Cervical screening in foreign domestic workers in Singapore.

INTRODUCTION: Globally, cervical cancer is the fourth most common cancer in women, with about 85% occurring in low-middle income countries (LMIC) and an age-standardised incidence rate of more than 15 per 100,000. It is largely preventable through HPV vaccination and cervical cancer screening. In Singapore, 18% of the foreign domestic workforce hail from Indonesia, the Philippines, Myanmar, and India. However, there is no data on preinvasive cervical disease and cervical cancer in foreign domestic workers (FDWs) and the aim of this pilot programme is to determine the baseline screen positive rate of high-grade intraepithelial in this population. METHODS: A total of 322 FDWs were offered HPV screening through the Helping Our Helper (HOH) pilot programme. Data from this pilot programme were analysed and reported using simple descriptive statistics. RESULTS: Out of the 322 FDWs who registered for HPV screening, 68.6% participated. There was a 22.2% screen-positive rate; 10% of those who screened positive for high-risk HPV had histologically confirmed high-grade cervical intraepithelial neoplasia. This result is similar to other data on cervical cancer screening in Singaporeans. This pilot project screened less than 1% of the eligible FDWs in Singapore. DISCUSSION: The findings of this pilot programme suggest that there is public health value in providing cervical cancer screening to FDWs. Improving cervical cancer screening by increasing awareness and including routine cervical cancer screening as part of the employment medical examination should be studied.

Cervical screening in foreign domestic workers in Singapore

INTRODUCTION@#Globally, cervical cancer is the fourth most common cancer in women, with about 85% occurring in low-middle income countries (LMIC) and an age-standardised incidence rate of more than 15 per 100,000. It is largely preventable through HPV vaccination and cervical cancer screening. In Singapore, 18% of the foreign domestic workforce hail from Indonesia, the Philippines, Myanmar, and India. However, there is no data on preinvasive cervical disease and cervical cancer in foreign domestic workers (FDWs) and the aim of this pilot programme is to determine the baseline screen positive rate of high-grade intraepithelial in this population.@*METHODS@#A total of 322 FDWs were offered HPV screening through the Helping Our Helper (HOH) pilot programme. Data from this pilot programme were analysed and reported using simple descriptive statistics.@*RESULTS@#Out of the 322 FDWs who registered for HPV screening, 68.6% participated. There was a 22.2% screen-positive rate; 10% of those who screened positive for high-risk HPV had histologically confirmed high-grade cervical intraepithelial neoplasia. This result is similar to other data on cervical cancer screening in Singaporeans. This pilot project screened less than 1% of the eligible FDWs in Singapore.@*DISCUSSION@#The findings of this pilot programme suggest that there is public health value in providing cervical cancer screening to FDWs. Improving cervical cancer screening by increasing awareness and including routine cervical cancer screening as part of the employment medical examination should be studied.

The pitfall of treating low bone turnover: Effects on cortical porosity.

Although it is recognized that cortical bone contributes significantly to the mechanical strength of the skeleton, little is known about this compartment from bone biopsy studies, particularly in CKD patients. In addition, there is no prospective data on the effects of CKD-MBD therapy on cortical porosity (Ct.Po). This is a post hoc analysis on data from a randomized controlled trial on the effects of different phosphate binders on bone remodelling. Therapy was adjusted according to the first biopsy, and included sevelamer or calcium acetate, calcitriol and changes in calcium dialysate concentration. We measured Ct.Po at baseline and one year after. Fifty-two patients (46±13years old, 67% women and 60% white) were enrolled. Ct.Po was already high at baseline in 85% of patients [30% (17, 46)] and correlated with PTH (p=0.001). Low bone turnover was seen in 28 patients (54.9%). After one-year treatment, PTH increased in patients with low turnover, as intended. However, increased Ct.Po was seen in 49 patients (94%). This increase correlated with the delta of phosphate (p=0.015) and the delta of PTH (p=0.03); it was also higher among non-white patients than in white patients (p=0.039). The risk of increase in Ct.Po was 4.5 higher among non-white patients. Adjusted multiple regression analysis showed that the delta of Ct.Po was dependent on delta PTH and race (r(2)=0.193). We concluded that in an attempt to increase bone turnover, the increase in PTH levels might be associated with higher cortical porosity, particularly in non-white patients. Whether this finding leads to a high risk of fracture deserves further investigation.

Aspectos obstétricos e perinatais da gestante com insuficiência renal / Obstetrics and perinatal features in pregnant women with renal insufficiency

A insuficiência renal, tanto em sua forma aguda quanto na forma crônica, impõe à gestação alto risco materno e fetal, reforçando a necessidade de adequado controle pré-natal. Frente à insuficiência renal aguda, a restrição de líquidos e monitorização da bioquímica sanguínea devem ser prontamente instituídas tão logo haja suspeita diagnóstica. Caso o valor da creatinina encontre-se superior a 3 mg/dL, a diálise está indicada. Ainda assim, a realização do parto mostra-se como o tratamento mais adequado para essas pacientes. Por outro lado, em gestantes com insuficiência renal crônica, elevação de 20 porcento do nível basal de creatinina é considerada deterioração da função renal, o que dificulta o manejo dessas pacientes. Nesse contexto, o objeto do presente artigo é realizar atualização sobre insuficiência renal na gravidez, enfatizando etiologia, manejo e prognóstico.

The renal insufficiency, in its acute or chronic form, imposes pregnancy maternal and fetal high risk, which demands appropriate care. As soon as the diagnosis of acute renal insufficiency is suspected, the liquid restriction and serum biochemistry control must be immediately established. If creatinine levels get higher than 3 mg/dl, the dialysis is indicated. Anyway, delivery is the best treatment for these patients. Otherwise, in pregnant women with chronic renal insufficiency, the elevation of 20 percent on basal creatinine levels is considered renal function deterioration, leading to a difficult management. In this article, we wil argue up-to-date data about renal insufficiency in pregnancy, focusing on etiology, management and prognosis.

Frequency of clinically unsuspected myocardial injury at a children's hospital.

BACKGROUND: Ill children are at risk but rarely screened for myocardial injury. The frequency of such injury in ill children is unknown. Elevated levels of plasma cardiac troponin I (cTnI) can detect subclinical myocardial injury. METHODS: We measured cTnI levels from 283 Children's Hospital, Boston patients (median age 2.10 years, range 0.13-22.4 years) seen in an outpatient or emergency clinic without clinically apparent cardiac disease. We took > or = 0.5 ng/mL as an indication of myocardial injury. We also measured plasma creatine kinase-MB, total creatine kinase, and myoglobin, and performed a chart review. RESULTS: Fifteen (7.8%) of the 193 acutely ill children and 4 (4.4%) of the 90 well children had an elevated cTnI level (P = .44). Within the acutely ill group, the children with elevated cTnI were younger and had lower mean hemoglobin and hematocrit levels. Cardiac troponin I levels correlated with creatine kinase-MB (r = 0.22; P < .001) but not with creatine kinase or myoglobin. The 4 children with cTnI > 0.89 ng/mL, who also had plasma cardiac troponin T measured, showed cardiac troponin T elevations that were consistent with unstable angina levels in adults. Four children had high-level cTnI elevations (> 2 ng/mL) consistent with acute myocardial infarction levels in adults. CONCLUSIONS: Elevated cTnI levels occur in children without clinically apparent cardiac disease and can be at adult unstable angina or acute myocardial infarction levels. Prospective studies to determine the clinical significance of these findings and their relationship to the development of cardiomyopathy are warranted.

Lithiasis inside a blind-ending branch of a trifid ureter.

A case of lithiasis inside a blind-ending branch of a trifid ureter is presented. This is a very uncommon anomaly and its association with lithiasis is not previously reported. The diagnosis was made by means of excretory urography followed by computed tomography (CT). The embryology, classification, and clinical aspects of such malformation are discussed.