A case of mixed infections in a patient presenting with acute febrile illness in the tropics.

Concurrent infections with more than one etiological agent can result in an illness with overlapping symptoms, resulting in a situation where the diagnosis and management of such a patient could be challenging. We report a case of vivax malaria in a patient who was also serologically positive for leptospirosis and dengue.

Patient education in the management of diabetes mellitus.

AIM: A patient education programme in the management of diabetes mellitus (DM) was piloted in a government polyclinic. This study aimed to evaluate the effectiveness of the education programme in improving knowledge of DM and skills in self-care in order to achieve long term control of DM. METHOD: The study was carried out on an intervention group of 183 diabetic patients who completed the education programme and a control group of 95 diabetic patients who attended the clinic during the period of the study. The patients were assessed on their knowledge of diabetes and their practice for good control of the disease (dietary practice, compliance, home monitoring) through a questionnaire. Long term control was assessed by their glycosylated haemoglobin levels. The education programme comprised individual counselling using a diabetes education guide, talks, videoshows and food displays. RESULTS: The intervention group showed a significant and greater improvement in the knowledge of the disease and self-care and in the dietary practice (taking more unpolished rice/high fibre food, reducing calories intake and cutting down oily/fatty food) when compared to the control group. Compliance with medication and the mean HbA1c levels were also improved in the intervention group. CONCLUSION: In this study the educational intervention was observed to have improved the diabetic patients' knowledge of the disease and self-care and the long term control of the disease. Patient education is thus an important component in the management of diabetes mellitus.

Smoking restrictions in private workplaces in Singapore.

This survey aims to determine the number and profile of private workplaces in Singapore which have a smoking restriction policy. The response rate was 43%. Of the companies which responded, 59% had some form of smoking restriction. Private companies are more likely to have a smoking restriction policy: (a) where smoking poses inherent fire risks, such as those dealing with inflammable chemicals or gases; (b) where smoking poses inherent detrimental effects to the quality of the products, such as those dealing with precision electronic microcomponents, where a smoke-free and dust-free environment is essential; (c) are larger companies; and (d) have strong management support in initiating and enforcing smoking restriction. Future programmes should give more emphasis to the service industries such as construction, insurance, banking and finance, and smaller companies (with fewer than 100 employees). They should involve the management who play an important role in implementing smoking restriction at their workplace.

Attitudes and experience of Singapore doctors and dental surgeons regarding acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) positive patients.

A survey conducted in September 1987 among medical doctors and dental surgeons in Singapore found that most respondents expressed personal reservations and inadequacies in dealing with AIDS/HIV-positive patients and homosexuals. They were also concerned about exposure of their staff to AIDS patients and their likely reactions towards treating these patients. The risk of contagion with AIDS was a major deterrent expressed. The majority of the health professionals had no experience in the management of AIDS related conditions. Although many indicated interest in training, only less than half were willing to undergo what they perceived as the more effective clinically based training themselves.

PIP: A survey of all doctors and dentists in Singapore was conducted by mail in September 1987 to document their attitudes and experience in treating HIV-infected patients. As of October 1987, 2 AIDS cases and 10 carriers were reported in Singapore. 770 doctors and 175 dentists returned their questionnaires. Some misinformation about AIDS appeared in that 2% did not believe HIV is spread only by sexual or blood contact, and 5% believed that nothing can be done to prevent infection. 64% stated that nurses who take care of AIDS/HIV positive people are at high risk of getting AIDS. 74% expressed fear of contracting AIDS from patients. 85% agreed that their staff would be very upset at treating AIDS patients, and 69% believed that staff would quit in this situation. 85% or doctors said HIV infected patients should be treated in special clinics, and 92% said they would refer such patients. Most practitioners admitted that they had little or no experience with treating opportunistic infections seen in AIDS patients, except for Candida. While 90% felt that hospital training for AIDS treatment would be more effective than didactic courses, 44% said they would not attend a course conducted in an AIDS clinic or hospital.