Vibrio cholerae 0139 'Bengal' in Singapore

Vibrio cholerae 0139 was isolated from five patients with cholera-like illness. All were imported cases. Laboratory investigations found our five isolates in show similar morphological, biochemical and serological characteristics to the V. cholerae 0139 strains causing epidemics in Bangladesh and India. Our isolates were toxin producers resistant to streptomycin and co-trimoxazole. No local transmission was known to have occurred following introduction of these imported cases.

The thiol-specific antioxidant protein from human brain: gene cloning and analysis of conserved cysteine regions

The complete cDNA encoding human thiol-specific antioxidant protein (PRP) was isolated from a human brain cDNA library in the lambda Zap expression vector. An open reading frame (ORF) was identified and found to encode a polypeptide of 197 aa with a M(r) of 21,729. The cDNA contained 98 bp of 5'-untranslated sequence (UTR) and 259 bp of 3'-UTR containing a poly(A) signal, AATAAA. Expression of the human PRP cDNA in Escherichia coli yielded a functionally active protein. The observed local sequence homologies between human PRP and other homologous proteins whose functions have not yet been defined give important insight into elucidating the biochemical function of a new protein family which has highly conserved regions containing cysteine.

Purification and characterization of thiol-specific antioxidant protein from human red blood cell: a new type of antioxidant protein

A thiol-specific antioxidant protein (Protector Protein, PRP) was purified from human red blood cells (RBC). The PRP exists as a predominant protein in human RBC, which showed distinct thiol-specific antioxidant activities in the presence of dithiothreitol (DTT) as a reducing equivalent. The human RBC PRP (HRPRP) completely inhibited visible absorption spectral changes of oxyhemoglobin, DNA cleavage, and the peroxidation of RBC membrane by a nonenzymatic Fe3+/O2/thiol mixed-function oxidation system capable of generating hydroxyl radical. These observations suggest that HRPRP could act as a new type of antioxidant protein to maintain the RBC integrity by scavenging reactive oxygen species.

Removals of hydrogen peroxide and hydroxyl radical by thiol-specific antioxidant protein as a possible role in vivo

Thiol-specific antioxidant protein (Protector Protein; PRP) from Saccharomyces cerevisiae was found to remove hydrogen peroxide and hydroxyl radical in the presence of dithiothreitol (DTT). Without DTT as a reducing equivalent, the antioxidant protein did not show the activities for destroying hydrogen peroxide and hydroxyl radical. N-ethylmaleimide (NEM) was observed to prevent the PRP from both removing hydrogen peroxide and protecting the cleavage of DNA. These observations suggest that the sulfhydryl of cysteine in PRP could function as a strong nucleophile to attack and destroy H2O2 and .OH.

Epidemiology of typhoid fever in Singapore

A total of 1452 cases of typhoid fever was notified in Singapore from 1980-9. The morbidity rates of indigenous cases showed a steady decline from 5.9 per 100,000 population in 1980 to 1.2 per 100,000 population in 1989. The mean case fatality was 0.8%. Children, adolescents and young adults were most susceptible to typhoid fever. There was no significant difference in morbidity rates between the major ethnic groups. The vast majority of indigenous cases were sporadic while outbreaks accounted for almost one third of them. Food was the main vehicle of transmission. The commonest indigenous phage types were B1, D1 and A. Antimicrobial resistance was infrequently seen. The proportion of imported cases rose from 32% in 1980 to 72% in 1989. Almost half (48.5%) of all imported cases were local residents who contracted typhoid fever while travelling in endemic countries. As imported cases assume greater importance in the epidemiology of typhoid fever in Singapore, further drop in typhoid fever incidence would require reduction of travel-related cases through greater awareness of food hygiene and effective vaccination.

A 7-day course of ciprofloxacin for enteric fever

A prospective, open and non-randomised clinical trial using a 7-day short course of oral ciprofloxacin 500 mg twice daily was conducted on 25 adult patients with bacteraemic enteric fever. Twenty-four patients (96%) were cured and there was one treatment failure. Two patients with typhoid fever relapsed 6 weeks after finishing treatment. Defervescence of fever was rapid (median: 4 days) and the duration of hospitalisation was short (median: 8 days). Both factors resulted in patient satisfaction. A short-course regime of ciprofloxacin for the treatment of enteric fever, is therefore, highly promising.

Pasteurella multocida infection in Singapore

A case of Pasteurella multocida infection in Singapore is presented. The patient was a 21-year-old Chinese male who developed fever and cellulitis with abscess formation of his right index finger after it was bitten by a stray cat. The organism was isolated in pure culture and identified as Pasteurella multocida subspecies septica. The patient responded to antibiotic therapy and had an uneventful recovery.

Failure to isolate Yersinia enterocolitica from patients with diarrhoea in Singapore

To determine the presence of Yersinia enterocolitica in Singapore, an attempt was made to isolate this organism from the stool samples of 6,619 patients with diarrhoea. No Y. enterocolitica was detected. The results suggest that Y. enterocolitica is not an important bacterial pathogen causing diarrhoeal disease in this region.

Diagnostic value of the Widal test for typhoid fever in Singapore

A study was conducted to assess the diagnostic value of the Widal test in patients with bacteraemic typhoid fever. The Widal test was carried out on 25 bacteriologically proven cases of typhoid fever and 50 patients with non-typhoid fever. All the patients with non-typhoid fever had an O agglutinin titre of less than 1:40, while 82% had an H agglutinin titre of less than 1:40. In the patients with typhoid fever, 56% had an O agglutinin titre of greater than or equal to 1:40 and 72% had an H agglutinin titre of greater than or equal to 1:40. Typhoid patients with titres greater than or equal to 1:40 for O and H antigens of Salmonella typhi were significantly different (P less than 0.01) from those with non-typhoid fever. The O agglutinin was highly specific (100%) in the diagnosis of the disease. The study shows that a single Widal test is useful in the diagnosis of typhoid fever in Singapore.

Prevalence of bacterial agents of diarrhoeal disease at the National University Hospital, Singapore and their resistance to antimicrobial agents

Over a 50-month period, 4,508 stool specimens from patients with diarrhoea were bacteriologically examined at the National University Hospital, Singapore. Salmonella serotypes other than the typhoid and paratyphoid bacilli were the most common finding, being isolated in 10.8% of cases. Campylobacter jejuni was unexpectedly infrequent (1.9%); Aeromonas hydrophila was found in 1.8%. No other aerobic pathogen occurred in more than 1% of cases. Clostridium difficile was sought only when requested, and was isolated from 9.6% of cases tested. Testing for enteropathogenic Escherichia coli was limited to children under 1 year old. Gentamicin was active against the greatest number of aerobic isolates, followed by chloramphenicol and cotrimoxazole. The C. difficile isolates were all sensitive to metronidazole.

A one-year study of enteric Campylobacter infections in Singapore

A total of 7344 inpatients with diarrhoea were investigated for Campylobacter infections in Singapore over one year. Campylobacter species were recovered from 1.2% of diarrhoeal stools; 70.3% of the 91 campylobacters were from children under 5 years of age. Further identification of these isolates showed that 89% were Campylobacter jejuni and 10.9% were C. coli, and a high level of resistance to erythromycin was observed among them. Concomitant isolation of Salmonella species or Shigella species was achieved in eight of the Campylobacter-infected patients. Campylobacter enteritis occurred throughout the year, with the highest isolation rate being recorded in September.

Serotype distribution and antimicrobial resistance of Shigella isolates in Singapore

Serogrouping of 506 Shigella strains isolated in Singapore from 1986 to 1990 showed that Shigella flexneri (60.3%) was the most common, followed by S. sonnei (33.6%), S. boydii (3.2%) and S. dysenteriae (3%). Of the 23 Shigella serotypes identified, the predominant ones were S. flexneri types 2a and 1b, S. boydii types 1 and 5, and S. dysenteriae types 1 and 3. More than 80% of the Shigella species were resistant to at least one antimicrobial drug, and the incidence of multiresistance was particularly high in S. flexneri strains. Due to the high incidence of antimicrobial resistance, the susceptibility pattern of Shigella strains should be determined for treatment purposes.

Typhoid fever in Singapore: a review of 370 cases

The medical records of 370 patients treated for typhoid fever between 1986 and 1988 at the Communicable Disease Centre, Singapore, were reviewed. The disease was generally mild. There was no mortality. Fever was found in 98.4% of patients on admission and diarrhoea in 21%. Cough was predominantly a symptom of children and occurred in 7.1% of patients aged below 15 years. Other symptoms were uncommon. Hepatomegaly was found in 71% and splenomegaly in 47%. Leucopenia was not a helpful diagnostic marker. Chloramphenicol was the drug of choice. The relapse rate was 5.4% and the convalescent and temporary carrier rates 11.6%. The risk of developing the carrier state was significantly higher among patients who were afebrile on admission compared with those who were febrile (P less than 0.001); it was also higher in patients treated with ampicillin as compared to those treated with chloramphenicol (P less than 0.001, chi 2 = 22.7, odds ratio = 5.25, 95% confidence limits: 2.46 and 11.29). The role of ampicillin as a first line treatment for acute typhoid fever may need further re-evaluation.

[Effect of shift interval for the clinical nurse with respect to circadian rhythm]

Circadian rhythm is entrained in the 24-hour time interval by periodic factors in the environment, known as zeitgeber. But most rotating work schedules are outside the range of the entrainment of the pacemaker timing the human circadian sleep-wake cycle. It has been postulated that physiological and emotional disturbances occur in most human functions when the circadian rhythm is disturbed. So application of circadian principles to the design of shift schedules can aid in maintaining the temporal integrity of the circadian system and thereby minimize for the shift worker any detrimental consequences of circadian disruption. This study was a quasi-experimental study to test the effect of shift intervals for the clinical nurse on the circadian rhythm. Twenty nurses newly employed in general units of two hospitals were selected as an experimental group and twelve college nursing students as a control group. Both groups were selected according to an established criteria using a purposive sampling technique. Ten subjects were assigned to a weekly shift group and another ten to a biweekly shift group engaged in a semi-continuous shift schedule (sunday off) with a backward direction; that is, morning-evening-night shift. The control group worked a morning shift for 42 days. Oral temperature rhythm, waking time, sleep-wake cycle, fatigue, and mental performance were measured during the experimental period. The data collection period was from April 30, 1990 to June 10, 1990. MANOVA, paired t-test, ANOVA, and Student Newman Keuls method were used for statistical analysis. The results are summarized as follows. 1. Phase delay in the acrophase of temperature rhythm was shown according to the backward rotating shift. A complete adaptation to work on the night shift was achieved between the sixth and ninth day of the night shift. 2. There was no difference in either waking time or sleep-wake cycle according to the duration of the working day for every shift group. Significant difference was found in the waking time and the sleep-wake cycle for subjects on the morning, evening, and night shift in both of the shift groups (weekly shift group: lambda = 0.121, p less than 0.01, lambda = 0.112, p less than 0.01, biweekly shift group: lambda = 0.116, p less than 0.01, lambda = 0.084, p less than 0.01). 3. There was no difference in fatigue between the first working day and the last working day for the control group and for the biweekly shift group.(ABSTRACT TRUNCATED AT 400 WORDS)

Sodium salicylate sensitivity in an asthmatic patient with aspirin sensitivity

Non-acetylated salicylates have been recommended for use as alternatives to nonsteroidal anti-inflammatory drugs (NSAIDs) in aspirin and/or tartrazine-sensitive patients. We experienced a case of an aspirin-sensitive asthmatic patient who developed a broncho-obstructive reaction after taking 100 mg of sodium salicylate. The result of this study suggests that sodium salicylate may cross-react with aspirin in aspirin-and tartrazine-sensitive patients.

[A study on the development of standardized nursing care plans for computerized nursing service]

A central issue in the development of nursing practice is to describe the phenomenon with which nursing is concerned. To identify the health problems which can be diagnosed and managed by the nurse is the first step to organize and ensure the development of nursing science. Therefore the academic world has been discussing the application of the nursing diagnosis in nursing practice as a means of improving quality of care. The objectives of this study were to develop a standardized nursing care plan for ten selected nursing diagnoses to form a database for computerized nursing service. The research approach used in the study was (1) the selection of the ten nursing diagnoses which occur most frequently on medical-surgical wards, (2) the development of a standardized nursing care plan for the ten selected nursing diagnoses, (3) application of the plan to hospitalized patients and evaluation of the content validity by the nurses, and (4) evaluation of the clinical effects after the use of the standardized nursing care plans. The subjects were 56 nurses and 395 hospitalized patients on two medical and two surgical unit. The results of this study were as follows: 1) The ten selected nursing diagnoses for the development of the standardized nursing care plans were "PAIN, SLEEP DISTURBANCE, ALTERED HEALTH MAINTENANCE, ALTERATION IN NUTRITION, ANXIETY, CONSTIPATION, ALTERED PATTERNS OF URINARY ELIMINATION, DISTURBANCE IN BODY IMAGE, POTENTIAL FOR ACTIVITY INTOLERANCE AND ACTIVITY INTOLERANCE". 2. The developed standardized nursing care plans included the nursing diagnosis, definition, defining characteristics, etiologic or related factors that contribute to the condition, recording pattern, desired outcomes and nursing orders (nursing interventions). 3. The plan was used with hospitalized patients on medical-surgical wards to test for content validity. The patient's satisfaction with the nursing care and nurses' job satisfaction were investigated to evaluate the clinical effects after the use of the standardized nursing care plans. A comparison of patient satisfaction with nursing care before and after the introduction of the standardized nursing care plans showed a statistically significant higher level of satisfaction with the standardized care plans. There was no difference in the level of job satisfaction expressed by the nursing staff before and after the standardized nursing care plans were introduced. However, when opinions about the use of the standardized nursing care plans were examined it was found that there was a positive effect on clarity in defining the nursing problems, determining nursing cost, more feasible goal setting, effective and systematic nursing records and indications for nursing research.(ABSTRACT TRUNCATED AT 400 WORDS)

[A study on differences of opinion on health care care programs among physicians, nurses, non-medical personnel and patients]

The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is: First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to try out the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9, 1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups--nurses, non-medical personnel and patients--gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, reveals that the physicians were least positive for the effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients (who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer.(ABSTRACT TRUNCATED AT 400 WORDS)

[A study on the nurse's response for the clinical application of nursing diagnosis]

Although the usefulness and importance of clinical application of nursing diagnosis are well recognized by the academic circle, it is not yet generally practiced. In order to provide data for establishing a policy for clinical nursing diagnosis; a study was made at a seminar, sponsored by the Department of nursing, Severance Hospital, with participation of 190 nurses from 33 hospitals. The objective of the study was to find out: 1) if the nurses agree with the academic community in recognizing the benefits and problems of clinical application of nursing diagnosis; 2) how the nurses evaluate their ability to carry out nursing diagnosis; and 3) if educational programs would help enhance ability of nursing diagnosis among nurses. The summary of findings by the study is as follows: 1. While all nurses responded positively on the question of benefits improving science and quality of nursing, thus elevating credibility and position of nurses, some expressed concern on the practicality of the system in setting up nursing objectiveness, confirming the nursing problems and utilizing patient information. For the 20 questions and the scale of 1-5, the lowest average score was 3.223 and the highest 4.066. 2. The study attempted to find out the opinion of the nurses on the problems that would make difficult to adopt the nursing diagnosis in clinics. The result of the study indicates the nurses believe the major problems are the fact that the subject of nursing diagnosis are not well defined and that the form sheets do not match with the ones that are currently being used. However, comparing it with the result of the previous study on the same question (inadequate manpower and insufficient time allocated for the job were two major problems pointed out then). It can be said that the opinion of the nurses studied this time was much more positive and it suggests that they believe the system can be adopted without increasing manpower and only by giving additional training and by adjusting the format of nursing record sheets. It suggests that the future for adopting a clinical nursing diagnosis is very bright. 3. As the most urgent problem to be solved for adopting clinical nursing diagnosis, 38. 5% responded that it was "education of nurses", and 34.2% responded that it was "staffing adequate number of nurses". 4. For the 10 questions asked for self-evaluation of ability to adopt the system, with the scale of 1-5, average score was lower than 3.(ABSTRACT TRUNCATED AT 400 WORDS)

Evaluation of the GO Slide, a growth transport system for the laboratory diagnosis of gonorrhoea

A growth transport system, the GO Slide (Roche Diagnostica), for the isolation of Neisseria gonorrhoeae from clinical specimens was evaluated. This system was compared with culture on chocolate agar (CA) and modified Thayer-Martin (MTM) agar, and Gram-stained smear for the diagnosis of gonorrhoea. Of 94 urethral specimens from symptomatic males, 77.7% were positive on MTM, 80.9% were positive on CA and Gram stain, and 81.9% were positive on GO Slide. Of the 77 isolates, 26.0% were penicillinase producers, 12.3% belonged to WI serogroup and 87.7% belonged to WII/III serogroup. The ease of transportation and the easy examination of growth on agar surfaces make the GO Slide an attractive system. It would be particularly useful for general practitioners without culture facilities to transport specimens to the laboratory for the isolation of N. gonorrhoeae.