optimal therapy for each unique situation. Patients on NOAC undergoing PCI should undergo routine assessment with intravascular imaging as the role of high-risk lesion-related features have increased importance prior to determining optimal duration of treatment with DAPT. We review the best practices for the pharmacologic management of patients requiring anticoagulation with NOAC who are treated with PCI and require antiplatelet therapy.
Anticoagulants ; Hemorrhage ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Practice Guidelines as Topic ; Risk Assessment ; Stents ; Stroke ; Thrombosis

The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the tradeoff is an increased risk for bleeding while on DAPT. The addition of a novel oral anticoagulant (NOAC) further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on NOAC must be assessed and therapy individualized to ensure optimal therapy for each unique situation. Patients on NOAC undergoing PCI should undergo routine assessment with intravascular imaging as the role of high-risk lesion-related features have increased importance prior to determining optimal duration of treatment with DAPT. We review the best practices for the pharmacologic management of patients requiring anticoagulation with NOAC who are treated with PCI and require antiplatelet therapy.