Health System for Dengue Control in Singapore

Dengue fever/dengue haemorrhagic fever (DF/DHF) first appeared in Singapore in an outbreak in 1960. In 1966, the Ministry of Health established the Vector Control Unit which was charged with the responsibility of controlling the dengue vector mosquitoes, Aedes aegypti and Aedes albopictus. The Unit immediately launched an Aedes control programme based on source reduction and public health education. To obtain reliable statistics on disease incidence, DF/DHF was made administratively notifiable in 1966, and finally, legally notifiable in 1977. It was also recognized early in the control programme that long-term and active participation by the community was essential for its implementation. A new legislation called the Destruction of Disease-Bearing Insects Act was thus enacted in 1968. The Act empowers vector control officers to enter and examine houses for mosquito breeding, to take appropriate control measures, and to serve offenders with orders and summonses which carry a fine or imprisonment by the court. With the new legislation in force, the Aedes control programme adopted an integrated approach of source reduction, public health education and law enforcement. When the new Ministry of the Environment was formed in 1972 to take over the responsibility of environmental health, its Vector Control and Research Department and the Quarantine & Epidemiology Department became responsible for the surveillance and control of DF/DHF in the country. Surveillance of disease incidence and Aedes vectors is important in the prevention and control of DF/DHF outbreaks. Disease surveillance is conducted by officers of the Quarantine & Epidemiology Department based on notifications on clinically diagnosed cases as well as on the number of blood specimens submitted by hospitals, clinics, and private practitioners to the Virology Division of the Department of Pathology in the Ministry of Health and the Department of Microbiology of the National University of Singapore for laboratory confirmation of dengue infection. Aedes surveillance depends on regular surveys of mosquito larvae and adults in designated DF/DHF-sensitive areas. In addition to destruction of breeding habitats, fogging is carried out when the Aedes house index is 2% and above, or when a potential outbreak situation arises such as the occurrence of a focus of two or more DF/DHF cases in an area

Epidemiology of Dengue in Singapore-Current Situation

There has been a resurgence of dengue fever/dengue haemorrhagic fever (DF/DHF) cases in Singapore in recent years. Following the large outreak in 1973 with 1,187 cases and 27 deaths, the incidence of DF/DHF declined with minor bi-annual outbreaks occurring in 1978, 1980 and 1982. Beginning from 1986, however, the DF/DHF situation changed for the worse when outbreaks of increasing size occurred almost annually. In the past 3 years, there were 1,733 cases in 1990, 2,179 cases in 1991 and 2,878 cases in 1992. In the 1991 and 1992 outbreaks, 93-95% of the notified cases required hospitalization and 92-95% of them were serologically confirmed by the IgM capture ELISA and/or the commercial Dengue Blot assay. The number of fatal cases, however, remained low with 3-6 reported deaths in the three outbreaks. All age groups were affected with the highest morbidity rate in children and young adults between 15 and 24 years of age. In contrast, in the earlier 1973 and 1978 outbreaks, more patients below the age of 15 years were observed. There was a slight predominance among males and Chinese had the highest morbidity rate compared with Malays and Indians. The recent outbreaks occurred mainly in highly populated urban and suburban areas in the eastern, northeastern and southeastern parts of the island. Patients living in landed property such as compound houses had a 9X higher morbidity rate than those living in high-rise flats. Cases were reported throughout the year and the number increased during May and June. The increased DF/DHF incidence was preceded by an increase in the Aedes mosquito population. In the 1991 and 1992 outbreaks, although the overall Aedes house index was<1 for both Ae aegypti and Ae albopictus higher indices were detected in localized areas with high dengue transmission. The proportion of compound houses found breeding Ae aegypti was 3-4 times and Ae albopictus 7-10 times higher than that of flats. The major breeding habitats were ornamental and domestic containers and discarded receptacles

Frontiers in Pigment Cell and Melanoma Research

We identify emerging frontiers in clinical and basic research of melanocyte biology and its associated biomedical disciplines. We describe challenges and opportunities in clinical and basic research of normal and diseased melanocytes that impact current approaches to research in melanoma and the dermatological sciences. We focus on four themes: (1) clinical melanoma research, (2) basic melanoma research, (3) clinical dermatology, and (4) basic pigment cell research, with the goal of outlining current highlights, challenges, and frontiers associated with pigmentation and melanocyte biology. Significantly, this document encapsulates important advances in melanocyte and melanoma research including emerging frontiers in melanoma immunotherapy, medical and surgical oncology, dermatology, vitiligo, albinism, genomics and systems biology, epidemiology, pigment biophysics and chemistry, and evolution

Taxing the self-employed

The self-employed taxpayers are the greatest source of concern to tax authorities around the world as far as voluntary compliance is concerned. This report looks at the problems encountered by the Inland Revenue Authority of Singapore in taxing the self-employed and the methods employed in ensuring compliance from this particular group of taxpayers. It will also attempt to evaluate the adequacies of our present system of taxation with respect to this group of taxpayers. The major sources- of information for this report were from · the conference proceedings of tax authorities of the various countries as well as from journals and articles by both practitioners and academia. Informal discussions with senior officers of the IRAS and self-employed taxpayers were also carried out during the course of this project. The study showed that our present mode of assessment leaves much to be desired and that a switch to the self-assessment system might prove to be more efficient due to better utilization of resources.ACCOUNTANC

Simplified cellular grafting for treatment of vitiligo and piebaldism: the '6-well plate' technique

Abstract: BACKGROUND Vitiligo is a disfiguring depigmenting dermatosis that affects approximately 0.5% to 1% of the general population regardless of race and sex. In patients with stable vitiligo who fail conventional therapies, surgical transplant offers a viable alternative. Noncultured cellular grafting offers the advantage of repigmenting vitiligo 5 to 10 times the size of the donor skin and can be completed on the same day on an outpatient basis. In recent years, ways to simplify this procedure have been explored, including the use of commercially available kits. OBJECTIVES To simplify the extraction of epidermal cells from donor skin using a 6-well plate and to evaluate the clinical efficacy of this simplified technique in repigmenting stable vitiligo and piebaldism. METHODS Four patients with focal or segmental vitiligo and one with piebaldism were treated using the simplified noncultured cellular grafting protocol. Percentage of repigmentation 6 months after grafting was objectively measured using digital contour mapping. RESULTS Patients with stable segmental or focal vitiligo achieved 65% to 92% repigmentation 6 months after grafting; the treated sites involved face or limbs. The patient with piebaldism achieved 86% repigmentation. One year after grafting, the extent of repigmentation remained for all patients. CONCLUSION This set-up is simple and inexpensive; it reduces cell preparation time, amount of reagents used, and costs, and obviates the need of a laboratory for extraction of epidermal cells

Association of NOD1, CXCL16, STAT6 and TLR4 gene polymorphisms with Malaysian patients with Crohn’s disease

Crohn’s disease (CD) is a prominent type of inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract. CD is known to have higher prevalence in the Western countries, but the number of cases has been increasing in the past decades in Asia, including Malaysia. Therefore, there is a need to investigate the underlining causes of CD that may shed light on its prevention and treatment. In this study, genetic polymorphisms in NOD1 (rs2075820), CXCL16 (rs2277680), STAT6 (rs324015) and TLR4 (rs4986791) genes were examined in a total of 335 individuals (85 CD patients and 250 healthy controls) with PCR-RFLP approach. There was no significant association observed between NOD1 rs2075820 and STAT6 rs324015 with the onset of CD in the studied cohort. However, the G allele of CXCL16 rs2277680 was found to have a weak association with CD patients (P = 0.0482; OR = 1.4310). The TLR4 rs4986791 was also significantly associated to CD. Both the homozygous C genotype (P = 0.0029; OR = 0.3611) and C allele (P = 0.0069; OR = 0.4369) were observed to confer protection against CD. On the other hand, the heterozygous C/T genotype was a risk genotype (P = 0.0015; OR = 3.1392). Further ethnic-stratified analysis showed that the significant associations in CXCL16 rs2277680 and TLR4 rs4986791 were accounted by the Malay cohort. In conclusion, the present study reported two CD-predisposing loci in the Malay CD patients. However, these loci were not associated to the onset of CD in Chinese and Indian patients

Risk factors for immune-related adverse events from anti-PD-1 or anti-PD-L1 treatment in an Asian cohort of nonsmall cell lung cancer patients

10.1002/ijc.33822INTERNATIONAL JOURNAL OF CANCER1504636-64