Predictors of nursing home conveyances to emergency department.

BACKGROUND: With increasing rates of patient conveyances from nursing homes to emergency departments worldwide, we aim to examine factors causing high rates of conveyances from nursing homes to the emergency department (ED) of an acute tertiary hospital. METHODS: This was a prospective study involving presentation of ED attendances from nursing home residents during out-of-hours over a 23-month period from April 2020 to February 2022. Data was collected from a standardized manual form used by the Emergency Department to document nursing home conveyances. RESULTS: A total of 338 pre-conveyance forms were reviewed. The most common reasons for conveyances to ED were neurological symptoms (16%), unstable hemodynamics (12%), fever (11%) and falls (10%). The peak conveyances occurred between 1600 and 1900 h on weekends. Respiratory rate, oxygenation requirements and high National Early Warning Score (NEWS) were significantly associated with increased conveyances to the emergency department. When the components of NEWS were analyzed individually, decision for ambulance conveyance to emergency department was significantly associated with respiratory rate (p < .001), oxygen saturation (p < .001), and the use of oxygen supplementation (p < .005). CONCLUSIONS: Unstable hemodynamics and falls were among the leading factors for nursing home conveyances to the emergency department, which highlights the need to implement better fall prevention strategies and standardized parameters monitoring in nursing homes. Future research should focus on outcomes of conveyances and the characteristics of nursing home with higher conveyance rates. This would aid to assess the appropriateness of conveyances and to identify strategies to decrease preventable conveyances.

Association of COVID-19 'circuit breaker' with higher rates of elderly trauma admissions.

Introduction: In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus emerged and caused a worldwide pandemic, leading to measures being imposed by many countries to reduce its transmission. Singapore implemented the 'circuit breaker', which restricted all movements except for access to necessities and healthcare services. We aimed to investigate the impact of lockdown measures on the pattern of trauma and its effects. Methods: An observational, retrospective, single-centre descriptive study was conducted using the trauma registry in Singapore General Hospital. It included patients above 18 years old who presented to the emergency department with trauma and were subsequently admitted. Patients admitted from 1 February 2020 to 31 July 2020 and those admitted during the same timeframe in 2019 were studied. Subgroup analyses were performed for patients aged ≥65 years and those <65 years. Results: A total of 1,037 patients were included for analysis. A 17.6% increase in trauma presentations was seen from 2019 to 2020. Patients aged ≥65 years accounted for the rise in admissions. The predominant mechanism of injury was falls at home for older patients and vehicular accidents in patients <65 years. There were no significant differences in injury severity score, intensive care/high-dependency unit admission rates, length of stay, mortality rate, and subsequent need for inpatient rehabilitation. Conclusion: Our study provided information on differences in trauma presentations before and during the COVID-19 pandemic. Further studies are required to better inform on additional precautionary measures needed to reduce trauma and improve safety during future lockdowns and pandemics.

Neuroinflammation: A Common Pathway in Alzheimer's Disease and Epilepsy.

BACKGROUND: Neuroinflammation is an innate immunological response of the central nervous system that may be induced by a brain insult and chronic neurodegenerative conditions. Recent research has shown that neuroinflammation may contribute to the initiation of Alzheimer's disease (AD) pathogenesis and associated epileptogenesis. OBJECTIVE: This systematic review aimed to investigate the available literature on the shared molecular mechanisms of neuroinflammation in AD and epilepsy. METHODS: The search included in this systematic review was obtained from 5 established databases. A total of 2,760 articles were screened according to inclusion criteria. Articles related to the modulation of the inflammatory biomarkers commonly associated with the progression of AD and epilepsy in all populations were included in this review. RESULTS: Only 7 articles met these criteria and were chosen for further analysis. Selected studies include both in vitro and in vivo research conducted on rodents. Several neuroinflammatory biomarkers were reported to be involved in the cross-talk between AD and epilepsy. CONCLUSION: Neuroinflammation was directly associated with the advancement of AD and epilepsy in populations compared to those with either AD or epilepsy. However, more studies focusing on common inflammatory biomarkers are required to develop standardized monitoring guidelines to prevent the manifestation of epilepsy and delay the progression of AD in patients.

Effects of MDR1 and OPRM1 genetic polymorphisms on the pharmacodynamics of propofol-remifentanil TIVA in pediatrics.

Aims: To investigate the roles of MDR1 (1236C>T, 2677G>T/A, and 3435C>T) and OPRM1 (118A>G) gene polymorphisms on the anesthetic and adverse effects of propofol-remifentanil total intravenous anesthesia in pediatric surgery. Materials & methods: The genotypes were identified through Sanger sequencing. The clinical data including hemodynamics on anesthesia, postanesthesia pain and sedation score and the occurrence of adverse effects were recorded and compared against the genetic data. Results: A total of 72 pediatric patients undergoing surgery were recruited. A weak to no association was found between the genetic polymorphisms of MDR1 and OPRM1 and the anesthetic and adverse effects of propofol-remifentanil. Conclusion: Genetic polymorphisms in OPRM1, but not in MDR1, gene polymorphism, demonstrated plausible association with the effects of propofol-remifentanil.

COVID-19 in systemic lupus erythematosus: A pooled analysis and systematic review of case reports and series.

OBJECTIVE: In the recent months, there have been several case reports and case series on COVID-19 in patients with systemic lupus erythematosus(SLE). We conducted a pooled analysis and systematic review to summarise the findings of these articles. Besides, we aimed to determine the predictors of severe COVID-19 infection in SLE by comparing the mild to moderate cases with the severe to critical ones. METHOD: All case reports and case series pertaining to COVID-19 in SLE were retrieved from Pubmed, Wiley Online Library, Springer Link, Science Direct and Web of Science databases using 'lupus', 'systemic lupus erythematosus', 'coronavirus', 'SARS-CoV-2', 'SLE' and "Covid-19" as keywords. The following data were extracted from the selected articles: country, age of the patient and the characteristics of SLE such as disease duration, organ or system involved, baseline medications and the severity of the COVID-19 infection. Data extracted from the articles were utilised to perform the pooled analysis. RESULTS: A total of 24 articles with 48 patients met the eligibility criteria. The median age at diagnosis of COVID-19 infection was 41 years (IQR: 11-66 years). The median SLE disease duration prior to the diagnosis of COVID-19 was 9 years (IQR: 0-30 years). A total of 22 (45.83%) patients had severe to critical COVID-19. This pooled data did not demonstrate any difference in the baseline medications between the 2 groups. Patients with lupus nephritis were significantly more prone to develop severe to critical disease (p = 0 .036) with an odds ratio of 5.40 (95% confidence interval of 1.120-26.045). CONCLUSION: We found that lupus nephritis was the only predictor of severe to critical COVID-19 in SLE.

Effects of genetic polymorphisms of ABCB1 on the efficacy of anesthetic and analgesic agents: a systematic review.

Aim: To perform a systematic review to determine the effect of ABCB1 (1236C>T, 2677G>T/A and 3435C>T) variants on the effects of anesthetic and analgesic agents in various surgical procedures. Materials & methods: Literature was obtained from established databases and reference tracking. The main outcome measures were efficacy of anesthetic and analgesic agents intraoperative or within 48 h post surgery of human population. Results: Seventeen studies were included for data extraction from 1127 screened studies. The influences of ABCB1 gene polymorphisms on analgesic effects showed conflicting results. The mutational homozygous TT genotypes of 1236C>T and 3435C>T polymorphisms demonstrated significant association with the anesthetic effects. Conclusion: The mutational homozygous TT genotype in both ABCB1 1236C>T and 3435C>T is associated with weaker anesthetic effect but there are no clearly demonstrated analgesic effects.

A case of colonic obstruction combined with ischemic colitis.

CT scan of the abdomen showing a large amount of feces in the anterior descending recto-sigmoid colon with wall thickening (red arrow) and surrounding fat stranding (yellow arrow) suggestive of stercoral colitis.

Stacked deep analytic model for human activity recognition on a UCI HAR database.

Background Owing to low cost and ubiquity, human activity recognition using smartphones is emerging as a trendy mobile application in diverse appliances such as assisted living, healthcare monitoring, etc. Analysing this one-dimensional time-series signal is rather challenging due to its spatial and temporal variances. Numerous deep neural networks (DNNs) are conducted to unveil deep features of complex real-world data. However, the drawback of DNNs is the un-interpretation of the network's internal logic to achieve the output. Furthermore, a huge training sample size (i.e. millions of samples) is required to ensure great performance. Methods In this work, a simpler yet effective stacked deep network, known as Stacked Discriminant Feature Learning (SDFL), is proposed to analyse inertial motion data for activity recognition. Contrary to DNNs, this deep model extracts rich features without the prerequisite of a gigantic training sample set and tenuous hyper-parameter tuning. SDFL is a stacking deep network with multiple learning modules, appearing in a serialized layout for multi-level feature learning from shallow to deeper features. In each learning module, Rayleigh coefficient optimized learning is accomplished to extort discriminant features. A subject-independent protocol is implemented where the system model (trained by data from a group of users) is used to recognize data from another group of users. Results Empirical results demonstrate that SDFL surpasses state-of-the-art methods, including DNNs like Convolutional Neural Network, Deep Belief Network, etc., with ~97% accuracy from the UCI HAR database with thousands of training samples. Additionally, the model training time of SDFL is merely a few minutes, compared with DNNs, which require hours for model training. Conclusions The supremacy of SDFL is corroborated in analysing motion data for human activity recognition requiring no GPU but only a CPU with a fast- learning rate.

The impact of virtual learning on Multimedia University student performance: a cross-sectional study.

Background: The Covid-19 pandemic has imposed adaption to virtual learning for students and educators across all levels of education in the world. The effectiveness of virtual learning varies amongst age groups. It has been suggested that the adoption of virtual learning will continue to be implemented even after pandemic, particularly in higher education. Therefore, it is crucial to validate the effectiveness of a virtual learning approach among university students to ensure a smooth transition from a conventional education model to a hybrid education model. Thus, this study aims to evaluate the impact of virtual learning on students' performance in a virtual classroom. Methods: We analysed survey data collected from undergraduate students at Multimedia University, Malaysia. Convenience sampling and self-administered online surveys were used to understand the impact of virtual learning. Multiple regression analysis was performed using SPSS software Results: A total of 210 first and second year degree and diploma students responded to the online surveys. Factors affecting virtual learning were segregated into three categories: virtual teaching techniques, technology issues, and environment distraction. Respondents stated that the critical factor that affect the effectiveness of virtual learning and impacts on students' performance was the virtual teaching techniques employed by educators. Conclusions: This study concluded that virtual teaching techniques have significant impact on students' performance whereas technology issues and environment distraction do not significantly influence students' performance during virtual learning. Although this study is limited to students from Multimedia University, it lays the groundwork for future research to involve students from other universities or other countries. A future study can address more factors that affect virtual learning and students' performance, such as students' attitude and motivation.

Case report: Mononeuritis multiplex in the course of dengue fever.

BACKGROUND: Dengue fever usually presents as a self-limiting acute febrile illness with worsening thrombocytopenia, with a small minority of patients developing hemorrhagic or life-threatening complications. Organ specific manifestations like myocarditis, acalculous cholecystitis, encephalitis has been described but are uncommon presentations. Even more rarely, such manifestations are the presenting complaint of Dengue fever. In this case report, we highlight a case of Dengue fever where unrelated neuropathies were the presenting complaint. CASE PRESENTATION: An elderly man presents with 1 day of diplopia and left foot drop, associated with 2 days history of fever. A decreasing white cell count (WBC) and platelet on the 2nd day of admission prompted Dengue virus to be tested and a positive NS-1 antigen was detected, confirming the diagnosis of Dengue fever. He was treated with supportive treatment with a short duration of intravenous fluids recovered uneventfully and was discharged 6 days after admission with almost full resolution of diplopia and partial resolution of left foot drop. Left foot drop recovered completely 2 weeks later. CONCLUSION: Neurological manifestations can be the presenting symptoms in Dengue fever, a diagnosis which should be borne in mind when such symptoms present in patients from endemic areas or in returning travellers from these areas.

New peril on our roads: a retrospective study of electric scooter-related injuries.

INTRODUCTION: The electric scooter has been gaining popularity locally as a commute mode. We aimed to understand the current landscape of electric scooter-related injuries in Singapore. METHODS: A retrospective review was performed of the medical records of patients seen from 2015 to 2016 at an emergency department (ED) in Singapore. Patient demographics, circumstances of the accident, injuries sustained and clinical progress were analysed. RESULTS: There were 36 cases, all of whom were electric scooter users. The median age was 34 (range 17‒70) years and 66.7% were male. There was a 2.3-fold increase in the number of cases from 2015 to 2016. In 11 (30.6%) of cases, another road user was implicated. Two cases involved the use of protective equipment. 14 (38.9%) cases were conveyed by Emergency Medical Services. In the ED, 4 (11.1%), 17 (47.2%) and 15 (41.7%) cases were triaged as P1 (emergent), P2 (urgent) and P3 (ambulatory), respectively. Investigations were performed in the ED for 31 (86.1%) cases. External injuries were most common (72.2%), followed by extremity injuries (33.3%), with median Abbreviated Injury Scale scores of 1 and 2, respectively. Overall, the median Injury Severity Score was 1. Nine patients were admitted to the hospital with three requiring surgery. The median length of stay was 2 (range 1‒6) days. CONCLUSION: The incidence of electric scooter-related injuries appears to be on the rise and may potentially incur significant morbidity and healthcare costs. Further efforts at safety education and enforcement should be made to prevent accidents and minimise the impact of these injuries.