Problem: Emergency medical teams (EMTs) responding to mass casualty incidents attend to casualties in a chaotic, high-pressure and resource-limited environment that is vastly different from their day-to-day work. The nature of mass casualty incidents and the work environment can impact psychological resilience, but the psychological resilience of members of EMTs has not been evaluated. Context: In Singapore, EMTs are deployed from public hospitals, polyclinics and the Singapore Red Cross to disaster sites, where they triage, stabilize and treat casualties before evacuating them to public hospitals for further management. Action: Twenty-four members of EMTs responded to a cross-sectional survey based on a psychological resilience tool developed for health-care rescuers involved in mass casualty incidents to evaluate their psychological resilience after a full-scale exercise involving an aviation accident. Respondents completed a psychological resilience tool that was developed by experts in disaster work and research using a modified Delphi approach. There were 27 items across eight domains: optimism, altruism, preparations for disaster rescue, social support, perceived control, self-efficacy, coping strategies and positive growth. Outcome: The key observations from the survey were that (i) staff demonstrated a strong sense of altruism and had good social support; (ii) staff were not confident about their preparedness, and this led to a lack of optimism, perceived control and ability to deal with emotions; and (iii) it was necessary for respondents to reflect on their experience to find meaning to support growth after the deployment. Discussion: Optimizing casualty survival and outcomes during mass casualty incidents requires not only excellent procedural training and robust standard operating procedures and work processes but also dedicated efforts to enhance the psychological resilience of members of EMTs.

Endometriosis is a common chronic gynecological disease with endometrial cell implantation outside the uterus.Angiogenesis is a major pathophysiology in endometriosis.Our previous studies have demon-strated that the prodrug of epigallocatechin gallate(ProEGCG)exhibits superior anti-endometriotic and anti-angiogenic effects compared to epigallocatechin gallate(EGCG).However,their direct binding targets and underlying mechanisms for the differential effects remain unknown.In this study,we demonstrated that oral ProEGCG can be effective in preventing and treating endometriosis.Additionally,1D and 2D Proteome Integral Solubility Alteration assay-based chemical proteomics identified metadherin(MTDH)and PX domain containing serine/threonine kinase-like(PXK)as novel binding targets of EGCG and ProEGCG,respectively.Computational simulation and BioLayer interferometry were used to confirm their binding affinity.Our results showed that MTDH-EGCG inhibited protein kinase B(Akt)-mediated angiogenesis,while PXK-ProEGCG inhibited epidermal growth factor(EGF)-mediated angiogenesis via the EGF/hypoxia-inducible factor(HIF-1a)/vascular endothelial growth factor(VEGF)pathway.In vitro and in vivo knockdown assays and microvascular network imaging further confirmed the involvement of these signaling pathways.Moreover,our study demonstrated that ProEGCG has superior therapeutic effects than EGCG by targeting distinct signal transduction pathways and may act as a novel anti-angiogenic therapy for endometriosis.

The COVID-19 pandemic has resulted in significant challenges for the resuscitation of paediatric patients, especially for infants and children who are suspected or confirmed to be infected. Thus, the paediatric subcommittee of the Singapore Resuscitation and First Aid Council developed interim modifications to the current Singapore paediatric guidelines using extrapolated data from the available literature, local multidisciplinary expert consensus and institutional best practices. It is hoped that this it will provide a framework during the pandemic for improved outcomes in paediatric cardiac arrest patients in the local context, while taking into consideration the safety of all community first responders, medical frontline providers and healthcare workers.
Infant ; Child ; Humans ; Cardiopulmonary Resuscitation/methods* ; COVID-19/therapy* ; Pandemics ; Singapore ; Heart Arrest

INTRODUCTION: Paediatric patients presenting to the general emergency departments (EDs) differ from those presenting to paediatric EDs. General EDs vary in preparedness to manage paediatric patients, which may affect delivery of emergency care with varying clinical outcomes. We aimed to elucidate the differences in utilisation patterns of paediatric and general EDs by paediatric patients. METHODS: This study was conducted in a public healthcare cluster in Singapore consisting of 4 hospitals. A retrospective review of the medical records of paediatric patients, defined as age younger than 16 years old, who attended the EDs from 1 January 2015 to 31 December 2018, was performed. Data were collected using a standardised form and analysed. RESULTS: Of the 704,582 attendances, 686,546 (97.4%) were seen at the paediatric ED. General EDs saw greater number of paediatric patients in the emergent (P1) category (921 [5.1%] versus 14,829 [2.2%]; CONCLUSION General EDs need to build their capabilities and enhance their preparedness according to the paediatric population they serve so that optimal paediatric emergency care can be delivered, especially for critically ill patients who are most in need of life-saving and timely treatment.

Key Findings There is currently no evidence to support the use of sanitation tents in the prevention of COVID-19 transmission. • Sanitation tents or disinfection tents have been installed in various areas of the Philippines as a measure to decontaminate individuals and prevent COVID-19 transmission. • The commonly used disinfectant in these tents is diluted household bleach. Others propose to use alcohol or diluted povidone iodine to decontaminate individuals in the tent. • Bleach is an irritant to mucous membranes and loses its antimicrobial effect over time or when exposed to heat and sunlight. • Alcohol is flammable and also causes irritation to mucous membranes. • Povidone iodine may cause skin irritation, chemical pneumonitis when inhaled, and acute kidney injury when systemically absorbed. • There are no completed or ongoing studies on the use of sanitation tents for the prevention of COVID-19 transmission. • To date, there are no guidelines that recommend the use of sanitation tents for prevention of COVID-19 transmission. • The World Health Organization explicitly recommends against spraying alcohol or chlorine all over a person's body due to adverse health effects and the lack of inhibitory activity against viruses that have already entered the body. • The Centers for Disease Control and Prevention note that most environmental protection agency-registered household disinfectants are effective against COVID-19. However, these products are approved for use only on surfaces and not on humans. • The Department of Health guidelines recommend the avoidance of spraying or misting for COVID-19 due to lack of evidence of its efficacy.
Coronavirus ; Covid-19

INTRODUCTIONThis study aimed to investigate the risk factors associated with mortality in haematopoietic stem cell transplant (HSCT) patients admitted to our paediatric intensive care unit (PICU) over an 8-year period.

MATERIALS AND METHODSA retrospective chart review was conducted of all HSCT patients requiring PICU admission at our centre (a tertiary care university hospital in Singapore) from January 2002 to December 2010. Chief outcome measures were survival at the time of PICU discharge and survival at 6 months after initial PICU admission.

RESULTSNinety-eight patients underwent HSCT during this period; 18 patients (18%) required 24 PICU admissions post-HSCT. The overall survival to PICU discharge was 62.5%. Of those who survived discharge from the PICU, 33% died within 6 months of discharge. Non-survivors to PICU discharge had a higher incidence of sepsis (89% vs 33%,= 0.013) and organ failure as compared to survivors (cardiovascular failure 100% vs 20%,= 0.0003; respiratory failure 89% vs 20%,= 0.002; and renal failure 44% vs 7%,= 0.047). Mortality rates were higher in patients requiring mechanical ventilation (70% vs 14%,= 0.010) and inotropic support (70% vs 14%,= 0.010). Mortality in all patients with renal failure requiring haemodialysis (n = 4) was 100%. Presence of 3 or more organ failures was associated with 80% mortality (= 0.003).

CONCLUSIONSepsis, multiple organ failure and the need for mechanical ventilation, inotropes and especially haemodialysis were associated with increased risk of mortality in our cohort of HSCT patients.

Adolescent ; Cardiotonic Agents ; therapeutic use ; Child ; Child, Preschool ; Female ; Heart Failure ; drug therapy ; epidemiology ; mortality ; Hematopoietic Stem Cell Transplantation ; Hospital Mortality ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Multiple Organ Failure ; epidemiology ; mortality ; Prognosis ; Renal Dialysis ; statistics & numerical data ; Renal Insufficiency ; epidemiology ; mortality ; therapy ; Respiration, Artificial ; statistics & numerical data ; Respiratory Insufficiency ; epidemiology ; mortality ; therapy ; Retrospective Studies ; Risk Factors ; Sepsis ; epidemiology ; mortality ; Singapore ; epidemiology

Diabetes mellitus is an 'insulin problem' as the maintenance of normoglycaemia is affected by either reduced pancreatic insulin production or cellular insulin resistance. During a patient's first visit for type 2 diabetes mellitus, there are several consultation tasks that the doctor should consider. First, the doctor has to disclose the diagnosis. Second, there is a need to correct any myths and misconceptions that the patient may have on the disease. Next, to allow the doctor to provide patient-specific disease education and advice on lifestyle modifications and goal setting, the biopsychosocial impact of the disease on the patient should be assessed, and relevant lifestyle information gathered. Lastly, screening for the complications of diabetes mellitus and its associated medical conditions should be planned.
Diabetes Mellitus, Type 2 ; diagnosis ; prevention & control ; Humans ; Life Style ; Patient Care Planning ; organization & administration ; Physician-Patient Relations ; Truth Disclosure

We present a case of localised AA-type amyloidosis of the ureter with spheroids of amyloid. Localised AA-type amyloidosis of the urogenital tract is uncommon and extremely rare as a cause of ureteric obstruction, with only two such cases described in the literature to date. Most previously described cases at this site are related to primary AL-type amyloidosis. Another interesting finding in this case is the presence of spheroids of amyloid, which to the best of our knowledge, has not been previously reported at this site, and is also unusual at other sites.
Adult ; Amyloid ; analysis ; Amyloidosis ; pathology ; Female ; Humans ; Ureter ; pathology ; Ureteral Diseases ; pathology