Quality Appraisal of Clinical Guidelines for Vulvar Disorders Using the AGREE II Instrument ABSTRACT Introduction This systematic review aims to appraise clinical practice guidelines and consensus statements on the management of common benign vulvar disorders using the AGREE II checklist. Methods A systematic search for articles was conducted employing PubMed, EMBASE, Cochrane, and Science Direct from 1 January 2013 to 31 December 2023. The quality of eighteen practice guidelines was independently assessed by four appraisers using the AGREE II checklist. Results Of the eighteen guidelines assessed, one was classified as “recommended”, sixteen were designated as “recommended with modifications” and one as “not recommended”. Conclusion All guidelines proposed similar management strategies for the selected vulvar disorders with only minor variations. Medical practitioners are encouraged to treat patients in accordance with evidence-based recommendations in these guidelines.

INTRODUCTION: Cannabis has consistently been the third most commonly abused drug among drug arrestees in Singapore over the past few years. Accordingly, this study aimed to understand the profile of cannabis users in Singapore and explore the effects of cannabis use on drug progression. METHODS: A total of 450 participants who had used cannabis at least once in their lifetime were recruited from the National Addictions Management Service, prisons, the Community Rehabilitation Centre and halfway houses from August 2017 to May 2018. A face-to-face questionnaire was administered and descriptive analyses were conducted. RESULTS: The mean participant age was 40.9 ± 14.51 years, and 93.1% of them were male. The participants generally initiated cannabis use during adolescence, at a mean onset age of 16.5 ± 4.46 years. Most (89.6%) were introduced to cannabis by peers. Approximately half of them (46.9%) had used cannabis before other illicit drugs and 42.1% of them had used heroin as the succeeding drug. CONCLUSION In Singapore, cannabis use is often initiated during adolescence, largely under peer influence. Cannabis users may progress to other illicit drugs, particularly heroin, later in life.
Adolescent ; Humans ; Male ; Adult ; Middle Aged ; Child ; Young Adult ; Female ; Cannabis ; Singapore/epidemiology* ; Heroin ; Substance-Related Disorders/epidemiology* ; Illicit Drugs

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. CONCLUSION Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.
Humans ; Cross-Sectional Studies ; Pandemics ; COVID-19/epidemiology* ; Burnout, Psychological ; Health Personnel

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. Methods: Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. Results: Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. Conclusions Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.

INTRODUCTIONThis study aimed to compare medication adherence and treatment persistence of patients on warfarin versus rivaroxaban in Singapore. A secondary objective was to identify significant covariates influencing adherence.

MATERIALS AND METHODSA retrospective cohort study was conducted where data from September 2009 to October 2014 was retrieved from the hospital electronic databases. Prescription records of rivaroxaban patients with 3 months or more of continuous prescription were extracted and compared against those of patients on warfarin. Primary outcome of adherence was determined based on the medication possession ratio (MPR), while treatment persistence was determined by outpatient clinic appointment gaps.

RESULTSA total of 94 rivaroxaban and 137 warfarin users were analysed by complete case analysis. The MPR of warfarin patients was lower than rivaroxaban patients by 10% (95% CI, 6.4% to 13.6%; P <0.0001). Also, there were more warfarin patients who had gaps in treatment persistence compared to those prescribed rivaroxaban (8.0% vs 1.1%; P = 0.03). Significant factors affecting medication adherence were age and duration of anticoagulant use. For every 10-year increase in age, MPR increased by 1.7% (95% CI, 0.7% to 2.8%). Similarly, for every year increase in duration of use, MPR increased by 1.8% (95% CI, 0.6% to 3.0%). Race, gender, concomitant medication and type of residence were not found to be significant covariates in the multivariable analysis.

CONCLUSIONPatients on rivaroxaban are likely to be more adherent to their prescribed oral anticoagulant with increasing age and duration of treatment influencing adherence.

Adult ; Age Factors ; Anticoagulants ; therapeutic use ; Databases, Factual ; Factor Xa Inhibitors ; therapeutic use ; Female ; Humans ; Male ; Medication Adherence ; statistics & numerical data ; Middle Aged ; Pulmonary Embolism ; drug therapy ; Retrospective Studies ; Rivaroxaban ; therapeutic use ; Singapore ; Venous Thrombosis ; drug therapy ; Warfarin ; therapeutic use

ObjectiveTo investigate the influence of recombinant thioredoxin (TRX)on apoptosis of myocardium cell in viral myocarditis of mice.MethodsTwenty-four Balb/c mice,weighting 12 - 14 g,were randomly divided into 3 groups:the control group,the virus group and the protective group,8 mice in each group.The virus group and the protective group were injected with 0.1 ml 100TCID50 Coxackie virus B3 (CVB3)intraperitoneally,and the control group was injected equal volume of saline.Therewithal the protective group was injected with TRX(2 mg/kg) by tail vein,and the virus group was injected saline the same way.After 14 days all mice were killed and hearts were taken.Changes of myocardial histopathology was observed with optical microscope,cell apoptosis was checked by TUNEL technique,and the expression of apoptosis-related proteins (Bcl-2,caspase-3)in infiltrated cell of myocardium was determined by immunohistochemistry.Results(①)Lymphocyte infiltration and necrosis were observed in survivals of the virus group,sporadic coagulation necrosis and ballooning degeneration of cells were observed in the protective group,however no myocardial lesion was found in the control group.(②)TUNEL technique showed that the positive ratio of apoptosis in the virus group and the protective group[(90.23 ± 3.63)％,(20.02 ± 2.41)％] was significantly higher than that of the control group(0.00 ± 0.00,all P ＜ 0.05),the positive ratio of apoptosis in the protective group was significantly lower than that of the virus group (P ＜ 0.05 ).(③)Immunohistochemistry showed that the expression of protein Bcl-2(+,++,+++) in the virus group and the protective group was significantly higher than that of the control group (all P ＜ 0.05).The expression of protein Bcl-2 in the protective group was significantly higher than that of the virus group(P ＜ 0.05).The expression of caspase-3 (+,++) was significantly higher in the virus group and the protective group than the control group (all P ＜ 0.05).Compared with the virus group,the expression of caspase-3 in the protective group was significantly lower(P ＜ 0.05).ConclusionTRX could inhibit cardiomyocyte apoptosis in viral myocarditis mice and the inhibition is related to regulation of apoptosis-related protein expression.

Objective To study the correlations between O (6) -methylguanine-DNA-methyltransferase (MGMT) gene promoter methylation status in malignant glioma tissues and both MGMT protein expression and survival prognosis in these patients, and evaluate the significance of MGMT gene methylation status analyzing with methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) method in chemotherapy of brain glioma.Methods Thirty-nine patients with gliomas confirmed by pathology (WHO grade Ⅲ and grade Ⅳ)were collected in our study; the patient's overall survival (OS) after chemotherapy was tracked.MGMT protein expression of glioma tissues was detected by immunohistochemical staining,and MGMT promoter methylation status was detected by MS-MLPA method. Results Statistical difference of OS time was noted between patients with MGMT-negative and patients with MGMT-positive/-weak-positive (P=0.003).The prognosis in patients with positive MGMT protein expression was obviously poorer than that in patients with negative expression. In the groups of MGMT promoter un-methylation, mild hypermethylation, moderate hypermethylation and extensive hypermethylation, significant statistical difference of OS time was noted between each 2 groups (P＜0.05); the higher degree of methylation,the better prognosis. Statistical correlation was noted between MGMT protein expression and promoter methylation status (r=0.697,P=0.000); the higher degree ofmethylation,the lower protein exression of MGMT. Conclusion Both MGMT protein expression and promoter methylation status can be regarded as prognostic indicator of OS in patients with malignant glioma accepted alkylating agent chemotherapy; MS-MLPA is a reliable method to detect MGMT gene promoter methylation status.

This paper introduces the familiar mothed for standard clinic novitiate, lecture compiling, preparation before the classes and concrete execution. By compiling standard lecture, training the teaches, regulating the novitiate teaching quality for practical curricula can be improved.