In recent years HIV infections have declined in many parts of the world, however, there are still 35 million persons living with HIV infection and 2.1 million new infections occurred in 2011 worldwide. In many areas HIV continues to affect certain at risk communities viz. men who have sex with men, sex workers, clients of sex workers and injecting drug users. In Singapore the number of newly diagnosed HIV infections appears to have stabilised, however the current trend is that infected individuals are presenting at a late stage of infection and more HIV infections are being diagnosed among MSM and fewer in heterosexuals. The trend for other sexually-transmitted infections is generally stable, with gonorrhea, Chlamydia trachomatis infection and anogenital herpes showing decreases, whilst the incidence of syphilis showed an increase in 2012. Interviews with patients attending the DSC Clinic indicate that most STIs are contracted locally from casual partners. Unregulated sex workers are more frequently cited as primary contacts than are local regulated sex workers, who continue to have very low levels of STIs, underlining the benefits of the programme of routine screening, treatment and condom negotiation skills training provided by the Department of STI Control (DSC) Clinic in Singapore.

Epidemics ; HIV Infections ; drug therapy ; epidemiology ; prevention & control ; Humans ; Singapore ; epidemiology

Anti-Retroviral Agents ; Congresses as Topic ; HIV Infections ; drug therapy ; prevention & control ; Human Rights ; Humans ; Public Health

INTRODUCTIONThis article presents recent developments in biomedical interventions for prevention of sexual transmission of the human immunodeficiency virus (HIV) infection.

MATERIALS AND METHODSA review of results from randomised clinical trials on the use of antiretroviral (ARV) medications and other biomedical methods to prevent the transmission and acquisition of HIV infection.

RESULTSPre-exposure prophylaxis (PrEP) refers to the provision of ARV medications to uninfected persons at high risk of HIV infection either in the form of topical agents, e.g. vaginal microbicide gels, or orally administered tablets. The Caprissa study demonstrated the efficacy of vaginal microbicides, the Vaginal and Oral Interventions to Control the Epidemic (VOICE) study however was not able to confirm these results. Oral PrEP was found to be efficacious in the iPrEx study on men who have sex with men (MSM), and among heterosexual couples in the Partners-PrEP and the TDF2 studies in Africa. The HPTN 052 trial demonstrated that the provision of early ARV treatment was able to prevent transmission of HIV by 92% compared with delayed treatment. This has led to enthusiasm to roll out treatment as prevention (TasP) programmes. Encouraging results from studies on male circumcision to prevent HIV acquisition have resulted in several implementation projects in Africa. Another encouraging result has been the success, albeit modest, of the prime-boost combination RV144 vaccine trial in Thailand.

CONCLUSIONNew advances in prevention strategies are urgently needed to slow down the HIV pandemic. Recent developments particularly in the form of PrEP and TasP have given new hope that we will be able to achieve this goal.

Anti-Retroviral Agents ; therapeutic use ; Female ; HIV Infections ; prevention & control ; transmission ; Humans ; Male ; Outcome Assessment (Health Care) ; Randomized Controlled Trials as Topic ; Singapore

OBJECTIVE: Lister's tubercle is used as a standard anatomical landmark in hand surgery and arthroscopy procedures. In this study, we aimed to evaluate and propose a classification for anatomical variants of Lister's tubercle. MATERIALS AND METHODS: Between September 2011 and July 2014, 360 MRI examinations for wrists performed using 1.5T scanners in a single institution were retrospectively evaluated. The prevalence of anatomical variants of Lister's tubercle based on the heights and morphology of its radial and ulnar peaks was assessed. These were classified into three distinct types: radial peak larger than ulnar peak (Type 1), similar radial and ulnar peaks (Type 2) and ulnar peak larger than radial peak (Type 3). Each type was further divided into 2 subtypes (A and B) based on the morphology of the peaks. RESULTS: The proportions of Type 1, Type 2, and Type 3 variants in the study population were 69.2, 21.4, and 9.5%, respectively. For the subtypes, the Type 1A variant was the most common (41.4%) and conformed to the classical appearance of Lister's tubercle; whereas, Type 3A and 3B variants were rare configurations (6.4% and 3.1%, respectively) wherein the extensor pollicis longus tendon coursed along the radial aspect of Lister's tubercle. CONCLUSION: Anatomical variations of Lister's tubercle have potential clinical implications for certain pathological conditions and pre-procedural planning. The proposed classification system facilitates a better understanding of these anatomical variations and easier identification of at-risk and rare variants.
Arthroscopy ; Classification* ; Hand ; Magnetic Resonance Imaging* ; Prevalence ; Retrospective Studies ; Tendons ; Wrist

Administration, Cutaneous ; Administration, Topical ; Betamethasone Valerate ; therapeutic use ; China ; Clobetasol ; therapeutic use ; Cohort Studies ; Diabetes Mellitus ; epidemiology ; Ethnic Groups ; statistics & numerical data ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Hyperlipidemias ; epidemiology ; India ; Lichen Planus ; drug therapy ; epidemiology ; Malaysia ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Triamcinolone ; therapeutic use

INTRODUCTIONThis is a review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1994 to 2003.

MATERIALS AND METHODSData collated for both notifiable and non-notifiable STIs from 1994 to 2003 were analysed. This data consisted of STI notifications from medical practitioners in Singapore as well as from the Department of STI Control clinic itself.

RESULTSThere was a decline in the overall STI incidence in Singapore in the first half of the last decade from 215 cases per 100,000 population (7,200 cases) in 1994 to 162 cases per 100,000 population (6,318 cases) in 1999, followed by an increasing trend in the number of acute STIs (both bacterial and viral) over the past 5 years to 195 cases per 100,000 population (8,175 cases) in 2003 (P <0.001). The incidence of HIV has risen sharply over the last decade whilst that of other viral STIs has not decreased. Singaporeans are becoming sexually active at a younger age, with casual partners constituting the main primary contacts.

CONCLUSIONSAlthough there has been a significant decline in the overall incidence of STIs in Singapore over the last decade, a rise in acute STIs over the last 5 years has resulted in the need to identify the causal factors, and to intensify existing as well as develop new STI/HIV prevention programmes for the general population and certain core groups.

Adolescent ; Adult ; Child ; Female ; HIV Infections ; epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Sexually Transmitted Diseases, Viral ; epidemiology ; Singapore ; epidemiology

Epigenetic alterations are associated with all aspects of cancer, from tumor initiation to cancer progression and metastasis. It is now well understood that both losses and gains of DNA methylation as well as altered chromatin organization contribute significantly to cancer-associated phenotypes. More recently, new sequencing technologies have allowed the identification of driver mutations in epigenetic regulators, providing a mechanistic link between the cancer epigenome and genetic alterations. Oncogenic activating mutations are now known to occur in a number of epigenetic modifiers (i.e. IDH1/2, EZH2, DNMT3A), pinpointing epigenetic pathways that are involved in tumorigenesis. Similarly, investigations into the role of inactivating mutations in chromatin modifiers (i.e. KDM6A, CREBBP/EP300, SMARCB1) implicate many of these genes as tumor suppressors. Intriguingly, a number of neoplasms are defined by a plethora of mutations in epigenetic regulators, including renal, bladder, and adenoid cystic carcinomas. Particularly striking is the discovery of frequent histone H3.3 mutations in pediatric glioma, a particularly aggressive neoplasm that has long remained poorly understood. Cancer epigenetics is a relatively new, promising frontier with much potential for improving cancer outcomes. Already, therapies such as 5-azacytidine and decitabine have proven that targeting epigenetic alterations in cancer can lead to tangible benefits. Understanding how genetic alterations give rise to the cancer epigenome will offer new possibilities for developing better prognostic and therapeutic strategies.
Chromatin ; metabolism ; Chromatin Assembly and Disassembly ; DNA Methylation ; Enhancer of Zeste Homolog 2 Protein ; Epigenesis, Genetic ; Histones ; metabolism ; Humans ; Neoplasms ; genetics ; metabolism ; pathology ; Polycomb Repressive Complex 2 ; genetics ; metabolism

BACKGROUND: Family doctors are increasingly managing the diabetes care of Korean-Americans. Little is known about the prevalence of diabetes among non-obese Korean-Americans, or the extent to which they receive timely and appropriate diabetes care. The purpose of this investigation is to: (1) identify the prevalence of diabetes and to determine the adjusted odds of diabetes among non-obese Korean-Americans compared to non-Hispanic White (NHW) Americans, (2) examine the factors associated with having diabetes in a large sample of non-obese Korean-Americans, and (3) determine the prevalence and adjusted odds of optimal frequency of eye care, foot care and A1C blood glucose level monitoring among non-obese Korean-Americans with diabetes in comparison to NHWs with diabetes. METHODS: Secondary analysis of population-based data from the combined 2007, 2009, and 2011 adult California Health Interview Survey. The sample included 74,361 respondents with body mass index (BMI) <30 kg/m2 (referred to as ‘non-obese BMI’), of whom 2,289 were Korean-Americans and 72,072 were NHWs, and 4,576 had diabetes. RESULTS: The prevalence and adjusted odds of diabetes among non-obese Korean-Americans are significantly higher than among their NHW peers. More than 90% of Korean-Americans with diabetes were non-obese. NHWs had substantially higher odds of having optimal frequency of eye care, foot care and A1C glucose level monitoring, even after adjusting for insulin dependence, sex, age, education, income, and BMI. CONCLUSION: Non-obese Korean-Americans are at higher risk for diabetes and are much less likely to receive optimal diabetes care in comparison to NHWs. Targeted outreach is necessary.
Adult ; Asian Americans ; Blood Glucose ; Body Mass Index ; California ; Chronic Disease ; Community Medicine ; Cross-Cultural Comparison ; Education ; Emigrants and Immigrants ; Foot ; Glucose ; Healthcare Disparities ; Humans ; Insulin ; Prevalence ; Surveys and Questionnaires

Monkeypox is a global health emergency. Prior to 2022, there were few reports of monkeypox outside of endemic countries, which were mostly travel-related. Since May 2022, an exponential increase in monkeypox infections in previously non-endemic countries has been reported. Unlike previous outbreaks of monkeypox, which were zoonotically transmitted and presented with generalised vesicular eruptions after prodromal symptoms, cases of the current outbreak feature significant travel and sexual history, and atypical localised genital eruptions with unpredictable onset relative to viral prodrome-like symptoms. We summarise the 15 Singapore cases reported to date as of August 2022, and highlight salient clinical clues that may aid physicians in narrowing the broad differential diagnosis of an acute vesicular genital eruption. Although research into vaccination and antiviral strategies is ongoing, monkeypox is currently conservatively managed. Clinical vigilance and a high index of suspicion are required to facilitate early detection and isolation of cases to contain transmission in Singapore.
Disease Outbreaks ; Humans ; Monkeypox/epidemiology* ; Singapore/epidemiology* ; Travel-Related Illness