Ministry of Health Clinical Practice Guidelines: Hypertension.

The Ministry of Health (MOH) has updated the clinical practice guidelines on hypertension to provide doctors and patients in Singapore with evidence-based treatment for hypertension. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on hypertension, for the information of SMJ readers. 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/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. 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.

Investigation of thoracolumbar T12-L1 burst fracture mechanism using finite element method.

A finite element model of the T12-L1 motion segment was subjected to dynamic vertical impact to investigate vertebral burst fracture mechanism at the thoracolumbar junction. A rigid ball was directed vertically towards a rigid plate fixed on top of the T12 vertebral body to simulate the axial impact. The results show that upon impact, the T12 vertebra exhibited a vibratory motion. At its maximum compression, the endplates bulged towards their vertebral bodies. The central parts of the endplates adjacent to the nucleus experienced the highest effective stress, and localized stress concentration developed correspondingly within the central parts of the cancellous bone adjacent to the endplates. This appears to confirm the hypothesis that nucleus material is forced to enter the vertebral body, pressurizing it further and squeezing the fat and marrow contents out of the cancellous bone. When the nucleus material enters the vertebral body faster than fat and marrow being expulsed, the vertebral body could burst through the anterior and posterior cortical shell. Upon sudden posterior cortex fracture, the transient fragment encroachment could be further into the spinal canal than the final observed locations, as the fragments are retropulsed to the vertebral body during the bursting process.

Trends in importation of communicable diseases into Singapore.

INTRODUCTION: Singapore is a transition country in Southeast Asia that is both vulnerable and receptive to the introduction and re-introduction of imported communicable diseases. MATERIALS AND METHODS: For a 10-year period between 1998 and 2007 we studied the trend, epidemiological characteristics, proportion of imported versus local transmission of malaria, viral hepatitis (hepatitis A and E), enteric fevers (typhoid and paratyphoid), cholera, chikungunya and SARS. RESULTS: Of a total of 4617 cases of the above selected diseases notified in Singapore, 3599 (78.0%) were imported. The majority of the imported cases originated from Southeast Asia and the Indian subcontinent. Malaria constituted the largest bulk (of which 95.9% of the 2126 reported cases were imported), followed by hepatitis A (57.1% of 1053 cases imported), typhoid (87.6% of 596 cases imported), paratyphoid (87.6% of 241 cases imported), and hepatitis E (68.8% of 231 cases imported). Furthermore, there were 14 cases of imported cholera, 6 cases of imported severe acute respiratory syndrome (SARS) and 13 cases of imported chikungunya. CONCLUSION: This study underlines that diseases such as malaria, viral hepatitis and enteric fever occur in Singapore mainly because of importation. The main origin of importation was South and Southeast Asia. The proportion of imported diseases in relation to overall passenger traffic has decreased over the past 10 years.