Adult ; Bandages ; Fournier Gangrene ; therapy ; Humans ; Male ; Negative-Pressure Wound Therapy ; methods ; Perineum ; pathology ; Wound Healing

OBJECTIVES: Recently the care of cerebrovascular and cardiovascular disease is important as much as that of cancer care in public health, so the control of diabetes mellitus(DM) which is a risk factor of cerebrovascular and cardiovascular disease has been also important consideration. This study was carried out to investigate the blood glucose change of the participants in diabetes mellitus class(DM class) of a health center. METHODS: Study subjects were 54 participants of DM class in a health center that had been held once a month, from January 2005 to March 2006. RESULTS: Among the DM class participants, 67.3% participated by 50% or over in the DM class. After DM class, the level of random blood sugar decreased from 176mg/dl to 156mg/dl in DM class participants(p<0.05). In a comparison between more than 50% participation group and less than 50% participation group, more than 50% participation group got decreased level of blood sugar from 182mg/dl to 155mg/dl and less than 50% participation group also got decreased level from 172mg/dl to 156mg/dl. But there was no statistically significant difference between two groups. CONCLUSION: DM class of health center was effective program to manage diabetes mellitus patients in community.
Blood Glucose ; Cardiovascular Diseases ; Diabetes Mellitus ; Humans ; Public Health ; Risk Factors

INTRODUCTION: Frontline healthcare workers (HCWs) exposed to coronavirus disease 2019 (COVID-19) are at risk of psychological distress. This study evaluates the psychological impact of COVID-19 pandemic on HCWs in a national paediatric referral centre. METHODS: This was a survey-based study that collected demographic, work environment and mental health data from paediatric HCWs in the emergency, intensive care and infectious disease units. Psychological impact was measured using the Depression, Anxiety, Stress Scale-21. Multivariate regression analysis was performed to identify risk factors associated with psychological distress. RESULTS: The survey achieved a response rate of 93.9% (430 of 458). Of the 430 respondents, symptoms of depression, anxiety and stress were reported in 168 (39.1%), 205 (47.7%) and 106 (24.7%), respectively. Depression was reported in the mild (47, 10.9%), moderate (76, 17.7%), severe (23, 5.3%) and extremely severe (22, 5.1%) categories. Anxiety (205, 47.7%) and stress (106, 24.7%) were reported in the mild category only. Collectively, regression analysis identified female sex, a perceived lack of choice in work scope/environment, lack of protection from COVID-19, lack of access to physical activities and rest, the need to perform additional tasks, and the experience of stigma from the community as risk factors for poor psychological outcome. CONCLUSION A high prevalence of depression, anxiety and stress was reported among frontline paediatric HCWs during the COVID-19 pandemic. Personal psychoneuroimmunity and organisational prevention measures can be implemented to lessen psychiatric symptoms. At the national level, involving mental health professionals to plan and coordinate psychological intervention for the country should be considered.
Adult ; Anxiety/etiology* ; COVID-19/psychology* ; Depression/etiology* ; Female ; Health Surveys ; Hospitals, Pediatric ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Occupational Diseases/etiology* ; Pandemics ; Personnel, Hospital/psychology* ; Prevalence ; Risk Factors ; Self Report ; Severity of Illness Index ; Singapore/epidemiology* ; Stress, Psychological/etiology*

INTRODUCTIONTo determine the magnitude of gender difference in paediatric hospital admissions.

MATERIALS AND METHODSWe reviewed discharge data of general medical paediatric admissions to a university teaching hospital in Hong Kong from 1984 to 2000. Based on ICD-9 codes, 9 broad categories of disease with related sub-categories were used, namely respiratory, gastrointestinal, neurological, renal, cardiac, haematological/oncological, neonatal, miscellaneous and social. Data on patients admitted to the haematological, oncological and neonatal wards were excluded from this analysis.

RESULTSThere were 92,332 patients admitted to the general paediatric wards. The 7 leading causes for admission accounted for 62% of all admissions: gastroenteritis (14%), upper respiratory tract infections (12%), asthma/wheezy bronchitis (10%), pneumonia (10%), bronchiolitis (6%), febrile convulsions (7%) and other convulsions (4%). Across almost all categories, there was a consistent excess of males (59.1% of all admissions). The male excess was even more pronounced for urinary tract infections (72%) and nephrotic syndrome (80%). The main sub-categories without this male predominance were accidents, accidental ingestion and social admissions (50% males), failure to thrive (49% males), acyanotic congenital heart disease (48%), endocrine (42%), auto-immune conditions (30%) and attempted suicide (19%).

CONCLUSIONSAlthough male vulnerability to illness has long been recognised, the consistency and magnitude of these gender differentials in admissions was impressive. More vigorous exploration of the underlying mechanisms responsible for this phenomenon is warranted.

Adolescent ; Child ; Child, Preschool ; Female ; Gastrointestinal Diseases ; epidemiology ; Heart Diseases ; epidemiology ; Hematologic Diseases ; epidemiology ; Hong Kong ; epidemiology ; Hospitals, University ; utilization ; Humans ; Infant ; Kidney Diseases ; epidemiology ; Male ; Patient Admission ; statistics & numerical data ; Respiratory Tract Diseases ; epidemiology ; Retrospective Studies ; Sex Factors

INTRODUCTIONThe aim of this study was to analyse the thickness of the retinal nerve fibre layer (RNFL) of pulmonary tuberculosis patients on ethambutol and isoniazid.

MATERIALS AND METHODSThis was a prospective cohort study where patients with newly diagnosed pulmonary tuberculosis requiring chemotherapy, including ethambutol and isoniazid, were imaged using scanning laser polarimetry. Their mean baseline RNFL thickness and various scanning laser polarimetry parameters of both eyes were measured 2 weeks after the commencement of chemotherapy. The measurements were repeated at 3 months and 6 months after treatment. The various parameters of the baseline and the follow-up measurements were compared using paired sample t-test with Bonferroni correction.

RESULTSTwenty-four patients (16 males and 8 females; mean age, 51.0 +/- 17.6 years) were recruited. There was no statistically significant difference between the baseline and the follow-up measurements in RNFL thickness and all other scanning laser polarimetry parameters.

CONCLUSIONIn this cohort of subjects, there was no subclinical change in RNFL thickness detected by scanning laser polarimetry in pulmonary tuberculosis patients on chemotherapy, including ethambutol and isoniazid, after 6 months of treatment.

Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents ; adverse effects ; therapeutic use ; Diagnostic Techniques, Ophthalmological ; Ethambutol ; adverse effects ; therapeutic use ; Female ; Humans ; Isoniazid ; adverse effects ; therapeutic use ; Lasers ; Male ; Middle Aged ; Prospective Studies ; Retinal Diseases ; chemically induced ; diagnosis ; Tuberculosis, Pulmonary ; drug therapy

INTRODUCTIONThis is a retrospective study aimed to analyse the outcomes of oral tongue cancer with emphasis on young people.

MATERIALS AND METHODSPatients treated radically between 1998 and 2006 were included and categorised according to treatment modalities (Group A: Surgery, Group B: Surgery and adjuvant therapy, Group C: Definitive radiotherapy) and age groups (≤ 40 and > 40 years). Overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRS) and metastasis-free survival (MFS) were estimated using Kaplan-Meier method.

RESULTSThere were 123 patients with 32%, 53% and 15% in Group A, B and C, respectively. Of these, 17 patients (14%) were ≤40 years with 6 (15%), 8 (12%) and 3 (16%) young oral tongues in Group A, B and C, respectively. Five-year OS and DFS were 69%/72%, 41%/47% and 16%/9.5% for Group A, B and C, respectively. Young patients had similar survival as the older population with 5-year OS of 83%, 75% and 33% in Group A, B and C, as compared to the older patients (66%, 36% and 13%, respectively).

CONCLUSIONYoung oral tongue patients did not have worse outcomes.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tongue Neoplasms ; therapy ; Treatment Outcome ; Young Adult

INTRODUCTIONWe aimed to create a definition of neurophobia, and determine its prevalence and educational risk factors amongst medical students and junior doctors in Singapore.

MATERIALS AND METHODSWe surveyed medical students and junior doctors in a general hospital using electronic and paper questionnaires. We asked about knowledge, interest, perceived difficulty in neurology, and confidence in managing neurology patients compared to 7 other internal medicine specialties; quality and quantity of undergraduate and postgraduate neuroscience teaching, clinical neurology exposure, and postgraduate qualifications. Neurophobia was defined as ≤4 composite score of difficulty and confidence with neurology.

RESULTSOne hundred and fifty-eight medical students (63.5%) and 131 junior doctors (73.2%) responded to the questionnaire. Neurophobia prevalence was 47.5% in medical students, highest amongst all medical subspecialties, and 36.6% in junior doctors. Multivariate analysis revealed that for medical students, female gender (OR 3.0, 95% CI, 1.3 to 6.7), low interest (OR 2.5, 95% CI, 1.0 to 6.2), low knowledge (OR 10.1, 95% CI, 4.5 to 22.8), and lack of clinical teaching by a neurologist (OR 2.8, 95% CI, 1.2 to 6.6) independently increased the risk of neurophobia. For doctors, low interest (OR 3.0, 95% CI, 1.3 to 7.0) and low knowledge (OR 2.7, 95% CI, 1.2 to 6.2) independently increased the risk of neurophobia, and female gender was of borderline significance (OR 2.0, 95% CI, 0.9 to 4.6).

CONCLUSIONNeurophobia is highly prevalent amongst Singapore medical students and junior doctors. Low interest and knowledge are independent risk factors shared by both groups; female gender may also be a shared risk factor. The mnemonic GIK (Gender, Interest, Knowledge) identifies the risk factors to mitigate when planning teaching strategies to reduce neurophobia.

Attitude of Health Personnel ; Humans ; Medical Staff, Hospital ; Neurology ; Physicians ; Students, Medical ; Surveys and Questionnaires

OBJECTIVETo investigate the role of a potential diabetes-related mitochondrial region, which includes two previously reported mutations, 3243A-->G and 3316G-->A, in Chinese patients with adult-onset type 2 diabetes.

METHODSA total of 277 patients and 241 normal subjects were recruited for the study. Mitochondrial nt 3116 - 3353, which spans the 16S rRNA, tRNA(leu(UUR)) and the NADH dehydrogenase 1 gene, were detected using polymerase chain reaction (PCR), direct DNA sequencing, PCR-restriction fragment length polymorphism and allele-specific PCR. Variants were analyzed by two-tailed Fisher exact test. The function of the variants in 16S rRNA were predicted for minimal free energy secondary structures by RNA folding software mfold version 3.

RESULTSFour homoplasmic nucleotide substitutions were observed, 3200T-->C, 3206C-->T, 3290T-->C and 3316G-->A. Only the 3200T-->C mutation is present in the diabetic population and absent in the control population. No statistically significant associations were found between the other three variants and type 2 diabetes. The 3200T-->C and 3206C-->T nucleotide substitutions located in 16S rRNA are novel variants. The 3200T-->C caused a great alteration in the minimal free energy secondary structure model while the 3206C-->T altered normal 16S rRNA structure little.

CONCLUSIONSThe results suggest that the 3200T-->C mutation is linked to the development of type 2 diabetes, but that the other observed mutations are neutral. In contrast to the Japanese studies, the 3316G-->A does not appear to be related to type 2 diabetes.

Age of Onset ; Aged ; Alleles ; Base Sequence ; DNA Mutational Analysis ; DNA, Mitochondrial ; chemistry ; genetics ; Diabetes Mellitus, Type 2 ; genetics ; Humans ; Middle Aged ; Models, Molecular ; Nucleic Acid Conformation ; Point Mutation ; Polymerase Chain Reaction ; methods ; Polymorphism, Restriction Fragment Length ; RNA, Ribosomal, 16S ; chemistry ; genetics

INTRODUCTION: Institutional surgical antibiotic prophylaxis (SAP) guidelines are in place at all public hospitals in Singapore, but variations exist and adherence to guidelines is not tracked consistently. A national point prevalence survey carried out in 2020 showed that about 60% of surgical prophylactic antibiotics were administered for more than 24 hours. This guideline aims to align best practices nationally and provides a framework for audit and surveillance. METHOD: This guideline was developed by the National Antimicrobial Stewardship Expert Panel's National Surgical Antibiotic Prophylaxis Guideline Development Workgroup Panel, which comprises infectious diseases physicians, pharmacists, surgeons and anaesthesiologists. The Workgroup adopted the ADAPTE methodology framework with modifications for the development of the guideline. The recommended duration of antibiotic prophylaxis was graded according to the strength of consolidated evidence based on the scoring system of the Singapore Ministry of Health Clinical Practice Guidelines. RESULTS: This National SAP Guideline provides evidence-based recommendations for the rational use of antibiotic prophylaxis. These include recommended agents, dose, timing and duration for patients undergoing common surgeries based on surgical disciplines. The Workgroup also provides antibiotic recommendations for special patient population groups (such as patients with β-lactam allergy and patients colonised with methicillin-resistant Staphylococcus aureus), as well as for monitoring and surveillance of SAP. CONCLUSION This evidence-based National SAP Guideline for hospitals in Singapore aims to align practices and optimise the use of antibiotics for surgical prophylaxis for the prevention of surgical site infections while reducing adverse events from prolonged durations of SAP.
Humans ; Antibiotic Prophylaxis ; Anti-Bacterial Agents/therapeutic use* ; Methicillin-Resistant Staphylococcus aureus ; Singapore ; Surgeons ; Hospitals, Public