Elderly Hospitalised Patients-The Impact of Itch and its Prevalence.

INTRODUCTION: Pruritus in elderly patients can have a significant impact on the quality of life but may be underestimated and poorly addressed by healthcare professionals. MATERIALS AND METHODS: From March to May 2010, a structured interview questionnaire including the Dermatology Life Quality Index (DLQI) was administered to all patients admitted to the geriatric ward in Changi General Hospital, Singapore, except for those with cognitive impairment. RESULTS: A total of 194 patients were enrolled in the study; 94 patients (48.5%) were experiencing itch at the point of the interview; mean DLQI score for patients with itch was 6.7; 35.1% of patients experienced sleep disruption whilst 30.9% reported impairment of concentration levels as a consequence of their itch. Of the patients who had informed their doctor about the problem, 73.7% felt that doctors had not adequately addressed the cause of the itch. Among patients who reported itch, the DLQI score correlates with the severity of pruritus with a regression coefficient of 0.2737 (P <0.001); 9.6% of patients with itch were independent with their activities of daily living compared to 21% of patients who did not experience itch. CONCLUSION: Almost half of the subjects in our study experienced itch and a third of them reported impairment of quality of life. Patients who were independent of their activities of daily living were also less likely to experience itch. This study highlights the importance of increasing awareness of pruritus among physicians as pruritus can have adverse consequences on patients' quality of life when left unaddressed.

Use of an Interferon-γ Release Assay in the Detection of Latent Tuberculosis in Dermatology: A Descriptive Analysis.

With the increasing use of biologic therapy in psoriasis, it is becoming more important to identify and treat latent tuberculosis (TB) infection (LTBI). Tuberculin skin test (TST) has been traditionally used to detect LTBI, but interferon-γ release assays (IGRAs), such as the T-SPOT.TB test (T-Spot), are increasingly being used in its place. The indications and results of 51 T-Spot tests performed at the National Skin Centre in Singapore between 2008 and 2010 were analyzed and compared with TST results, decision on LTBI treatment, and previous use of immunosuppressants. T-Spot was most commonly performed as part of a prebiologic workup in patients with psoriasis. A total of 14 (27.5%) results were positive, and no patients had features of active TB. Ten of these patients also underwent TST, five of whom had negative TST results. Six patients (11.8%) had equivocal results with T-Spot test. This study shows poor concordance between T-Spot test and TST. A high incidence of equivocal results in IGRA may limit the utility of the T-Spot test.

CLINICAL EXPERIENCE AND IMPACT OF A COMMUNITY-LED VOLUNTEER ATMOSPHERIC HAZE CLINIC IN SINGAPORE.

The Pollutant Standards Index reached a life-threatening level of 401 in Singapore on 21 June 2013. Grassroot leaders in Ulu Pandan Constituency conducted the first community-led free atmospheric Haze Clinic from 25 June 2013 to 11 July 2013 to provide accessible medical assessment for affected community members. This provided insight into the common conditions afflicting that community during the haze period while allaying public anxiety. Seventy-two consultations were conducted over the 3 week period, of which 26 (36.1%) were haze related, 18 (25%) were possibly haze related and 28 (38.9%) were non-haze related. The majority of haze-related complaints were respiratory, eye and skin-related. During a haze crisis, such adhoc community-led clinics may help alleviate the surge in patients seen at emergency departments and public primary health clinics. Many of the patients seen were from low income families and a significant number (38.9%) sought help for non-haze related medical conditions.