Unusual presentation of uterine rupture following laparoscopic myomectomy: a case report and literature review

Laparoscopic myomectomy is preferred to the laparotomy approach as the former promises a better postoperative course, with fewer complications and faster recovery. It is increasingly performed in younger women in recent years. However, although rare, uterine rupture is an important and dangerous complication. Authors report a case of 36-year-old lady who presented at 23 weeks and 4 days gestation of an in vitro fertilization (IVF) dichorionic diamniotic twin pregnancy with spontaneous uterine rupture. She underwent a laparoscopic myomectomy three year prior for a 4.5cm fundal fibroid. Her presenting symptoms include acute onset of epigastric pain. Uterine rupture was confirmed using Computed Tomography scan. She underwent an exploratory laparotomy and the placenta was found extruding from a 4cm defect on the posterior fundus along the previous myomectomy scar with active bleeding. Current literature suggests it is difficult to predict when uterine rupture may happen. Proper selection criteria for suitable cases may allow trial of labour after myomectomy to be a viable option. Potential considerations include interval between myomectomy and conception, scar integrity, method of repair, and the use of electrocoagulation. This case reports the worrying features of an early antepartum rupture presenting with atypical symptomatology. In pregnant patients presenting with abdominal pain or haemodynamic instability, it is imperative to consider uterine rupture so as to perform timely intervention. Those with a history of laparoscopic myomectomy should be considered high risk and counseled about the risk of rupture with extensive discussion about mode of delivery.

Statistical Methodologies Symposium celebrating The Work Of Professor Chin-diew Lai

This study briefly look at some of the statistical methods that have been developed to model the HIVIAIDS epidemic and also use the back calculation method to estimate the HIV infection rate in Penang. The back calculation program has been chosen to model the underlying HIVIAIDS epidemic in Penang, Malaysia because it makes use of the AIDS incidence data which is more reflective of the epidemic as compared to the number of HIV infected recorded which is known only if tests are conducte

Developing a lifestyle intervention program for overweight or obese preconception, pregnant and postpartum women using qualitative methods.

The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors to improve the metabolic health of mothers and their offspring. However, the success of a lifestyle intervention is dependent on uptake and continued compliance. To identify enablers and barriers towards engagement with a lifestyle intervention, thematic analysis of 15 in-depth interviews with overweight or obese women in the preconception, pregnancy or postpartum periods was undertaken, using the integrated-Promoting Action on Research Implementation in Health Services framework as a guide to systematically chart factors influencing adoption of a novel lifestyle intervention. Barrier factors include time constraints, poor baseline knowledge, family culture, food accessibility, and lack of relevant data sources. Enabling factors were motivation to be healthy for themselves and their offspring, family and social support, a holistic delivery platform providing desired information delivered at appropriate times, regular feedback, goal setting, and nudges. From the findings of this study, we propose components of an idealized lifestyle intervention including (i) taking a holistic life-course approach to education, (ii) using mobile health platforms to reduce barriers, provide personalized feedback and promote goal-setting, and (iii) health nudges to cultivate sustained lifestyle habits

Mutation signatures implicate aristolochic acid in bladder cancer development

10.1186/s13073-015-0161-3Genome Medicine71Article number 3

Percutaneous coronary intervention in asians- are there differences in clinical outcome?

<p>Abstract</p> <p>Background</p> <p>Ethnic differences in clinical outcome after percutaneous coronary intervention (PCI) have been reported. Data within different Asian subpopulations is scarce. We aim to explore the differences in clinical profile and outcome between Chinese, Malay and Indian Asian patients who undergo PCI for coronary artery disease (CAD).</p> <p>Methods</p> <p>A prospective registry of consecutive patients undergoing PCI from January 2002 to December 2007 at a tertiary care center was analyzed. Primary endpoint was major adverse cardiovascular events (MACE) of myocardial infarction (MI), repeat revascularization and all-cause death at six months.</p> <p>Results</p> <p>7889 patients underwent PCI; 7544 (96%) patients completed follow-up and were included in the analysis (79% males with mean age of 59 years ± 11). There were 5130 (68%) Chinese, 1056 (14%) Malays and 1001 (13.3%) Indian patients. The remaining 357 (4.7%) patients from other minority ethnic groups were excluded from the analysis. The primary end-point occurred in 684 (9.1%) patients at six months. Indians had the highest rates of six month MACE compared to Chinese and Malays (Indians 12% vs. Chinese 8.2% vs. Malays 10.7%; OR 1.55 95%CI 1.24-1.93, p < 0.001). This was contributed by increased rates of MI (Indians 1.9% vs. Chinese 0.9% vs. Malays 1.3%; OR 4.49 95%CI 1.91-10.56 p = 0.001), repeat revascularization (Indians 6.5% vs. Chinese 4.1% vs. Malays 5.1%; OR 1.64 95%CI 1.22-2.21 p = 0.0012) and death (Indians 11.4% vs. Chinese 7.6% vs. Malays 9.9%; OR 1.65 95%CI 1.23-2.20 p = 0.001) amongst Indian patients.</p> <p>Conclusion</p> <p>These data indicate that ethnic variations in clinical outcome exist following PCI. In particular, Indian patients have higher six month event rates compared to Chinese and Malays. Future studies are warranted to elucidate the underlying mechanisms behind these variations.</p

Nocturnal Lifestyle Behaviours and Risk of Poor Sleep during Pregnancy

The extent to which lifestyle practices at night influence sleep quality in pregnant women remains unknown. This study aimed to examine whether nocturnal behaviours were associated with poor sleep during pregnancy. We performed a cross-sectional analysis of a prospective cohort of pregnant women at 18–24 gestation weeks recruited from KK Women’s and Children’s Hospital, Singapore, between 2019 and 2021. Nocturnal behaviours were assessed with questionnaires, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) with a global score ≥5 indicative of poor sleep quality. Modified Poisson regression and linear regression were used to examine the association between nocturnal behaviour and sleep quality. Of 299 women, 117 (39.1%) experienced poor sleep. In the covariate-adjusted analysis, poor sleep was observed in women with nocturnal eating (risk ratio 1.51; 95% confidence interval [CI] 1.12, 2.04) and nocturnal artificial light exposure (1.63; 1.24, 2.13). Similarly, nocturnal eating (β 0.68; 95% CI 0.03, 1.32) and light exposure (1.99; 1.04, 2.94) were associated with higher PSQI score. Nocturnal physical activity and screen viewing before bedtime were not associated with sleep quality. In conclusion, reducing nocturnal eating and light exposure at night could potentially improve sleep in pregnancy.publishedVersionPeer reviewe

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

The cheque clearing process - a case study on Post Office Savings Bank.

This report attempts to study the efficiency ofthe cheque clearing process, comparing the theory and practice, in the context of POSB. Through the literature review of relevant text books and study of relevant legislation, the duties, risks and liabilities faced by banks in the cheque clearing process were identified. With that in mind, personal interviews were conducted with the assistant manager and bank officers from the inward clearing unit of POSB to study the cheque clearing system adopted by the bank to fulfill its duty as a paying bank and a collecting bank.BUSINES

How small and medium enterprises can raise finance.

Small and Medium Enterprises (SMEs) are known as the building blocks of a successful economy. As these SMEs grow, so do the number of jobs available, distributable wealth and acountry's future economic stability. However studies have shown that many SMEs failed in the initial years of business. This study attempts to probe into the financing needs of SMEs in Singapore. A sample was drawn from the Economic Development Board's SMEs Register to respond to a structured questionnaire. Analysis was performed on the data gathered regarding how SMEs source finances for their operations and the channels through which these options are available. Interviews were also conducted with external financiers to gain more insights into findings of the survey. The study also attempts to probe into the reasons why SMEs applications for external financing were rejected. This study hopes to indicate the extent of difficulties faced by SMEs in Singapore.Master of Business Administration (Banking & Finance

The use of captives in Singapore.

The extend of use of captives in Singapore was gathered from both captive managers' and corporates' viewpoints. Further analysis shown that use of captive extremely depends on the size of parent company. Recommendations, based on above viewpoints and analysis, were then made on how Singapore's captive market can prosper in future