BACKGROUND:?There is a critical relationship of time to treatment and myocardial salvage in the patient with acute myocardial infarction (AMI). As the proven beneficial management options for AMI have been extensively studied, the challenge lies in developing a process that minimizes pre-hospital delays, delays in assessment and initiation of reperfusion therapy. A greater emphasis on pre-hospital care has more potential in reducing mortality from acute MI than further development of hospital based treatments.

OBJECTIVE:?This study identifies the socio-demographic risk factors in patients with acute coronary syndrome and correlate them with pre-hospital delay. This response time to treatment is then correlated with the clinical outcome.

STUDY DESIGN:?Clinical Descriptive Study

METHODS:?Adult patients with diagnosis of acute coronary syndrome at the ICU setting of the USTH were sampled. Charts were reviewed and socio-demographic profiles identified. Pre-hospital delay from the onset of chest pain were correlated with these socio-demographic factors using multiple regression logistic regression. Chi square test was used to determine association between pre-hospital delay and clinical outcome.

RESULTS:?The study sample consisted of 220 patients with acute coronary disease. The sample population included 63% Non ST Elevation Myocardial Infarction (NSTEMI), 4% ST Elevation Myocardial Infarction (STEMI) and 33 percent with unstable angina. Male population accounted for 54% of the population. Thirty eight?percent(38%) of the population belonged to the 61.70 age group with mean age of 65 years old. The prevalence of hypertension (70%) and DM (41%) was high and about 30% of the population had prior history of coronary artery disease (CAD). About 35% reported family history of CAD and 41% had family history of DM. More than half of the population are smokers (55%). Majority of the patient population live within 10 kilometers from USTH (70%) while 28 patients (13%) came from the province. Thirty-eight percent (38%) sought consultation after two pain events, while only 4% came after more than 4 chest pain events. A significant number of population in the present series presented to the hospital delayed by more than four hours. Majority of the patients (40%), came in more than 6 hours. Twenty one percent (21%) came 2-4 hours while 30 percent came 4-6 hours from the onset of chest pain. The most common reason for the delay in seeking medical attention is financial limitation (36%), 31% had relief of chest pain by nitrates. Of the 220 included in the group, 50% had morbidity (such as development of acute renal failure, congestive heart failure), 41% had unremarkable outcome while there was 10% mortality noted. However in this study, we were not able to associate any socio-demographlc factors and the delay in time to treatment with the clinical outcome using available data and statistical.

CONCLUSION:?The results of this study demonstrate that patients with acute coronary event continue to exhibit prolonged delay in seeking medical care. This paper, Likewise, demonstrated that certain demographic and socioeconomic characteristics are associated with pre-hospital delay such as age, sex, history of CAD, hypertension and DM, proximity to the hospital, pain events prior to consultation and educational attainment. However, no correlation can be made between delay in time to treatment and clinical outcome.

Objective: To evaluate the activity and safety of adding oxaliplatin to a standard chemoradiotherapy schema, including 5-fluorouracil (5-FU)/folinic acid (FA), in locally-advanced rectal cancer (LARC). Methods: Two cycles of oxaliplatin 130 mg/m2 plus FA 20 mg/m2 bolus for 5 days and 5-FU 350 mg/m2 continuous infusion for 5 days were given during week 1 and 4 of pelvic radiotherapy 46 Gy. Patients with a T3/4 and/or node-positive rectal tumour were eligible. Surgery was performed 4–6 weeks after radiotherapy. The primary endpoint was to determine the rate of pathological response. Secondary endpoints were to assess the rate of clinical response and the safety profile. Results: Between March 2005 and January 2009, a total of 35 patients were enrolled. The pathological downstaging rate was 79% with a pathological complete response rate of 17%. The overall clinical response rate (assessed by computed tomography or transrectal ultrasound) was 77%. Grade 3 diarrhoea and Grade 3 neutropaenia were reported in 14% and 11% of the patients, respectively. Eleven patients did not undergo surgery: four of them refused the operation, and seven patients were inoperable due to disease progression. In 24 patients who had surgery, a sphincter-preserving procedure could be performed in 29%. At the median follow-up time of 28.1 months, 25 patients (71%) survived with no evidence of disease. Conclusion: The promising results in terms of pathological response, and the associated good safety profile of a regimen of oxaliplatin plus 5-FU/FA with concomitant radiotherapy, suggest that the regimen could be used in LARC.

Two duplex PCR assays were established for the detection of C. trachomatis (Ct), N. gonorrhoeae (GC), M. hominis (Mh), and U. urealyticum (Uu). These assays were used on clinical specimens obtained from women with Premature Rupture of Membrane or Post Partum Fever, from preterm infants, as well as from women with uneventful pregnancies and their babies delivered vaginally at term. The analytical sensitivity of the duplex PCR assays with internal controls incorporated is 7.0, 19.0, 5x10(3) and 7x10(2) genome copies per reaction for Ct, GC, Mh and Uu respectively. Specificity was demonstrated by the amplification of only target DNA in the presence of other organisms. Among 40 women with normal, at term, deliveries, there were 6 positives for Ct, 2 for GC and 1 for Uu. None of these women had signs of genital tract infection. The Mh/Uu PCR was positive in 11 of 40 PROM cases, with 7 women positive for Uu, 2 for Mh and 2 others for both organisms. Of 40 blood cultures taken from post-partum maternal infections, 6 were positive for Ct and 1 for Mh. Respiratory secretions from 30 premature neonates yielded 5 positives for Uu and one each for Mh and Ct. In contrast, there was only 1 positive result (for Mh) in 30 mature neonates. With 1 exception, all mycoplasma and ureaplasma positives were confirmed by culture and the concordance between paired tracheal aspirates and nasopharyngeal swabs from neonates was 96.7%. These results show the potential use of the duplex PCR assays for the diagnosis of maternal and neonatal disease caused by the four urogenital pathogens.
Polymerase Chain Reaction ; Human Females ; seconds ; Neisseria gonorrhoeae ; Infant, Newborn

The post-operatve course of amputees is poorly documented. This cross-sectional survey was unertaken to determine functional outcomes of 213 patients who had undergone either a below-knee or above-knee amputation from 2000 to 2002 in a state-hospital setting. The study comprises a self-constructed questionnaire and interview conducted by phone. Of the 213 amputees, 41 out of 61 documented telephone numbers of the patients were useful for contact. Only 30 amputees were available for the study as the remaining 11 had passed away. Included in the questionnaire was the modified Barthel Index, a measurement to assess the amputees' ability to carry out activities of daily living (ADL). It contains ten questions pertaining to ADL with a total score of 20 points. Two-thirds of the respondents (67%) use their prosthesis for less than six hours per day. The Barthel Index of 30 patients ranged from 9-20 (mean 17.7). However, the mean Barthel Index in those with and without prosthesis was 18.4 and 15.2 respectively, but this difference was not significant. Half of the respondents were unable to maintain their pre-amputation jobs, while the remaining 50% were still able to work. Forty seven percent of amputees took less than a year to return to their activities, while 33% took between one to two years. Regarding the adequacy of preamputation information provided by the doctors, 73% amputees responded in the affirmative, while 27% felt otherwise. Amputees were still facing substantial disabilities following major amputation of the lower limb. Although 80% of respondents surveyed own prosthesis, the full use of prosthesis is suboptimal due to prosthetic-related problems. Most amputees had a good functional outcome based on the modified Barthel Index. Some amputees were unhappy as they felt that they were insufficiently informed regarding post-amputation expectation prior to the amputation. Despite good support from family, the community support for amputees is still lacking.
Amputation ; Lower Extremity ; Indexes ; Prosthesis Implantation ; Surveys

Teleradiology will have a significant impact on the delivery of healthcare and the practice of medicine. In order to ensure a positive outcome, the expected benefits, limitations and potential pitfalls of teleradiology must be carefully considered. For Singapore, teleradiology can be used to facilitate a quantum leap in the standards of radiological services. This can be achieved through the development of an integrated, nationwide, high-speed radiology network which will allow patients to have access to high-quality and responsive subspecialty radiology expertise located throughout the country. If judiciously implemented, teleradiology has the potential to propel Singapore radiology to an unprecedented level of professional quality and service delivery, and will provide the framework for sustainable radiological insourcing from other countries.
Communication ; Economic Competition ; Health Services Accessibility ; Humans ; International Cooperation ; Outsourced Services ; Quality of Health Care ; Singapore ; Teleradiology ; organization & administration ; trends

Disinfection ; Escherichia coli ; isolation & purification ; Hospitals ; Medical Waste ; Sewage ; Waste Products ; Water Microbiology

Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment in children. Varying degrees of success for the procedure have been reported depending on the type and etiology of hydrocephalus, age of the patient and certain technical parameters. Review of these factors for predictability of success, complications and validation of success score is presented.
Cerebrospinal Fluid Shunts ; Child ; Humans ; Hydrocephalus ; Ventriculostomy*

A retrospective study was undertaken on 103 diabetic patients with foot ulcers who were confined at the UERM Memorial Medical Center from January 1988 to June 1991 with the aim of determining clinical and laboratory criteria which are useful in predicting the need for amputation. Patients were divided into two groups according to treatment modality: Group A, debridement (58 patients) and Group B, amputation (45 patients). Nineteen variables chosen from the patients demographic characteristics, clinical histories and evaluation, and laboratory work-up were reviewed, evaluated, and processed using the normal approximation statistics and logistic regression to obtain a resulting set of predictors. Osteomyelitis, leukocytosis, decreased or absent peripheral pulses, systolic hypertension and smoking history were the five variables found to be significantly associated with the need for an ablative surgical procedure. These quantitated variables are entered into the computed logistic equation to obtain a score which will enable us to determine the appropriate therapeutic intervention tailored to the individuals risk status. If the computed value is greater than or equal to 7, amputation should be the course of action. If the computed value is less than or equal to 3, conservative treatment is advocated. If the value obtained is between 3 and 7, the patient is considered a borderline case and proper management will have to depend on the judgment of the surgeon. With this scoring system as a guide, a definitive operation can be performed at an early stage to prevent the burden of multiple operations and the accompanying high morbidity and post-operative mortality rates.

Bone Regeneration/*physiology ; *Bone Substitutes ; Bone and Bones/pathology ; Bone and Bones/surgery ; *Computer-Aided Design ; *Magnetic Resonance Imaging ; Organ Culture Techniques/*methods ; Tissue Engineering/*methods ; *Tomography, X-Ray Computed

Background: High blood pressure is both a cause and a complication of chronic kidney disease. As complication, high blood pressure may develop early during course of chronic kidney disease and is associated with adverse outcomes, in particular faster loss of kidney function and development of cardiovascular disease. The purpose of this study is early detection of chronic kidney disease in patients with hypertension by defining the prevalence of microalbuminuria.Methods: The study population consisted of 169 subjects with a hypertension. Individuals were considered to have hypertension if the blood pressure measured greater than 140/90 mmHg or if they were taking blood pressure lowering medications. Microalbuminuria was defined as 20 mg/l or greater. Results: We are presenting data on 169 subjects :male 38 (22.5%) female 131 (77.5%), average age 51.6±0.89 At screening, 14.8% of all participants were smokers, 62.1 % engaged in low levels of physical activity, 72.8% - were having tea with salt (table1). Microalbuminuria and renal failure, as GFR<60 ml/ min/1.73 m2, were documented in 34.3% and 16.6% of subjects, respectively. There is positive correlation between MAU and increasing-range of blood pressure (table2). Correlation was found between albuminuria and GFR(r= -0.2 p<0.01) and serum creatinine(r=0.31 p<0.01) the regression result has shown that GFR is associated with MAU and serum creatinine (table 3).Conclusions:1. In 34.3% of patient with hypertension was found nephropathies with MAU2. Microalbuminuria is increased with decline of GFR and raise of systolic blood pressure. GFR decline is with the raise of age and serum. It is important to implement in clinical practice screening of MAU hypertensive patients.3. In 2/3 of all screened subjects was found 1 and more risk factors for CVD.