Planning and coordination of the radiological response to the coronavirus disease 2019 (COVID-19) pandemic: the Singapore experience.

Coronavirus disease 2019 (COVID-19) has spread fast and extensively around the world, with significant mortality and morbidity. As this is a respiratory infection, chest radiography and computed tomography (CT) are important imaging techniques in the work-up of this disease. Given its highly infectious nature, cross-infection within the healthcare setting and radiology departments needs to be addressed actively and prevented. We describe the response of radiology departments in Singapore to this pandemic, in terms of diagnosis, re-configuration of the department, re-organisation and segregation of staff, infection control, managerial, and leadership issues.

Inhibition of the acquisition of conditioned place aversion by dopaminergic lesions of the central nucleus of the amygdala in morphine-treated rats.

The negative affective state of opiate abstinence plays an important role in craving and relapse to compulsive drug use. The dopamine system participates in the reward effects of opiate use and the aversive effect of opiate abstinence. The amygdala is an essential neural substrate for associative learning of emotion. To establish a model of conditioned place aversion (CPA) in morphine-treated rats, we used different visual and tactual cues as conditioned stimuli (CS) within a conditioning apparatus. An injection of naloxone served as the unconditioned stimulus (US). The 6-hydroxydopamine (6-OHDA) lesion technique was used to investigate the effects of the dopaminergic system of the central nucleus of the amygdala (CeA) on naloxone-induced CPA. Rats were rendered physically dependent via administration of increasing doses of morphine delivered via intraperitoneal injection. Doses increased by 20 % each day for 14 days, starting from an initial dose of 6 mg/kg. All rats also received a low dose of naloxone (0.1 mg/kg) by injection 4 hours after morphine treatment on days 11 and 13 to induce CPA in a biased two-compartment conditioned place apparatus. Morphine-dependent rats with sham lesions were found to develop significant CPA after naloxone treatment. Bilateral 6-OHDA lesions of the CeA impaired the acquisition of CPA but had no effect on locomotor activity. These results suggest that the dopaminergic system of the CeA plays an important role in the negative affective state of opiate abstinence.

Ultrasonographical diagnosis of acute gynaecological pain.

Acute pelvic pain is a common presentation in women. There are a myriad of causes, both gynaecological and non-gynaecological in origin. Ultrasonography is well-established as the primary initial investigation of choice. Familiarity with the imaging features of the commonly-associated conditions aids in the rapid diagnosis, and immediate management of the patient. This article provides a pictorial review of the common gynaecological causes of pelvic pain.

WITHDRAWN: Oxytocin for prelabour rupture of membranes at or near term.

BACKGROUND: Induction of labour after prelabour rupture of membranes may reduce the risk of neonatal infection. OBJECTIVES: The objective of this review was to assess the effects of induction of labour with oxytocin versus expectant management for prelabour rupture of membranes at or near term (34 weeks or more). SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of early use of oxytocin versus no early use of oxytocin for spontaneous rupture of membranes, before labour (34 weeks gestation or more). DATA COLLECTION AND ANALYSIS: Trials were assessed for quality and data were abstracted. MAIN RESULTS: Eighteen studies were included. The trials were of variable quality with potential for significant bias. Compared to expectant management, induction of labour by oxytocin was associated with a decreased risk of maternal infection (odds ratio for chorioamnionitis of 0.63, 95% confidence interval 0.51 to 0.78, endometritis 0.72, 95% confidence interval 0.52 to 0.99). There was also a decreased risk of neonatal infection (odds ratio 0.64, 95% confidence interval 0.44 to 0.93). The size of this effect may have been biased in favour of oxytocin. Based on one trial, women were more likely to view their care positively if labour was induced with oxytocin. Caesarean section rates were not statistically different between groups, although the trend was towards fewer interventions with expectant management. Oxytocin was associated with more frequent use of pain relief and internal fetal heart rate monitoring. Perinatal mortality rates were low and not significantly different between groups, although the trend was towards fewer deaths with induction of labour by oxytocin. AUTHORS' CONCLUSIONS: Induction of labour by oxytocin may decrease the risk of maternal and neonatal infection compared to expectant management. Induction of labour with oxytocin does not appear to increase the rate of caesarean section, although it may increase use of pain relief and internal fetal heart rate monitoring.[This abstract has been prepared centrally.].

WITHDRAWN: Prostaglandins versus oxytocin for prelabour rupture of membranes at or near term.

BACKGROUND: The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used. OBJECTIVES: The objective of this review was to assess the effects of induction of labour with prostaglandins compared with oxytocin, at or near term. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes before labour (34 weeks or more gestation). DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Seventeen trials were included. Most of the trials were of moderate to good quality. Based on six trials, prostaglandins compared with oxytocin were associated with increased chorioamnionitis (odds ratio of 1.49, 95% confidence interval 1.07 to 2.09) and maternal nausea/vomiting. Based on eight trials, prostaglandins were associated with a decrease in epidural analgesia, odds ratio of 0.85, 95% confidence interval 0.73 to 0.98 and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups. AUTHORS' CONCLUSIONS: Women with prelabour rupture of membranes at or near term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and nausea/vomiting with prostaglandins compared to oxytocin.[This abstract has been prepared centrally.].

WITHDRAWN: Prostaglandins versus oxytocin for prelabour rupture of membranes at term.

BACKGROUND: The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used. OBJECTIVES: The objective of this review was to assess the effects of induction of labour with prostaglandins versus oxytocin for prelabour rupture of membranes at term. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes at term (37 weeks or more gestation). DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Eight trials were included. Based on three trials, prostaglandins compared to oxytocin were associated with increased chorioamnionitis (odds ratio of 1.51, 95% confidence interval 1.07 to 2.12) and neonatal infections (odds ratio 1.63, 95% confidence interval 1.00 to 2.66). Based on four trials, prostaglandins were associated with a decrease in epidural analgesia (odds ratio of 0.86, 95% confidence interval 0.73 to 1.00) and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups. AUTHORS' CONCLUSIONS: Women with prelabour rupture of membranes at term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and neonatal infections after prostaglandin induction compared to oxytocin.[This abstract has been prepared centrally.].

WITHDRAWN: Prostaglandins for prelabour rupture of membranes at or near term.

BACKGROUND: Induction of labour after prelabour rupture of membranes may reduce the risk of neonatal infection. However an expectant approach may be less likely to result in caesarean section. OBJECTIVES: The objective of this review was to assess the effects of induction of labour with prostaglandins versus expectant management for prelabour rupture of membranes at or near term. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing early use of prostaglandins (with or without oxytocin) with no early use of prostaglandins in women with spontaneous rupture of membranes before labour, and 34 weeks or more of gestation. DATA COLLECTION AND ANALYSIS: Trials were assessed for quality and data were abstracted. MAIN RESULTS: Fifteen trials were included. Most were of moderate to good quality. Different forms of prostaglandin preparations were used in these trials and it may be inappropriate to combine their results. Induction of labour by prostaglandins was associated with a decreased risk of chorioamnionitis (odds ratio 0.77, 95% confidence interval 0.61 to 0.97) based on eight trials and admission to neonatal intensive care (odds ratio 0.79, 95% confidence interval 0.66 to 0.94) based on seven trials. No difference was detected for rate of caesarean section, although induction by prostaglandins was associated with a more frequent maternal diarrhoea and use of anaesthesia and/or analgesia. Based on one trial, women were more likely to view their care positively if labour was induced with prostaglandins,. AUTHORS' CONCLUSIONS: Induction of labour with prostaglandins appears to decrease the risk of maternal infection (chorioamnionitis) and admission to neonatal intensive care. Induction of labour with prostaglandins does not appear to increase the rate of caesarean section, although it is associated with more frequent maternal diarrhoea and pain relief.

Novelty-seeking behavior and stress-induced locomotion in rats of juvenile period differentially related to morphine place conditioning in their adulthood.

The relationship between motor responses in a novel environment and susceptibility to place conditioning effect of psychostimulants has been reported in adult rats. However, it is in question whether this correlation could be generalized to motor activity in rats of juvenile period and place conditioning effect in their adulthood for narcotic morphine. In the present study, we tested locomotor activity in an arena open-field and the subsequent novelty-seeking behavior after adaptation process in juvenile rats (P42) and morphine (2 mg/kg) place conditioning effect 56 days later in the same rats' adulthood (P98). Our results showed that rats with high response to novelty (HRN) spent more prolonged duration in the drug-paired compartment in the place conditioning test compared with their low response counterparts (LRN), with the latter group no salient change on this measure. Moreover, rats with high response to the open-field test (HRS) expressed equally elevated duration in drug-paired side relative to their low response counterparts (LRS). The present research demonstrated that novelty-seeking behavior and locomotor activity in the open-field in rats of juvenile period differentially related to morphine place conditioning in their adulthood, with slow acquisition of morphine place conditioning effect in LRN animals.

Surgical results of intercondylar fractures of the adult femur.

INTRODUCTION: Although surgical treatment of intercondylar fractures of the adult femur gives satisfactory results in the majority of cases, there are complications reported with operative management. We aim to analyse the surgical results of these cases performed in our institution and compare them to other reported series. MATERIALS AND METHODS: A total of 16 patients with intercondylar fractures of the femur were operatively treated from 1989 to 1997. The ages of these patients ranged from 24 to 77 years, with a mean age of 42 years. Average length of follow-up was 28 months. The fractures were classified according to AO classification. Twenty-five per cent of the fractures were significantly comminuted. They were internally fixed with various implants such as cancellous screw fixation, dynamic condylar screw plate, condylar blade plate and condylar buttress plate. RESULTS: Average time to full weight bearing was 12 weeks. Results of treatment were assessed according to the criteria described by Shelbourne. Eighty-three per cent of minimally comminuted fractures had a good result, but only 50% of significantly comminuted fractures did well. CONCLUSIONS: We recommend the use of anterior midline approach and condylar buttress plate for very comminuted fractures. Infection, if detected early and treated aggressively could avoid a poor outcome. Elderly patients should benefit from internal fixation and earlier mobilisation.

Oxytocin for prelabour rupture of membranes at or near term.

BACKGROUND: Induction of labour after prelabour rupture of membranes may reduce the risk of neonatal infection. OBJECTIVES: The objective of this review was to assess the effects of induction of labour with oxytocin versus expectant management for prelabour rupture of membranes at or near term (34 weeks or more). SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of early use of oxytocin versus no early use of oxytocin for spontaneous rupture of membranes, before labour (34 weeks gestation or more). DATA COLLECTION AND ANALYSIS: Trials were assessed for quality and data were abstracted. MAIN RESULTS: Eighteen studies were included. The trials were of variable quality with potential for significant bias. Compared to expectant management, induction of labour by oxytocin was associated with a decreased risk of maternal infection (odds ratio for chorioamnionitis of 0.63, 95% confidence interval 0.51 to 0.78, endometritis 0.72, 95% confidence interval 0.52 to 0.99). There was also a decreased risk of neonatal infection (odds ratio 0.64, 95% confidence interval 0.44 to 0.93). The size of this effect may have been biased in favour of oxytocin. Based on one trial, women were more likely to view their care positively if labour was induced with oxytocin. Caesarean section rates were not statistically different between groups, although the trend was towards fewer interventions with expectant management. Oxytocin was associated with more frequent use of pain relief and internal fetal heart rate monitoring. Perinatal mortality rates were low and not significantly different between groups, although the trend was towards fewer deaths with induction of labour by oxytocin. REVIEWER'S CONCLUSIONS: Induction of labour by oxytocin may decrease the risk of maternal and neonatal infection compared to expectant management. Induction of labour with oxytocin does not appear to increase the rate of caesarean section, although it may increase use of pain relief and internal fetal heart rate monitoring.

Prostaglandins versus oxytocin for prelabour rupture of membranes at or near term.

BACKGROUND: The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used. OBJECTIVES: The objective of this review was to assess the effects of induction of labour with prostaglandins compared with oxytocin, at or near term. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes before labour (34 weeks or more gestation). DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Seventeen trials were included. Most of the trials were of moderate to good quality. Based on six trials, prostaglandins compared with oxytocin were associated with increased chorioamnionitis (odds ratio of 1.49, 95% confidence interval 1.07 to 2.09) and maternal nausea/vomiting. Based on eight trials, prostaglandins were associated with a decrease in epidural analgesia, odds ratio of 0.85, 95% confidence interval 0.73 to 0.98 and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups. REVIEWER'S CONCLUSIONS: Women with prelabour rupture of membranes at or near term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and nausea/vomiting with prostaglandins compared to oxytocin.

Prostaglandins versus oxytocin for prelabour rupture of membranes at term.

BACKGROUND: The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used. OBJECTIVES: The objective of this review was to assess the effects of induction of labour with prostaglandins versus oxytocin for prelabour rupture of membranes at term. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes at term (37 weeks or more gestation). DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Eight trials were included. Based on three trials, prostaglandins compared to oxytocin were associated with increased chorioamnionitis (odds ratio of 1.51, 95% confidence interval 1.07 to 2.12) and neonatal infections (odds ratio 1.63, 95% confidence interval 1.00 to 2.66). Based on four trials, prostaglandins were associated with a decrease in epidural analgesia (odds ratio of 0.86, 95% confidence interval 0.73 to 1.00) and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups. REVIEWER'S CONCLUSIONS: Women with prelabour rupture of membranes at term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and neonatal infections after prostaglandin induction compared to oxytocin.

Prostaglandins for prelabour rupture of membranes at or near term.

BACKGROUND: Induction of labour after prelabour rupture of membranes may reduce the risk of neonatal infection. However an expectant approach may be less likely to result in caesarean section. OBJECTIVES: The objective of this review was to assess the effects of induction of labour with prostaglandins versus expectant management for prelabour rupture of membranes at or near term. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing early use of prostaglandins (with or without oxytocin) with no early use of prostaglandins in women with spontaneous rupture of membranes before labour, and 34 weeks or more of gestation. DATA COLLECTION AND ANALYSIS: Trials were assessed for quality and data were abstracted. MAIN RESULTS: Fifteen trials were included. Most were of moderate to good quality. Different forms of prostaglandin preparations were used in these trials and it may be inappropriate to combine their results. Induction of labour by prostaglandins was associated with a decreased risk of chorioamnionitis (odds ratio 0.77, 95% confidence interval 0.61 to 0.97) based on eight trials and admission to neonatal intensive care (odds ratio 0.79, 95% confidence interval 0. 66 to 0.94) based on seven trials. No difference was detected for rate of caesarean section, although induction by prostaglandins was associated with a more frequent maternal diarrhoea and use of anaesthesia and/or analgesia. Based on one trial, women were more likely to view their care positively if labour was induced with prostaglandins,. REVIEWER'S CONCLUSIONS: Induction of labour with prostaglandins appears to decrease the risk of maternal infection (chorioamnionitis) and admission to neonatal intensive care. Induction of labour with prostaglandins does not appear to increase the rate of caesarean section, although it is associated with more frequent maternal diarrhoea and pain relief.