Predictors of acute neurological complication following tetralogy of Fallot operation in Serdang Hospital, Malaysia.

BACKGROUND: The long waiting time for Tetralogy of Fallot (TOF) operation may potentially increase the risk of hypoxic insult. Therefore, the objective of this study is to determine the frequency of acute neurological complications following primary TOF repair and to identify the peri-operative risk factors and predictors for the neurological sequelae. METHODS: A retrospective review of the medical and surgical notes of 68 patients who underwent TOF repair in Hospital Serdang, from January 2013 to December 2017 was done. Univariate and multivariate analyses of demographics and perioperative clinical data were performed to determine the risk for the development of acute neurological complications (ANC) among these patients. RESULTS: ANC was reported in 13 cases (19.1%) with delirium being the most common manifestation (10/68, 14.7%), followed by seizures in 4 (5.9%) and abnormal movements in two patients (2.9%). Univariate analyses showed that the presence of right ventricular (RV) dysfunction, prolonged duration of inotropic support (≥7 days), prolonged duration of mechanical ventilation (≥7 days), longer length of ICU stays (≥7 days), and longer length of hospital stay (≥14 days), were significantly associated with the presence of ANCs (p<0.05). However, multivariate analyses did not show any significant association between these variables and the development of ANC (p>0.05). The predictors for the development of postoperative delirium were pre-operative oxygen saturation less than 75% (Odds Ratio, OR=16.90, 95% Confidence Interval, 95%CI:1.36, 209.71) and duration of ventilation of more than 7 days (OR=13.20, 95%CI: 1.20, 144.98). CONCLUSION: ANC following TOF repair were significantly higher in patients with RV dysfunction, in those who required a longer duration of inotropic support, mechanical ventilation, ICU and hospital stay. Low pre-operative oxygen saturation and prolonged mechanical ventilation requirement were predictors for delirium which was the commonest neurological complications observed in this study. Hence, routine screening for delirium using an objective assessment tool should be performed on these high-risk patients to enable accurate diagnosis and early intervention to improve the overall outcome of TOF surgery in this country.

The Singapore state's response to migration.

PIP: Migration trends in Singapore are traced since 1819. Immigration has been encouraged to advance economic development. Local and international factors fuel migration to Singapore. Singapore depends upon foreign labor. Population growth has been mainly due to migration from China, India, Malaysia, and countries surrounding Singapore. Independence in 1965 led to policies aimed at controlling high population growth. Policies became pronatalist after 1987. Foreigners in 1998 were over 18% of the total population, which was six times the number in 1970. About 2000 Singaporeans per year emigrated during the 1990s. Singapore is encouraging overseas industrial development. In 1997, the Prime Minister called for recruitment of foreign talent in order to meet the challenges of an increasingly globalized world, low fertility, and an aging society. Economic planners recommend short-term migration of unskilled foreign workers who would be a revolving pool to fill jobs natives do not want. Singapore is promoting arts and culture in order to keep people in Singapore. The government has issued assurances that natives will have first priority on jobs, education, and training. Singapore's ability to absorb workers will depend upon its economic performance.^ieng

Singapore's "three or more" policy: the first five years.

"Although this article does not attempt a full evaluation of the 'selectively pro-natalist' national population policy of Singapore, it does bring out some indicative findings useful for assessing the effects of the policy on fertility. It finds that, while the new policy has succeeded in increasing the annual number of births, the total fertility rate still remains under two children per woman."

Brain drain or links to the world: views on emigrants from Singapore.

"This article will present a general picture of emigration and emigrants from Singapore, with specific references to Australia where the data permit. The first section presents some flow data on the magnitudes of emigration from Singapore.... It is necessary to place this outflow against the background of the constraints imposed by the country's small size. This is discussed in the second section, together with the economic policies and strategies adopted to overcome these constraints. The third section documents the public debate on emigration and the responses to the 'problem.' This is followed in the last section by a prognosis for the future, particularly with regard to the implications for Australia. The article ends with a discussion of the relationship between emigration and nation building, using Singapore as a case study."

The second national family planning and population survey in Singapore 1977.

PIP: A survey was conducted to assess current knowledge, attitude and practice pertaining to family planning and population issues and to gauge changes in these respects since 1973 when the 1st National Survey on Family Planning in Singapore was conducted. Field operations included 3 phases: updating of addresses; preliminary interviewing to identify and collect information on basic characteristics of women eligible for the main survey; and comprehensive interviewing of the selected women in their homes. 2467 women were successfully interviewed. The rise in the mean age at 1st marriage from 21.6 years among married women of reproductive age in 1973 to 22.1 years among a similar group of women in 1977 was indicative of a slight move towards later marriages. The mean number of children declined from 3.4 in 1973 to 2.8 in 1977; the mean number of children considered ideal for a married couple in Singapore fell from 3.1 to 2.7 over the same period. Awareness of the oral contraceptive and female sterilization rose from its high levels in 1973 to almost universal levels in 1977; awareness of the condom, IUD and male sterilization increased from 81% to 88%, 51% to 62% and 50% to 75% respectively. Contraceptive practice increased from 60% of respondents in 1973 to 71% in 1977. The ever-users increased from 77% to 86% over the same period. Awareness of the government policy advocating a 2-child family increased from 75% in 1973 to 93% in 1977.^ieng