Adherence to Continuous Positive Airway Pressure therapy in Singaporean patients with Obstructive Sleep Apnea.

PURPOSE: To investigate the rates of Continuous Positive Airway Pressure (CPAP) uptake and adherence amongst Singaporean patients diagnosed with Obstructive Sleep Apnea (OSA), and to evaluate factors correlated with CPAP uptake and adherence. STUDY DESIGN: Retrospective review of medical records. METHODS: Medical records were reviewed for baseline demographics, daytime sleepiness, presence of nasal symptoms and OSA severity, initial treatment choice, the rate of CPAP treatment uptake and CPAP adherence at 1 and 12 months. RESULTS: 2160 patients were diagnosed with OSA within the 5-year period (2011-2015). 463 (21.4%) had mild OSA, 583 (27.0%) had moderate OSA and 1114 (51.6%) had severe OSA. For initial therapy, 751 (34.8%) patients opted for a 1-month CPAP trial, 288 (13.3%) patients chose surgery upfront, 291 (13.5%) patients chose adjunctive treatments (weight loss, positional therapy, dental appliance, intranasal steroid spray for allergic rhinitis) and 830 (38.4%) patients rejected all forms of treatment. 337 out of 751 patients (44.9%) were adherent to CPAP therapy during the 1 month trial. 381 out of 751 (50.7%) patients took up CPAP therapy following the trial period, of which 299 out of 381 (78.5%) patients were adherent to CPAP therapy at 1 year. CPAP adherence during the 1-month trial was a predictor for eventual CPAP treatment uptake and CPAP adherence at 1 year (p < 0.001). Age (p < 0.001), BMI (p < 0.001) and normal ESS (p = 0.01) were predictors of treatment rejection. 24 patients underwent upper airway surgery during their first year of using CPAP. 21 out of the 24 patients (87.5%) were adherent to CPAP at 1 year after undergoing surgery. These patients had a higher rate of CPAP adherence compared to the overall cohort (87.5% versus 78.5%), but this was not statistically significant (p > 0.05). CONCLUSION: Singaporean patients who accept CPAP therapy after an initial 1-month CPAP trial will generally be adherent to CPAP therapy. Initial patterns of CPAP usage are predictive of long term CPAP adherence. However, there is a high rate of CPAP treatment rejection both at the time of diagnosis and after the CPAP trial. Upper airway surgery in selected patients may improve CPAP adherence.

A Novel Bioresorbable Implant for Repair of Orbital Floor Fractures.

PURPOSE: To describe clinical, radiologic, and safety outcomes of orbital floor fracture repair using a novel bioresorbable polycaprolactone (PCL) mesh implant (Osteomesh™, Osteopore International, Singapore). METHODS: This is a prospective interventional case series of orbital floor fractures repaired using a novel PCL mesh implant. Clinical evaluation was conducted at presentation and postoperatively at 1, 4, 12, 24 and 48 weeks. Computed tomography (CT) of the orbits was performed 1 year postoperatively. RESULTS: A total of 20 patients were recruited. Mean follow up was 50.4 ± 31.88 weeks. The majority of the patients were male (60%) and of Chinese ethnicity (75%), and the mean age was 39.35 (range 13-69) years. The most common mechanism of injury was assault. The average fracture size was 21.9 mm (range 12-32 mm) in the anteroposterior meridian and 18.65 mm (range 6-27 mm) in the horizontal meridian. Fifty percent of the patients were classified as having a large orbital defect (horizontal width ≥20 mm). The binocular single vision (BSV) score improved from 72.1% preoperatively to 90.8% postoperatively (P < 0.05) for 17 patients who had pre and postoperative charts. BSV improvement did not differ significantly between those with large and small orbital fracture sizes. There were features of neobone formation on CT scan performed 1.5 years after implantation. CONCLUSION: This bioresorbable implant is a promising material for the repair of both small and large orbital floor fractures, giving good functional and aesthetic outcomes.

When the simple migrated hair results in distressing ear symptoms.

We present 3 patients who complained of distorted hearing, tinnitus and otalgia resulting from scalp and facial hair impacting against the tympanic membrane. Removal of the migrated hair with microsuction relieved symptoms immediately. In 2 cases, the patients had presented to the primary care physician earlier, shortly after a haircut. The family physicians had correctly detected the migrated hair but failed to identify this as the cause of the patient's symptoms. Increased awareness of this potentially common complication will enable the family physician to identify and treat these patients in a primary care setting.

Health care utilization, productivity losses, and burden of adverse childhood experiences in Singapore: Findings from a national survey.

OBJECTIVE: There is poor understanding on health care utilization, productivity losses, and burden of adverse childhood experiences (ACEs) in multiethnic Asian populations. Part of this research gap stems from the limited epidemiological data on neglect, emotional abuse, bullying, and dysfunctional home environments. This study estimated health care utilization, productivity losses, and burden of ACEs (at least one exposure and multiple exposures) in Singapore. METHOD: A total of 4,441 adult residents were recruited via door-to-door surveys in a nationally representative study in Singapore. All participants were assessed for ACEs, health care utilization, productivity losses, chronic physical disorders, and mental disorders on structured interviews. Approximation formulas were applied to calculate the estimated cost of ACEs in Singapore. RESULTS: ACEs were prevalent (63.9%) in the Singapore population. Individuals exposed to ≥ 3 ACEs (13.1%) utilized more direct medical care (e.g., primary care doctor and accident and emergency visits) and experienced greater productivity losses than those without ACEs (36.1%). The adjusted excess costs associated with ACEs per person were estimated to be S$767.40 (at least one ACE; 63.9%) and S$2167.84 (≥ 3 ACEs; 13.1%). The adjusted incremental costs of ACEs in the Singapore population were estimated to be S$1.18 billion (at least one ACE) and S$680 million (≥ 3 ACEs) per year. CONCLUSIONS: The health and economic burden of ACEs is substantial in Singapore. Our results highlight the importance of investing in novel, population-based ACEs interventions, and the potential return on investment through preventive care and alleviation of the health care burden. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the Singapore general population's trust in COVID-19 information from different sources and its association with perceived risk of infection during the pandemic.

Background: The degree of public trust in the government's competence is crucial in preventing the spread of misinformation and reducing psychological distress during a pandemic. The study aimed to (i) explore the trust in COVID-19 information from different sources and trust in the ability of the World Health Organization (WHO), government departments and related institutions in handling the epidemic in Singapore and (ii) its association with perceived risk of infection among Singapore residents. Methods: A total of 1,129 participants (aged 21 and above) were recruited from a cross-sectional study examining the well-being and resilience of Singapore's population between May 2020 to June 2021. Trust in COVID-19 information from different sources was measured on a 10-point scale and an ordinal 7-point scale was used for perceived risk of infection. Descriptive statistics and multivariate logistic regression model were conducted. Results: 85.5% reported high trust in COVID-19 information from the government and their ability in handling the pandemic. Participants also reported high trust in COVID-19 information from local public health or infectious disease experts (84.4%) and traditional media (77.2%). Low trust in the ability of government departments and related institutions was associated with higher future (1 month) perceived risk of infection (OR: 5.7, 95% CI 1.02-32.45) and low trust in social media was associated with higher current perceived risk of infection (OR: 2.4, 95% CI 1.09-5.24). Discussion: The present study provided insight on the level of trust on COVID-19 information from different sources and its associated perceived risks of infection. Future qualitative studies are recommended to facilitate better understanding of public trust and identify strategies for how it can be effectively addressed to support future public health responses.

Problematic smartphone use and mental health outcomes among Singapore residents: The health and lifestyle survey.

BACKGROUND: The excessive use of smartphones and its association with adverse outcomes has been widely reported, with several studies showing an association between smartphone overuse, depression, anxiety, and sleep-related problems. METHODS: The study used data from the Health and Lifestyle Survey, a nationwide population survey. It examined the prevalence of Problematic Smartphone Use (PSU) and its association with mental health outcomes among Singapore residents aged 15-65 years. PARTICIPANTS: Participants were assessed for PSU using the Smartphone Addiction Scale-Short Version, psychological distress with the Patient Health Questionnaire-9, and Generalised Anxiety Disorder -7 questionnaire, sleep problems using the Insomnia Severity Index, and positive mental health with Rapid Positive Mental Health Instrument. RESULTS: In all, 6509 participants completed the survey, giving a survey response rate of 73.2 %. The prevalence of PSU was 30.2 % in the population. Individuals with PSU were more likely to have symptoms of moderate or severe depression (OR: 3.2, 95 % CI: 2.4-4.4), anxiety (OR: 3.4, 95 % CI: 2.4-4.8), insomnia (OR: 3.4, 95 % CI: 2.8-4.2), and poorer positive mental health (ß: -0.3, 95 % CI: -0.4 to -0.2). CONCLUSIONS: The study is the first to examine PSU in a national sample of Singaporeans across a wide age range. It provides valuable insights into mental health comorbidities among those with PSU, which is useful for practitioners.

Inflammatory pseudotumor of the endolymphatic sac: a case report.

The authors present a case of Endolymphatic Sac Inflammatory Pseudotumour treated at our institution and reviewed the relevant literature. This is a benign lesion which arises due to chronic inflammation. It has similar clinical and radiological features as endolymphatic sac tumors and is diagnosed through histopathological examination. To date, there have been over 200 case reports of ELSTs but only 2 case reports of endolymphatic sac pseudotumour. This report highlights the clinical presentation, radiological features, histological characteristics, treatment, and clinical outcomes of endolymphatic sac inflammatory pseudotumours and explores their likely etiology and discusses possible treatment options. Endolymphatic sac inflammatory pseudotumour may represent the end of a spectrum of immune-mediated inflammatory disease of the endolymphatic sac. Based on the experience of managing inflammatory pseudo-tumours elsewhere in the body, there may be a role for high dose steroids in its management.

Malignant transformation of keratocystic odontogenic tumor: two case reports.

INTRODUCTION: Keratocystic odontogenic tumors (KCOTs) are cystic tumours originating from the dental lamina of the maxilla and mandible that are lined with keratinized epithelium. While benign, they can be locally destructive and have a high recurrence rate despite treatment. Rarely, KCOTs may undergo malignant transformation into Primary Intraosseous Squamous Cell Carcinoma (PIOSCC). CASE REPORT: This study reports the clinical findings, radiological scans and histopathology of 2 patients with KCOTs that underwent malignant transformation into PIOSCC. DISCUSSION: A comprehensive literature review was performed to similar reports documenting the malignant transformation of KCOTs. The potential for KCOTs to undergo malignant change should prompt oral maxillofacial surgeons and otolaryngologists to exercise a high index of suspicion when treating these lesions. Patients persisting with unresolved disease after treatment should be investigated for malignant transformation. Detailed histopathological examination of KCOT specimens is recommended to detect small foci of SCC which may be present in the epithelium.

Combined radiological intervention and surgical excision of a periorbital arteriovenous fistula.

OBJECTIVE: To describe a case of periorbital arteriovenous fistula (AVF) treated with a combined approach of endovascular intervention and surgical excision. CASE REPORT: A 21-year-old lady presented with a vascular lump followed blunt trauma above the left medial brow area. Computed Tomography Angiogram (CTA) and Angiography of the internal and external carotid arteries showed presence of an AVF with main feeder vessel from a hypoplastic left ophthalmic artery. Pre-operative radiological embolization was performed but the patient defaulted planned surgery. She returned 4 months later complaining of pain and increased swelling of the lesion. Repeat CTA demonstrated residual shunt located below the supra-orbital rim medially supplied by the left supratrochlear artery. Excision was later performed without repeat embolization and was uncomplicated. Histological reported chronic inflammation with granulomatous foreign body giant cell reaction confirming pre-operative diagnosis of tissue reaction to glue cast. CONCLUSION: Treatments of Orbital AVFs are challenging and require multidisciplinary team management involving interventional radiologists and orbital surgeons. A foreign body reaction can develop followed embolization with tissue glue alone. Prompt surgical excision is therefore recommended to minimize post operation morbidity.

A land untouched by dentistry - singapore brings dental care to afghanistan.

In 2007, the Singapore Armed Forces deployed a Dental Project Team (DPT) to the capital city of the Bamiyan Province in Afghanistan. The team set up the province's first modern dental facility. Besides providing primary dental care to the 60,000 population there, the Singaporeans also trained and prepared a team of Afghan dentist and dental assistants. The Afghan dental team took over the dental clinic and continued to provide care when it was time for the DPT to depart for home. Braving challenging security and austere living conditions, the DPT completed its mission successfully.

Grisel's Syndrome in an Adult After Endoscopic Nasopharyngectomy.

BACKGROUND: Grisel's syndrome is rare in adults, and is characterized by nontraumatic atlanto-axial subluxation secondary to infection. Here, we report a case of Grisel's syndrome occurring after endoscopic nasopharyngectomy. METHODS: A 67-year-old man complained of fever and neck pain with reduced lateral rotation after an endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Flexion and extension X-rays of the cervical spine demonstrated atlanto-axial subluxation, and magnetic resonance imaging showed infective changes with cervical osteomyelitis. A diagnosis of Grisel's syndrome with cervical spine osteomyelitis was made. A later computed tomography (CT) scan demonstrated subluxation of C1 on C2, as well as the occipital-C1 joint. RESULTS: The patient was treated with intravenous antibiotics and offered surgery for spinal stabilization, but declined. He remained well 15 months post-op on a cervical collar with minimal pain and no neurologic deficits. CONCLUSION: A high index of suspicion for Grisel's syndrome is suggested in patients who have neck pain with reduced range of motion postnasopharyngectomy, and imaging is useful in clinching the diagnosis. LEVEL OF EVIDENCE: 4.

A review of tuberculosis prevention, diagnosis and treatment system in the Democratic People's Republic of Korea (DPRK).

This paper describes the current prevalence of tuberculosis and its management in the Democratic People's Republic of Korea. A review of technical reports of NGOs' experience working in North Korea with Democratic People's Republic of Korea officials, tuberculosis healthcare personnel and tuberculosis patients. Site visits, observations and experiences are also included. Until 2001, the Democratic People's Republic of Korea, was predominately isolated with an unknown healthcare system but has since allowed NGOs, WHO and international agencies to rehabilitate the healthcare infrastructure involving 200 people's Country Hospitals, 13 Prophylactic Hospitals, 62 Sanitariums and 4 Special Hospitals. The mid 1990s witnessed a resurgence of tuberculosis in North Korea with 100,000 new cases reported yearly. Preliminary analysis revealed that poverty, neglect, lack of resources and isolation resulted in the overall deterioration of public health services. Present estimates suggest a prevalence of 220 per 100,000 with 45,000 new cases. Tuberculosis is a major public health problem in North Korea that will require increased efforts by the national government and international agencies to control

Effect of mouthrinses on microhardness and wear of composite and compomer restoratives.

This study investigated the effect of commercially available mouthrinses on the microhardness and wear of composite (Esthet-X, Dentsply) and compomer (Dyract Posterior, Dentsply) restoratives. Fifty-four hardness and 36 wear specimens of each material were fabricated and stored in distilled water at 37 degrees C for two weeks. The specimens were then randomly divided into six equal groups and exposed to the following solutions for 24 hours at 37 degrees C: distilled water [WC] (control); Listerine Original [AP] (alcohol-containing essential oil/phenolic compound mouthrinse); Colgate Chloropharm [AC] (alcohol-containing chlorhexidine mouthrinse); Oral B Tooth & Gum Care [AF] (alcohol-containing fluoride mouthrinse); Oral B Tooth & Gum Care Alcohol Free [OF] (alcohol free fluoride mouthrinse) and Oral B Sensitive [PF] (phosphoric acid containing fluoride mouthrinse). After conditioning, the specimens were subjected to hardness testing using a digital microhardness tester (load = 500 gf; dwell time = 15 seconds) and wear testing with a reciprocal compression-sliding system (contact stress = 20 MPa). Wear depth was measured every 1,000 cycles up to 10,000 cycles using profilometry. Data was analyzed using ANOVA/Scheffe's test at significance level 0.05. Dyract was significantly softened by AP, while Esthet-X was significantly softened by AC and AP. The wear resistance of Dyract was significantly reduced after exposure to PF, while the wear resistance of Esthet-X was significantly reduced by AC. The effect of mouthrinses on hardness and wear was material dependent.

Reliability and determinants of retinal vessel oximetry measurements in healthy eyes.

PURPOSE: To assess the reliability and determinants of retinal vessel oximetry measurements with the Oxymap T1 Retinal Oximeter in normal Asian eyes. METHODS: Subjects older than 40 years without a history of stroke and heart disease were recruited from a community-based clinic. Subjects underwent standardized systemic and ocular examinations. Normal eyes were defined as eyes without major eye diseases such as age-related macular degeneration, glaucoma, or retinopathy. Retinal vessel oximetry levels were measured by using the Oxymap T1 Retinal Oximeter. Intra- and intergrader reliability of retinal vessel oximetry measurements were assessed by using 50 images. Intravisit repeatability of retinal vessel oximetry measurements was assessed by using 20 paired images. Univariable linear regression was performed to examine the associations between retinal vessel oximetry measurements and systemic determinants. RESULTS: A total of 118 retinal oximetry images were included in the final analysis. Intra- (intraclass correlation coefficient [ICC] values: 0.89-0.99) and intergrader (ICC values: 0.77-0.94) reliability, and intravisit (ICC values: 0.85-0.96) repeatability were both high. In the linear regression analysis, older age was associated with reduced overall retinal venular oximetry levels (ß: -2.61%; 95% confidence interval [CI]: -4.92 to -0.29) and reduced inferior-nasal retinal venular oximetry levels (ß: -3.53%; 95% CI: -6.07 to -0.99). CONCLUSIONS: The Oxymap Retinal Oximeter allows reliable and repeatable retinal vessel oximetry measurements. Age is the main factor that influences retinal venular oximetry levels and should be taken into account when retinal oximetry measurements are interpreted.