Ministry of Health clinical practice guidelines: Chronic Hepatitis B Infection.

The Ministry of Health (MOH) publishes clinical practice guidelines on Chronic Hepatitis B Infection to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Chronic Hepatitis B Infection, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=26108). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Genetic data for the 13 CODIS STR loci in Singapore Chinese.

Allele frequencies for the 13 CODIS STR loci included in the AmpFISTR Profiler Plus and AmpFISTR Cofiler kits (Applied Biosystems, Foster City, USA) were determined in a sample of 209 unrelated Chinese in Singapore. The combined random match probability for the 13 loci is about 6.6 x10(-15) and the overall probability of excluding paternity is 0.9999899. The results demonstrate that the loci are useful for forensic human identification and parentage testing for the Chinese population in Singapore.

STR data for the 13 CODIS loci in Singapore Malays.

Allele frequencies for the 13 CODIS (Combined DNA Index System, USA) STR loci included in the AmpFISTR Profiler Plus and AmpFISTR Cofiler kits (Applied Biosystems, Foster City, USA) were determined in a sample of 197 unrelated Malays in Singapore.

Genetic data for the 13 CODIS STR loci in Singapore Indians.

Allele frequencies for the 13 CODIS short tandem repeat (STR) loci included in the AmpFISTR Profiler Plus and AmpFISTR Cofiler kits (Applied Biosystems, Foster City, USA) were determined in a sample of 174 unrelated Indians in Singapore.

Relation between morbidity and current treatment in patients who present with acute asthma to polyclinics.

BACKGROUND: It has been suggested that resources for asthma intervention should be focused mainly on patients in the community who experience a high burden of disease. These are who patients who have acute exacerbations which require urgent treatment. AIM: To assess the morbidity and identify deficiencies in the treatment of patients who present for urgent treatment of acute exacerbations to primary care clinics. PATIENTS: Adult patients who received urgent treatment for acute exacerbation of bronchial asthma SETTING: 4 primary care polyclinics. METHODS: A cross-sectional survey of consecutive patients which related regular preventive treatment to current asthma activity. Poor asthma control was defined as step 2 or higher (American National Asthma Education and Prevention Program, report II, 1997) or > or = 2 emergency room visits in 6 months. RESULTS: There were 116 patients of whom 53% were women. The mean (SD) age was 45(15) years and duration of current exacerbation 3 (3) days. The acute symptoms were successfully treated in 93% of patients. Quick relief medication was used regularly in 91% and inhaled corticosteroids (ICS) in 55%. Oral salbutamol was prescribed in 14% of patients. The asthma was poorly controlled in 54%. In the poorly controlled group 33% were not on regular ICS treatment and 64% were not receiving "add on" medication. CONCLUSIONS: Patients treated for acute asthma in primary care clinics: (1) were older and had less acutely severe exacerbations than those who presented to emergency rooms, (2) over half had poorly controlled asthma and (3) a third of patients with poor asthma control were inadequately treated.

Population genetic characteristics of the STR Loci D21S11 and FGA in eight diverse human populations.

A highly polymorphic multiplex short tandem repeat (STR) system composed of D21S11, FGA, and the sex-typing system amelogenin (AMG) has been used to investigate allele frequency distributions in two Canadian Caucasian samples (British Columbia and Alberta), three Canadian aboriginal populations (Coastal Salishans from British Columbia, Ojibwa from northern Ontario, and Cree from Saskatchewan), and three ethnic groups from Singapore (Chinese, Malays, and Asian Indians). Using the automated fluorescence detection approach on an ABD 373A DNA Sequencer, we distinguished 20 D21S11 and 22 FGA alleles with a nearly equal representation of two- and four-base variants. An overlap in allele sizes for both STR loci across populations was observed, but frequency differences were noted. Statistical analysis revealed that (1) both D21S11 and FGA loci conform to Hardy-Weinberg equilibrium in all eight surveyed populations based on five different tests and (2) both STR loci are in linkage equilibrium. Results from the 2 x N contingency table exact tests for population differentiation demonstrated that the Canadian samples from two different provinces were not distinguishable from one another at either STR locus and therefore could be combined to form one Caucasian group. Likewise, Chinese and Malays from Singapore did not show significant differences at either STR locus. In contrast, all other examined populations exhibited differences deemed statistically significant. As a complement to our study, we compared D21S11 allele frequency distributions in 21 worldwide populations and FGA allele frequency distributions in 14 populations. Many alleles never previously reported in worldwide populations were identified in Canadian aboriginal and Asian samples from this study. Twenty-four D21S11 and 29 FGA alleles were distinguished in worldwide groups. Interesting similarities in allele frequency distribution patterns across populations suggest that the STR polymorphism at these loci predates the geographic dispersal of ancestral human populations. This study further demonstrates the utility of highly informative STR loci such as D21S11 and FGA in human population evolutionary history and in forensic medicine.

Drinking and driving in Singapore, 1987 to 1989.

Between 1987 and 1989 there were approximately 5,000 cases of fatal and injury-sustained road traffic accidents, of which 2.3-3.0% were alcohol related (blood alcohol levels greater than the legal limit of 80 mg% ethanol). The offenders of alcohol-related accidents are mostly Chinese (> 79%), male (> 98%), and more often 30-40 years old. The majority of the alcohol-related accidents (> 74%) took place between 8 P.M. and 4 A.M. in fine weather and light traffic. Rear-end, head-on, and side-on collisions comprised > 60% of all the alcohol-related accidents, and losing control of vehicles approximately 30%. Drunken driving cases for the same period that were not accidents showed a number of characteristics similar to those for accidents. In Singapore, motorcycle riders and pedestrians are more prone to road fatality than other road-user groups. International comparisons of road fatalities per 100,000 population gave Singapore one of the lowest accident rates (8.1-8.4) as compared with countries such as Australia, the United Kingdom, the United States, New Zealand, Canada, and Japan.

Toxicological screen on gastric aspirates: the Singapore experience.

In the early eighties, in response to increasing self-poisoning incidents by pharmaceuticals in Singapore, a comprehensive wide-sweep screen for these drugs in clinical gastric aspirates was devised and implemented by us. The toxicological screen which involved quadruplicate extractions, two in acidic conditions and the other two in alkaline conditions, required the following analyses to be carried out: UV on the acidic fraction, TLC on the basic fraction and mega-bore capillary GC/NPD (nitrogen phosphorus detector) on the combined fraction. The combined fraction if necessary was subjected to GC/MS analysis. Our screen satisfied the need to confirm the analytical outcome of one method by another. Combining the acidic and basic fractions for a single GC analysis saves on instrument time and manpower. All coma and emergency cases were required to undergo GC/MS analysis to prove the identity of toxic agents beyond reasonable doubt. Quality control procedures were instituted at key steps to ensure quality of analytical outcome.

Drinking and driving in Singapore 1987 to 1989.

In the period 1987 to 1989 there were about 5,000 cases of fatal and injury-sustained road traffic accidents, of which 2.3 to 3.0% were alcohol-related (Blood alcohol levels greater than the legal limit of 80 mg % ethanol). The offenders of alcohol-related accidents are mostly Chinese (greater than 79%), predominantly of the male gender (greater than 98%), and more often than not in the 30 to 40 age-range. The majority of the alcohol-related accidents took place between 8 p.m. to 4 a.m. (greater than 74%) under fine weather and light traffic. Rear-end, head-on and side-on collisions comprised over 60% of all the alcohol-related accidents and losing control of vehicles about 30%. Drunken driving non-accident cases for the same period showed a number of characteristics similar to those for alcohol-related accident cases. In Singapore motorcycle riders and pedestrians are more prone to road fatality than other road-user groups. International comparisons of road fatalities per 100,000 population gave Singapore one of the lowest accident rates (8.1 to 8.4) as compared to countries such as Australia, the United Kingdom, the United States, New Zealand, Canada and Japan.