Accelerating TB diagnosis during the COVID-19 pandemic.

SETTING: The COVID-19 pandemic has caused significant disruption worldwide to economies and healthcare systems, even those with well-developed infrastructure.OBJECTIVE: To examine the effects of COVID-19 on TB diagnosis in Singapore, and to identify any factors that could facilitate early detection of TB among persons screened.DESIGN: To assess the impact of testing and diagnosis of the pandemic on TB, the number of TB-related tests from January 2018 to December 2020 were collected. We also conducted a retrospective case-control study of all adult patients admitted for COVID-19, TB or coinfection from 23 January to 31 May 2020.RESULTS: Nationwide testing for TB from 2018 to 2020 increased by 24.2%. We analysed 253 adult inpatients, of whom 107 (42.3%) were diagnosed with COVID-19, 134 (53.0%) had TB, while 12 (4.7%) had co-infection. Patients with TB were more likely to have chest X-ray abnormalities than those with COVID-19 (89.9% vs. 76.0%; P < 0.01). Patients with TB were more likely to have prolonged cough vs. those with COVID-19 infection (28 vs. 5 days; P < 0.01).CONCLUSION: Early screening for TB, even among patients with COVID-19, could lead to earlier diagnosis and treatment, thereby breaking the chain of transmission.

The 'not so short-bowel syndrome': potential health problems in patients with an ileostomy.

AIM: The study aimed to determine whether an ileostomy compromises nutritional, hydration and electrolyte status and bone mineral density. METHOD: Body weight, body mass index (BMI) and fat and lean body mass (LBM) were measured in 60 patients with an ileostomy [14 small-bowel resection (SBR); 46 non-small-bowel resection (NSBR)] and in 60 age- and sex-matched normal controls. Measurement of plasma sodium, potassium, calcium, magnesium, urea and creatinine and 24-h urinary output of water, Na, K, Ca and Mg was made in 45 NSBR and 14 SBR ileostomists and in all the controls. Forty-six NSBR and 13 SBR ileostomists had bone mineral density (BMD) measurements of lumbar spine (LS) and femoral neck (FN). RESULTS: The body weight of ileostomists was less than controls [median 67.8 (36.4-115.1) vs 77.7 (48.0-103.3) kg; P < 0.05]. BMI was also less [25.0 (14.3-43.0) vs 27.3 (20.2-32.2) kg/m(2) ; P < 0.05] with a lower LBM [47.8 (19.3-73.0) vs 52.9 (34.0-73.8) kg; P < 0.05]. The 24-h urinary output of the ileostomists was lower than for controls [1380 (430-4690) vs 2000 (840-4440) ml/24 h; P < 0.05] suggesting some degree of dehydration. In 62.7% of ileostomists 24-h urinary Na excretion was < 100 mmol/day vs 16.7% of controls, and ileostomists with lower urinary Na were more likely than ileostomists with normal Na excretion to have a low BMI [23.9 (14.3-33.0) vs 28.4 (16.6-43.0) kg/m(2) ; P < 0.001] and LBM [44.1 (19.3-73.0) vs 59.5 (36.6-67.9) kg; P < 0.001]. The respective 24-h output of Ca was [2.2 (0-6.1) vs 4.7 (0-13) mmol; P < 0.001] and Mg was [2.0 (0-13.7) vs 3.9 (1.2-5.4) mmol; P < 0.001], and BMD Z-score LS was -0.15 (-2.0 to 5.2) vs 0.3 (-2.5 to 2.1), Z-score FN -0.5 (-1.9 to 3.1) vs 0.2 (-1.2 to 1.4), both P < 0.05. CONCLUSION: Patients with an ileostomy tend to have low body weight, BMI, LBM and BMD. They also tend to have low urine volumes, and some are depleted of Na, Ca and Mg. Abnormalities are greater in those with a lower urinary Na and measuring this will identify ileostomists at risk of Na depletion who will be benefitted by Na supplements.

Awareness of smoking risks and attitudes towards graphic health warning labels on cigarette packs: a cross-cultural study of two populations in Singapore and Scotland.

BACKGROUND: Little is known about the level of awareness of blindness as a smoking-related condition, although the relationship has been well established. AIM: To compare the awareness of smoking risks and the impact of graphic health warning labels on cigarette packs in discouraging smoking among adults in Singapore and Scotland. METHODS: A cross-sectional survey using a structured interview of adults in ophthalmic, general medical, and general surgical outpatient clinics in Singapore and Scotland. RESULTS: One hundred and fifteen out of 163 (70.6%) outpatients in Singapore and 105 out of 112 (93.8%) outpatients in Scotland responded to the study. In both samples, awareness levels for smoking-related diseases such as lung cancer, mouth and throat cancer, heart disease, and stroke were all greater than 85%. These were found to be significantly higher than the level of awareness of blindness as a smoking-related condition (chi (2)-test, P<0.001). Although the awareness of blindness as a smoking-related condition was greater in Singapore (36.5%) than in Scotland (30.5%), this difference was not statistically significant. More than half of the respondents indicated that graphic health warning labels would be effective in discouraging them from smoking. CONCLUSION: Graphic health warning labels reading 'Smoking causes blindness' printed on cigarette packs may be useful in raising public awareness of blindness as a smoking-related condition and discouraging the habit of smoking in Singapore and Scotland.