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Singapore's enhanced surveillance programme for COVID-19 identifies and isolates hospitalised patients with acute respiratory symptoms to prevent nosocomial spread. We developed risk prediction models to identify patients with low risk for COVID-19 from this cohort of hospitalised patients with acute respiratory symptoms.

This was a single-centre retrospective observational study. Patients admitted to our institution's respiratory surveillance wards from 10 February to 30 April 2020 contributed data for analysis. Prediction models for COVID-19 were derived from a training cohort using variables based on demographics, clinical symptoms, exposure risks and blood investigations fitted into logistic regression models. The derived prediction models were subsequently validated on a test cohort.

Of the 1,228 patients analysed, 52 (4.2%) were diagnosed with COVID-19. Two prediction models were derived, the first based on age, presence of sore throat, dormitory residence, blood haemoglobin level (Hb), and total white blood cell counts (TW), and the second based on presence of headache, contact with infective patients, Hb and TW. Both models had good diagnostic performance with areas under the receiver operating characteristic curve of 0.934 and 0.866, respectively. Risk score cut-offs of 0.6 for Model 1 and 0.2 for Model 2 had 100% sensitivity, allowing identification of patients with low risk for COVID-19. Limiting COVID-19 screening to only elevated-risk patients reduced the number of isolation days for surveillance patients by up to 41.7% and COVID-19 swab testing by up to 41.0%.

Prediction models derived from our study were able to identify patients at low risk for COVID-19 and rationalise resource utilisation.

Prediction models derived from our study were able to identify patients at low risk for COVID-19 and rationalise resource utilisation.

The recovery room used after endoscopy has limited capacity, and an efficient flow of the endoscopy unit is desired. We investigated the duration of hospital stay after endoscopy and the risk factors for prolonged hospital stay among outpatients.

We retrospectively studied consecutive patients who underwent esophagogastroduodenoscopy or colonoscopy at the Toyoshima Endoscopy Clinic. We collected data on age, sex, body weight, midazolam and pethidine dosage, respiratory depression during endoscopy, and duration of hospital stay after endoscopy (scope out to check out). Risk factors for prolonged hospital stay (>100 minutes) were identified using multiple logistic regression analysis.

We enrolled 3,898 patients, including 3,517 (90.2%) patients tested under sedation and 381 (9.8%) patients tested without sedation. Overall, 442 (11.3%) patients had prolonged stay (>100 min). The mean time difference between sedation group and non-sedation group was 44.2 minutes for esophagogastroduodenoscopy and 39.1 minutes for colonoscopy. Age (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.014-1.036), female sex (OR, 1.657; 95% CI, 1.220-2.249), and midazolam dose (OR, 1.019; 95% CI, 1.013-1.026) were independently associated with prolonged hospital stay after esophagogastroduodenoscopy, with similar results for colonoscopy.

Old age, female sex, and midazolam dose were independent risk factors for prolonged hospital stay after endoscopy.

Old age, female sex, and midazolam dose were independent risk factors for prolonged hospital stay after endoscopy.Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrograde cholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or a basket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are large CBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage these stones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for large CBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the cost of the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted in a tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization of the stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. This technique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significant technical complications.

Pelvic and acetabular fractures (PAFs) usually result from high-energy, potentially life-threatening accidents. They are one of the major injuries that lead to death in patients involved in such accidents. We studied the recent epidemiology of these injuries in Singapore.

This is a retrospective data analysis of all trauma patients who underwent surgery for PAFs from 2008 to 2016 in a tertiary trauma centre in Singapore. Data including patient demographics, mechanism of injury and associated injuries was collected.

A total of 169 patients were admitted for PAFs over the eight-year period. The majority (79.3%) were male. The mean age was 41 (range 13-79) years. Most patients (51.5%) were Chinese. The most common mechanisms of injury were road traffic accidents (53.8%), falls (33.1%) and crush injuries (13.0%). 46.2% sustained acetabular fractures, while 44.4% sustained pelvic fractures. PAFs were most commonly associated with upper and lower limb injuries, followed by spinal and thoracic injuries. Average of length of stay in hospital was 24 (range 2-375) days.

PAF predominantly affects young working males. Compared to previously published local data, there has been a significant reduction in the incidence of PAFs, likely due to improved road and work safety. The demographics of PAFs have changed, with fewer injuries in females (20.7% vs. 33.3%), a reduction in the proportion of injuries in the Chinese (51.5% vs. 70.1%). While road traffic accidents remain the most common cause, crush injuries are now more prevalent (13.0%).

PAF predominantly affects young working males. Compared to previously published local data, there has been a significant reduction in the incidence of PAFs, likely due to improved road and work safety. The demographics of PAFs have changed, with fewer injuries in females (20.7% vs. 33.3%), a reduction in the proportion of injuries in the Chinese (51.5% vs. 70.1%). While road traffic accidents remain the most common cause, crush injuries are now more prevalent (13.0%).The aims of this study were to determine the short-term effectiveness of an internet-based lifestyle modification (LSM) program in preventing the onset of type 2 diabetes mellitus (T2DM) in prediabetes patients in community settings. A total of 415 subjects who were diagnosed with prediabetes were randomly assigned to the LSM and standard management (SM) groups. After the 6-month intervention, the LSM group had a statistically significant reduction in body weight, body mass index compared to the SM group participants. In the LSM group, blood glucose levels were significantly decreased after intervention and the clinical improvement effect was evident in the group that achieved the target weight loss of 5% or more of the initial weight for 6 months. Internet-based 6-month-intensive LSM programs conducted by public health center personnel are an effective way to provide lifestyle intervention programs and encourage maintenance of healthy behaviors in subjects with a high risk of T2DM in community settings.

The aim of this study was to evaluate the efficacy of ethanol ablation (EA) in the treatment of cystic thyroid nodules using low-dose ethanol regardless of the initial volume of the nodule or properties of the aspirate.

Sixty-one nodules in 60 patients were treated with EA from October 2013 to January 2020. In each patient, EA was performed only once, using less than 5 mL of ethanol (99.5%) instilled and removed completely after a few minutes of retention. Nodule volume, the symptom score, the cosmetic score, and complications were evaluated before and after treatment. The therapeutic success rate (TSR) and volume reduction rate (VRR) according to nodule volume and properties of the aspirate were evaluated. Therapeutic success was defined as the absence of any residual fluid or sufficient volume reduction (≥50%) with improvement of nodule-related symptoms.

The 61 nodules comprised 38 pure cysts and 23 predominantly cystic nodules. check details The initial nodule volume was 21.9±15.2 mL (range, 4.4 to 77.2 mL). The TSR was 88.5% (100% in pure cysts and 69.6% in predominantly cystic nodules, P<0.001). The TSR of pure cysts was 100% regardless of nodule volume and properties of the aspirate. In predominantly cystic nodules, the TSR and VRR gradually decreased as volume increased. One patient experienced arrhythmia during the procedure, but completely recovered without sequelae.

Single-session EA using low-dose ethanol might be effective for the treatment of symptomatic cystic thyroid nodules regardless of the initial cyst volume and properties of the aspirate, especially in pure cysts.

Single-session EA using low-dose ethanol might be effective for the treatment of symptomatic cystic thyroid nodules regardless of the initial cyst volume and properties of the aspirate, especially in pure cysts.Mitochondrial vitality is critical to cellular function, with mitochondrial dysfunction linked to a growing number of human diseases. Tissue and cellular heterogeneity, in terms of genetics, dynamics and function means that increasingly mitochondrial research is conducted at the single cell level. Whilst there are several technologies that are currently available for single-cell analysis, each with their advantages, they cannot be easily adapted to study mitochondria with subcellular resolution. Here we review the current techniques and strategies for mitochondrial isolation, critically discussing each technology's limitations for future mitochondrial research. Finally, we highlight and discuss the recent breakthroughs in sub-cellular isolation techniques, with a particular focus on nanotechnologies that enable the isolation of mitochondria from subcellular compartments. This allows isolation of mitochondria with unprecedented spatial precision with minimal disruption to mitochondria and their immediate cellular environment.This report describes a clinical case of asymptomatic compound odontoma in the anterior left side of the maxilla associated with an impacted canine and supernumerary tooth with a gubernacular canal of a 47- year-old female with no relevant medical history. Cone-beam computed tomography (CBCT) was performed for precise three-dimensional localization of each structure and assessment of their spatial relationship with the associated structures before surgery. The treatment protocol involved surgical enucleation of the odontoma and open extraction of both impacted and supernumerary teeth. The patient had uneventful healing and proceeded with the prosthodontic treatment plan. The dentist should be aware of the probability of a close relationship between the development of odontoma and presence of the gubernacular tract, which could be used as a future radiographic diagnostic criterion of an odontoma. Also, we recommend that more studies be performed in this field to deeply analyze the imaging characteristics of GT and its spatial association with various pathological lesions in the future.