This paper describes the Geriatrics services in the hospital and community in Brunei and the impact of the COVID-19 pandemic. Due to the need for clinical staff to assess and manage COVID-19 cases at the national isolation centre and to assist with contact tracing, outpatient services were suspended. Patients had to be contacted regarding clinic cancellations and ensure they had adequate medications. There was an increase in phone-call consultations and virtual clinics were introduced. Home based nursing patients had the interval of routine nasogastric and indwelling urinary catheter changes extended. Data on the pandemic effects on Geriatric services including outpatient clinics, home visits, phone-call and virtual consultations, admissions to hospital and the home-based nursing case load after the pandemic are shown. After the pandemic, there is a need to strengthen measures to prevent pressure injuries and delirium, improve patient self-management of chronic conditions and manage the physical and mental health sequalae of the pandemic such as frailty and depression.

Anticoagulants ; therapeutic use ; Carotid Arteries ; diagnostic imaging ; pathology ; Cerebral Infarction ; diagnostic imaging ; drug therapy ; pathology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thromboembolism ; complications ; diagnostic imaging ; drug therapy ; Ultrasonography

We report here a case of a kidney transplant recipient in whom the ureter was initially implanted into the peritoneum. Excessive ultrafiltration volume and reversal of serum vs dialysate creatinine ratio when the patient was recommenced on continuous ambulatory peritoneal dialysis first suggested the diagnosis which was subsequently confirmed by a plain abdominal x-ray demonstrating placement of ureteric stent in the peritoneum. This rare complication was successfully corrected with surgical re-implantation of ureter into the bladder and 5 years later, the patient remains well with good graft function.
Cadaver ; Kidney Transplantation/*methods ; Postoperative Complications ; Reoperation ; Replantation ; Ureter/*surgery

Primary sinonasal clear cell carcinoma is a rare neoplasm classified under malignant epithelial tumours of salivary gland – type carcinomas under World Health Organization (WHO) classification. We report a case which occurred on a 69 year old gentleman presented with epistaxis and nasal endoscopy examination showed tumour arising from the right ethmoid cells. Endoscopic excision of the tumour was done and histopathological examination revealed clear cell carcinoma. In addition, other secondary or primary sites of the lesion were excluded by clinical, immunohistochemical and radiological examinations. 10 months into the postoperative period, patient remains well without recurrence of the tumour. In conclusion: We report a rare case of primary sinonasal clear cell carcinoma in addition to the limited literature available and emphasize the differentials with other probable tumour through meticulous microscopic examination and use of special immunostains.
Adenocarcinoma, Clear Cell ; Carcinoma

INTRODUCTIONPruritus in elderly patients can have a significant impact on the quality of life but may be underestimated and poorly addressed by healthcare professionals.

MATERIALS AND METHODSFrom March to May 2010, a structured interview questionnaire including the Dermatology Life Quality Index (DLQI) was administered to all patients admitted to the geriatric ward in Changi General Hospital, Singapore, except for those with cognitive impairment.

RESULTSA total of 194 patients were enrolled in the study; 94 patients (48.5%) were experiencing itch at the point of the interview; mean DLQI score for patients with itch was 6.7; 35.1% of patients experienced sleep disruption whilst 30.9% reported impairment of concentration levels as a consequence of their itch. Of the patients who had informed their doctor about the problem, 73.7% felt that doctors had not adequately addressed the cause of the itch. Among patients who reported itch, the DLQI score correlates with the severity of pruritus with a regression coefficient of 0.2737 (P <0.001); 9.6% of patients with itch were independent with their activities of daily living compared to 21% of patients who did not experience itch.

CONCLUSIONAlmost half of the subjects in our study experienced itch and a third of them reported impairment of quality of life. Patients who were independent of their activities of daily living were also less likely to experience itch. This study highlights the importance of increasing awareness of pruritus among physicians as pruritus can have adverse consequences on patients' quality of life when left unaddressed.

Activities of Daily Living ; Aged ; Aged, 80 and over ; Attention ; Female ; Hospitalization ; Humans ; Male ; Prevalence ; Pruritus ; epidemiology ; psychology ; Quality of Life ; Severity of Illness Index ; Singapore ; epidemiology ; Sleep Wake Disorders ; epidemiology ; Surveys and Questionnaires

Background: Gliomas, characterized by their invasive persistence and tendency to affect critical brain regions, pose a challenge in surgical resection due to the risk of neurological deficits. This study focuses on a personalized approach to achieving an optimal onco-functional balance in glioma resections, emphasizing maximal tumor removal while preserving the quality of life. Methods: A retrospective analysis of 57 awake surgical resections of gliomas at the NationalUniversity Hospital, Singapore, was conducted. The inclusion criteria were based on diagnosis, functional boundaries determined by direct electrical stimulation, preoperative Karnofsky Performance Status score, and absence of multifocal disease on MRI. The treatment approach included comprehensive neuropsychological evaluation, determination of suitability for awake surgery, and standard asleepawake-asleep anesthesia protocol. Tumor resection techniques and postoperative care were systematically followed. Results: The study included 53 patients (55.5% male, average age 39 years), predominantlyright-handed. Over half reported seizures as their chief complaint. Tumors were mostly low-grade gliomas. Positive mapping of the primary motor cortex was conducted in all cases, with awake surgery completed in 77.2% of cases. New neurological deficits were observed in 26.3% of patients at 1 month after operation; most showed significant improvement at 6 months. Conclusion The standardized treatment paradigm effectively achieved an optimal onco-functional balance in glioma patients. While some patients experienced neurological deficits postoperatively, the majority recovered to their preoperative baseline within 3 months. The approach prioritizes patient empowerment and customized utilization of functional mapping techniques, considering the challenge of preserving diverse languages in a multilingual patient population.

Female ; Hearing Loss, Noise-Induced ; diagnosis ; Humans ; Leisure Activities ; Male ; Music ; Noise ; adverse effects

INTRODUCTIONDeliberate self-harm (DSH) is frequently seen in adolescents with a range of mental health problems. The prevalence and features of DSH vary among different countries and settings. This study examines the prevalence of self-harm in a sample of adolescents seen at a psychiatric outpatient clinic in Singapore.

METHODSInformation regarding self-harm, as well as its associated demographic and clinical risk factors, was extracted from the clinical records of 542 consecutive, new patients, aged 12-19 years, who presented between 2006 and 2010.

RESULTSDSH was reported in 23.6% of patients, and was positively associated with the female gender (odds ratio [OR] 4.54), mood disorders (OR 4.58), adjustment disorders (OR 3.41) and regular alcohol use (OR 4.80). However, there was no association with parental marital status, anxiety disorder, habitual smoking or family history of psychiatric illness.

CONCLUSIONDSH is a significant clinical problem that may be influenced by biological and clinical factors. Adolescents presenting with DSH should be examined for mood and alcohol use disorders.

Adolescent ; Child ; Female ; Humans ; Male ; Mental Health ; Odds Ratio ; Outpatients ; psychology ; statistics & numerical data ; Prevalence ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Self-Injurious Behavior ; epidemiology ; psychology ; Singapore ; epidemiology ; Surveys and Questionnaires ; Young Adult

INTRODUCTIONSingapore is the first Asian country to establish a nationwide breast screening programme, but our breast cancer screening uptake lags behind the Western countries. This survey focused on the subject of screening mammography, to assess the reasons for non-attendance and explore ways to improve our screening uptake.

MATERIALS AND METHODSFemales ≥21 years old were approached at primary healthcare clinics to participate in this survey, which questioned their knowledge, perception and expectations of breast screening.

RESULTSThere were 1011 respondents. Of the 740 respondents ≥40 years old, 332 respondents (45.5%) went for regular mammogram screening. Women who had lower household incomes [<$2000 (OR 0.49; 95% CI, 0.28 to 0.85); $2000 to $3999 (OR 0.59; 95% CI, 0.36 to 0.97)], did not know anyone with breast cancer (OR 0.62; 95% CI, 0.42 to 0.92), did not perform breast self-examination (OR 0.42; 95% CI, 0.28 to 0.62), had lower knowledge scores (OR 0.34; 95% CI 0.22 to 0.51), did not attend other health screening (OR 0.14; 95% CI, 0.05 to 0.41), and perceived mammography as embarrassing (OR 0.55; 95% CI, 0.31 to 0.96), were less likely to attend mammographic screening. Many did not know that screening is for the asymptomatic (51.2%), or the age to start screening (46.3%). Most respondents preferred to have their mammograms in the polyclinics (62.2%) and their screening reminders to be through short messaging service (SMS) (46.0%).

CONCLUSIONOur results show the current influences on Singapore women's screening practices, and also revealed that their understanding of mammogram screening is limited despite a high level of breast cancer awareness.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; diagnosis ; diagnostic imaging ; Breast Self-Examination ; Early Detection of Cancer ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Mammography ; Middle Aged ; Patient Acceptance of Health Care ; Singapore ; Surveys and Questionnaires ; Young Adult