Background Singapore’s current prevalence of diabetes exceeds 13.6%. Although lifestyle modification can be effective for reducing the risks for complications of type 2 diabetes mellitus (T2DM), traditional lifestyle interventions are often difficult to administer in the primary care setting due to limited resources. Mobile health apps can address these limitations by offering low-cost, adaptable, and accessible platforms for disseminating lifestyle management interventions. Objective Using the RE-AIM evaluation framework, this study assessed the potential effectiveness and feasibility of GlycoLeap, a mobile lifestyle management program for people with T2DM, as an add-on to standard care. Methods This single-arm feasibility study recruited 100 patients with T2DM and glycated hemoglobin (HbA 1c ) levels of ≥7.5% from a single community health care facility in Singapore. All participants were given access to a 6-month mobile lifestyle management program, GlycoLeap, comprising online lessons and the Glyco mobile phone app with a health coaching feature. The GlycoLeap program was evaluated using 4 relevant dimensions of the RE-AIM framework: (1) reach (percentage who consented to participate out of all patients approached), (2) effectiveness (percentage point change in HbA 1c [primary outcome] and weight loss [secondary outcome]), (3) implementation (program engagement as assessed by various participatory metrics), and (4) maintenance (postintervention user satisfaction surveys to predict the sustainability of GlycoLeap). Participants were assessed at baseline and at follow-up (≥12 weeks after starting the intervention). Results A total of 785 patients were approached of whom 104 consented to participate, placing the reach at 13.2%. Four were excluded after eligibility screening, and 100 patients were recruited. Program engagement (implementation) started out high but decreased with time for all evaluated components. Self-reported survey data suggest that participants monitored their blood glucose on more days in the past week at follow-up compared to baseline ( P <.001) and reported positive changes to their diet due to app engagement ( P <.001) (implementation). Primary outcome data were available for 83 participants. Statistically significant improvements were observed for HbA 1c (–1.3 percentage points, P <.001) with greater improvements for those who logged their weight more often ( P =.007) (effectiveness). Participants also had a 2.3% reduction in baseline weight ( P <.001) (effectiveness). User satisfaction was high with 74% (59/80) and 79% (63/80) of participants rating the app good or very good and claiming that they would probably or definitely recommend the app to others, respectively (main...

The live, attenuated rotavirus vaccine (RIX4414) was well tolerated and highly immunogenic in Singaporean infants. The immunogenicity of routinely administered infant vaccines was not impaired by concomitant administration of RIX4414 vaccine.

Early vaccination with two doses of this experimental MMRV vaccine at 9 and 12 months of age was well-tolerated and at least as immunogenic as two doses of separate licensed MMR and varicella vaccines.

BackgroundKidney disease is the 9th leading cause of death in Singapore. While preventive effects have focused on early detection and education, little is known about the knowledge level of chronic kidney disease (CKD) locally. We seek to evaluate the knowledge of CKD among primary care patients.MethodsWe conducted a cross-sectional survey of a convenience sample of 1520 patients from 3 primary care centers. Those with existing CKD or on dialysis were excluded. Knowledge was assessed based on 7 questions on CKD in the self-administered questionnaire. One point was given for each correct answer with a maximum of 7 points.Results1435 completed all 7 questions on CKD. Mean age was 48.9 ±15.0 (SD) years. 50.9% were male. 62.3% had a secondary and below education and 52.4% had a monthly household income of ≤ $2000. 43.7% had chronic diseases. Mean score was 3.44 ± 1.53 (out of a maximum of 7). Median score was 4. In multivariate logistic regression, being older {>60 years [Odds Ratio (OR) 0.50, 95% Confidence Interval (CI) 0.32-0.79]; 40–60 years (OR 0.62, 95% CI 0.43,0.89)}, less educated [up to primary education (OR 0.33, 95% CI 0.22-0.49)], having a lower monthly household income [

Angiotensin-converting enzyme (ACE) inhibitors are widely used in the treatment of hypertension, and renal and cardiovascular conditions. It is reported to be well tolerated by a high percentage of patients. However, dry cough is a common nuisance side effect with this class of medication, and the cough can be severe enough to require discontinuation of these medications.(1)The incidence of ACE inhibitor-induced cough has been reported to be 5%-20%.(2) A prospective study found that the incidence of cough necessitating the discontinuation of ACE inhibitors was reported to be 9.3%. We hypothesise that the local incidence of ACE inhibitor discontinuation due to cough is higher than that reported in the Caucasian population. (7,8) We believe that the objective data derived from our study will aid local physicians in their selection of drugs for their patients. Appropriate counselling can also be given to patients initiated on ACE inhibitors. Our study aimed to determine the incidence of discontinuation of ACE inhibitors due to cough, in a primary healthcare centre in Singapore. for an estimated incidence of discontinuation of ACE inhibitors due to cough (in our local population) of 40%, with 5% precision. M E TH O DSPatients prescribed ACE inhibitors for the first time at the study centre during the study period (i.e. between 1 July 2005 and 1 March 2006) were included in the study (Fig. 1). Using the clinic's electronic database, a list of patients who were prescribed the ACE inhibitors enalapril, lisinopril, captopril and perindopril was generated. These ACE inhibitors were selected as these were the only ACE inhibitors available at the study centre during the study period. The following patients were excluded from the study: (a) patients who defaulted on follow-up or were transferred to another institution within a year of initiation of ACE inhibitors; (b) patients whose ACE inhibitors were discontinued by other clinics for reasons that were notIncidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore

Laparoscopic management of Mirizzi's syndrome is feasible and safe but can be technically demanding. A policy of trial dissection by an experienced laparoscopic surgeon is recommended, and if anatomy remains unclear, it is prudent to convert.

The successful performance of laparoscopic cholecystectomy in a patient with situs inversus viscerum and empyema of the gallbladder is reported. The 62-year-old man presented with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and a palpable globular mass in the same region. CT scan demonstrated a distended gallbladder with thick shaggy walls which contained a 2 cm gallstone in the neck and also revealed dextrocardia and situs inversus. The patient's postoperative recovery was uneventful.

A prospective randomized trial was performed to assess the efficacy of the combined therapy of endoscopic injection of adrenaline and heater probe application in the management of patients with major peptic ulcer haemorrhage. Some 153 consecutive patients were randomized to receive either local injection of adrenaline (1:10,000) followed by heater probe thermocoagulation (74 patients) or no endoscopic treatment (79 patients). The two groups were well matched with regard to age, haemoglobin concentration on admission, non-steroidal anti-inflammatory drug usage and endoscopic findings. More patients in the treatment group were in shock on admission (21 versus 13). Initial haemostasis was achieved in all patients randomized to endoscopic therapy. Rebleeding occurred in fewer treated than control patients (five versus 16, P = 0.01). The treated group also had fewer deaths (zero versus two) and requirement for operation (two versus six). The results show that the combination of sclerotherapy with adrenaline and subsequent thermocoagulation reduces the rate of rebleeding in peptic ulcer haemorrhage.