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Background The incidence of skin cancers has been increasing in Singapore, owing to the country's location near the equator and its ageing population. Topical photodynamic therapy ( PDT) is a treatment method employing light and a topical photosensitizer to treat actinic keratosis ( AK). Most published data to date on PDT have been drawn from studies of patient with Fitzpatrick skin phototypes I and II. Aim To evaluate the effectiveness of PDT in the treatment of AK in patients with skin phototype IV in Singapore. Methods This was a retrospective analysis of 13 East Asian patients with AK treated with PDT at the National Skin Centre, Singapore, from 2006 to 2013. Results The overall clearance rate of AK at 3 months was 81.8% (9 of 11 patients; the other 2 were lost to follow-up). Mild to moderate pain during therapy was a common adverse event. Conclusions PDT is a useful treatment method for AK in East Asian patients with skin phototype IV. Further larger prospective studies will be needed to evaluate its overall efficacy in East Asian patients. [ABSTRACT FROM AUTHOR]

Background The primary purpose of this study was to report on an evaluation of the perceptions and beliefs of service providers towards family-centred practices in 11 early intervention programmes for infants and young children in Singapore. Methods The Measure of Processes of Care for Service Providers (MPOC-SP) and Measure of Beliefs about Participation in Family-Centred Service (MBP-FCS) were administered to 213 service providers made up of teachers, therapists, psychologists and social workers providing centre-based therapy to children with special needs who were below the age of 6 years. Results Exploratory factor analyses were performed with both scales. Nineteen of the 27 MPOC-SP items were retained and supported the original four-factor structure model. The exploratory factor analyses on MBP-FCS provided a less satisfactory outcome. Fourteen of the 28 items were retained and these loaded onto four factors. The two factors relating to Beliefs about benefits of FCS and Beliefs about the absence of negative outcomes from FCS failed to emerge as separate factors. Further multiple regressions indicated that more direct work with families and positive self-efficacy in implementing FCS contributed significantly to explaining service providers' positive perception towards family-centred practice in service delivery. Conclusions This is the first time MPOC-SP and MBP-FCS were administered to a population in an Asian context. While MBP-FCS would benefit from further development work on its construct, MPOC-SP offered important insights into service providers' perspectives about family-centred practices that would have useful implications for professional and service development. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a systemic noncaseating granulomatous disorder of unknown origin involving multiple organ systems. There has been no report so far to describe the epidemiological pattern of cutaneous involvement in sarcoidosis in South-East Asia with diverse ethnic groups. A retrospective study examining the clinicopathological features of all patients diagnosed with sarcoidosis at a tertiary dermatology centre in Singapore from 1980 to 2003 was conducted. Cutaneous sarcoidosis was diagnosed in 25 patients: 13 were Indian, 11 were Chinese and one was Eurasian. Cutaneous manifestations included papules, nodules, plaques and scarring alopecia. Extracutaneous involvement of lymph nodes (four patients), lungs (eight patients) and eyes (two patients) was seen. Eight patients had abnormal chest radiographic findings. Histopathological examination of skin lesions revealed noncaseating, epithelioid granulomatous infiltration in the dermis without evidence of mycobacterial infection, deep fungal infection or polarizable birefringent material. Treatment modalities included corticosteroids, hydroxychloroquine, isotretinoin, methotrexate and surgical excision. Five patients had complete resolution of the cutaneous lesions. Cutaneous sarcoidosis is rare in Asia and indeed in Singapore. Extracutaneous involvement is not uncommon and a thorough clinical evaluation should be undertaken. [ABSTRACT FROM AUTHOR]

Background: The focus of medicine is shifting from treatment to preventive care. The expression of biomarkers of dementia and Alzheimer's disease (AD) appear decades before the onset of observable symptoms, and evidence has emerged supporting pharmacological and non-pharmacological interventions to treat modifiable risk factors of dementia. However, there is limited research on the epidemiology, clinical phenotypes, and underlying pathobiology of cognitive diseases in Asian populations., Objectives: The objectives of the Biomarkers and Cognition Study, Singapore(BIOCIS) are to characterize the underlying pathobiology of Cognitive Impairment through a longitudinal study incorporating fluid biomarker profiles, neuroimaging, neuropsychological and clinical outcomes in a multi-ethnic Southeast Asian population., Design, Setting, Participants: BIOCIS is a 5-year longitudinal study where participants are assessed annually. 2500 participants aged 30 to 95 will be recruited from the community in Singapore. To investigate how pathology presents with or without minimal clinical symptoms and vice versa, CI and unimpaired individuals will be recruited. Participants will undergo assessments to characterise biomarkers of dementia through neuroimaging, fluid biomarkers, cognitive assessments, behavioural and lifestyle profiles, retinal scans and microbiome indicators., Results: Since commencement of recruitment in February 2022, 1148 participants have been enrolled, comprising 1012 Chinese, 62 Indian, and 35 Malay individuals. Mean age and education is 61.32 years and 14.34 years respectively with 39.8% males. 47.9 % of the cohort are employed and 32.06% have a family history of dementia. The prevalence of cerebral small vessel disease is 90.2% with a mean modified Fazekas white matter hyperintensity score of 4.1., Conclusion: The BIOCIS cohort will help identify novel biomarkers, pathological trajectories, epidemiology of dementia, and reversible risk factors in a Southeast Asian population. Completion of BIOCIS longitudinal data could provide insights into risk-stratification of Asians populations, and potentially inform public healthcare and precision medicine for better patient outcomes in the prevention of Alzheimer's disease and dementia., Competing Interests: On behalf of all authors, the corresponding author states that there is no conflict of interest.

Purpose: To describe the corneal and anterior segment determinants of posterior corneal arc length (PCAL) and posterior corneal curvature (PCC)., Methods: Cross-sectional, population-based study of 1069 subjects (1069 eyes) aged 40-80 years, from three major Asian ethnic groups. All underwent anterior segment optical coherence tomography imaging and analysis with Zhongshan Angle Assessment Program. Our main outcome measures were determinants of PCAL and PCC using adjusted, multivariate linear regression analysis, adjusted for confounders to obtain the estimated marginal means (EMM) with standard error (SE)., Results: The overall mean (± SD) of PCC was: 6.51±0.39 mm; and PCAL was: 12.52±0.59 mm. Malays had a relatively longer PCAL (EMM = 12.74 mm, SE = 0.04 mm) than Chinese (EMM = 12.48 mm, SE = 0.03 mm, P<0.001), and Indians (EMM = 12.42 mm, SE = 0.03 mm, P<0.001). Anterior segment parameters had weak-moderate correlations with PCAL, which included: anterior chamber depth (ACD) (r = 0.55, P<0.001), PCC (r = 0.27, P<0.001), anterior corneal curvature (ACC) (r = 0.14, P<0.001) and central corneal thickness (CCT) (r = -0.07, P = 0.023). In multivariate analysis, anterior segment parameters explained only 37.6% of the variance of PCAL, with ACD being the most important determinant (partial R2  = 0.300; P<0.001). The determinants of PCC included ACC, PCAL and CCT (explaining 72.1% variation of PCC), with ACC being the most important determinant (partial R2  = 0.683; P<0.001)., Conclusion: There was moderate correlation of PCAL with ACD, but anterior segment parameters accounted for only a small proportion of the variation in PCAL. The significant differences in PCAL and PCC amongst different Asian ethnic groups suggests that there is a need to consider this factor when planning for anterior segment surgeries such as endothelial keratoplasty.

Purpose: We provided normative data of corneal and anterior segment dimensions, and a novel parameter, posterior corneal arc length (PCAL), in an adult Malay population., Methods: The current analysis is a substudy of the Singapore Malay Eye Study (SiMES), a population-based, cross-sectional study of urban Malay adults aged 40 to 80. Subjects underwent ophthalmic and systemic examination, including imaging with anterior segment optical coherence tomography (AS-OCT). Ocular parameters subsequently were measured with the Zhongshan Assessment Program (ZAP), and included anterior chamber depth (ACD), central corneal thickness (CCT), anterior and posterior corneal curvature (ACC and PCC, respectively), and PCAL, which is a novel parameter defined as the arc-distance of the posterior corneal border between the scleral spurs. Age- and sex-adjusted analyses, and multivariate analyses were performed to determine correlations of PCAL with other ocular and systemic components., Results: We studied 237 subjects, among whom the mean age was 56.6 ± 10.4 years and 50.2% were women. Ocular parameters (mean ± SD) included central ACD 2.78 ± 0.34 mm, CCT 550.23 ± 37.12 mm, ACC 7.43 ± 0.37 mm, PCC 6.75 ± 0.37 mm, and PCAL 13.95 ± 0.51 mm. There was moderate correlation between PCAL and ACD (r = 0.476, P < 0.001), but poor correlation with PCC (r = 0.243, P < 0.001), ACC (r = 0.251, P < 0.001), and systemic parameters, like age, body mass index (BMI), blood pressure, blood glucose levels, hemoglobin A1c (HbA1c), and refractive parameters. Multivariate analysis showed a significant association between PCAL and ACD (P < 0.001), PCC (P < 0.001), and height (P < 0.05)., Conclusions: Our study, to our knowledge, provides the largest baseline anterior segment parameters in an adult Asian Malay population. PCAL correlated moderately with ACD. These data are applicable clinically for assessment and surgical management of patients requiring anterior segment or corneal surgery.

Purpose: To report normative results of anterior segment and corneal biometric parameters and their associations in ethnic South Asian Indian adults., Methods: The Singapore Indian Eye Study is a cross-sectional, population-based study of ethnic South Asian Indians ranging in age from 40 to 80 years. Subjects underwent ophthalmic and systemic examination, including imaging with anterior segment optical coherence tomography. Parameters were derived using the Zhongshan Assessment Program: anterior chamber depth (ACD), central corneal thickness (CCT), and anterior and posterior corneal curvatures (ACC and PCC). Posterior corneal arc length (PCAL) is a novel parameter defined as the arc distance between scleral spurs on the posterior border of the cornea. The authors studied correlations between PCAL with various anterior segment parameters and systemic parameters using univariate and multivariate analyses., Results: The authors studied 438 subjects whose mean age was 58.5 ± 9.9 years and of whom 50.7% were male. Parameters (mean ± SD) included central ACD 2.72 ± 0.37 mm, PCC 6.45 ± 0.35 mm, CCT 561.4 ± 34.1 μm, ACC 7.17 ± 0.35 mm, and PCAL 13.85 ± 0.54 mm. The authors found significant correlations between PCAL and ACD (r = 0.46, P < 0.001), PCC (r = 0.31, P < 0.001), and ACC (r = 0.16, P < 0.001), whereas they found poor correlations between PCAL and age, height, weight, blood pressure, and glucose levels. Multivariate analysis showed a significant association between PCAL and both ACD (P < 0.001) and PCC (P < 0.001)., Conclusions: The authors have described useful baseline anterior segment parameters from this population-based study of ethnic South Indian adults. These data may be useful for corneal and anterior segment procedures such as endothelial keratoplasty and anterior chamber intraocular lens insertion.

Introduction: This study aims to determine the epidemiology of viral warts in children seen at a tertiary referral centre and the treatments used., Materials and Methods: This is a retrospective study of viral warts in children aged 12 years and below seen at the National Skin Centre in the year 2000., Results: There were 302 cases of viral warts, 187 (61.9%) in boys and 115 (38.1%) in girls. The greatest number was seen at age 12 and none were noted in those below 1 year of age. The racial breakdown was as follows: 69.9% Chinese, 13.9% Malays, 11.3% Indians and 4.9% of other ethnic groups. Treatment with liquid nitrogen was used most commonly in 267 (88.4%) cases, with a clearance rate of 48.3%. Electrocautery was used in 11 cases with complete clearance in 8 cases., Conclusion: Viral warts are common in children, but uncommon in infants. There is no difference in distribution of warts among the races in Singapore. Liquid nitrogen and electrocautery are effective treatments of viral warts in children.

A template based computerized medical record system known as the Emergency Medicine Department System (EMDS) was installed in the emergency department of the National University Hospital, Singapore, replacing handwritten records. A study was carried out to show how the implementation of the EMDS improved the quality of medical records. A retrospective review of old manual records and the ones generated by the EMDS was done by means of a scoring system. The raw scores represent the amount of information captured. The calculated means of scores were then used to compare the records. It was found that EMDS improves the quantity of data capture over the old records in all sections compared. This was seen regardless of the experience of the user. The use of a non-structured generic template results in less data captured compared with a structured symptom-specific template. The design of questions has a great influence in that a double-choice question captures more data than single-choice questions. Building in 'locking' or enforcement mechanisms in the EMDS also helped achieve almost full capture of critical information, such as examination time.