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Fulminant type 1 diabetes (FT1D) is a unique subtype of type 1 diabetes, characterized by acute absolute insulin deficiency, severe ketosis, and increased risk of hypoglycemia, glycemic variability and microvascular complications. Seven people with FT1D were identified from two tertiary centers in Singapore. Six were Chinese, the mean age was 35 years and all were lean (mean body mass index 20.3 kg/m2). All presented with diabetes ketosis or ketoacidosis and low C‐peptide. All but one had low glutamic acid decarboxylase antibodies. Nearly half had a missed/delayed diagnosis of FT1D. Three had frequent hypoglycemia, which improved after transition to continuous subcutaneous insulin infusion therapy. Individuals with FT1D experience unique diagnostic and management challenges associated with rapid absolute insulin deficiency. Greater awareness about this clinical entity is required. [ABSTRACT FROM AUTHOR]

Taxila haquinus haquinus (the Harlequin) is a moderately rare species in the butterfly family Riodinidae which occurs in Singapore. There is a general lack of information on the autecology of Riodinidae globally, including this species. A series of observations and experiments was therefore conducted to investigate the behavior and diet of larvae and adults of the Harlequin in its natural habitat and in captivity, to provide insights into its autecology and to aid in the design of recovery programmes targeted at this species. We found that resting was the main activity performed by adults of both sexes, with this behavior perhaps partly functioning in thermoregulation. Males spent a larger proportion of their time feeding and in flight, while females 'hopped' more than males, in which the butterfly performed a quick, short flight with a maximum duration of 3 seconds, and then alighted on the surface of a plant. Behavioral differences observed between sexes may reflect the priorities for males to search for mates and females to search for suitable oviposition sites. This study is the first to document a female Harlequin ovipositing on a non-host plant species and an interaction between a male and a female in their natural habitat, possibly an aspect of courtship behavior. Adult Harlequin were not recorded feeding on flowers but they were observed extending their proboscis to touch the leaf surface of multiple plant species, although it is not clear whether this behavior represents feeding. Caterpillars, regardless of their instars and the age of the leaf, appeared to be less receptive to feeding on non-host plant species belonging to the same plant family as the known host plant. During a leaf diet test, many individuals died between one and seven days following a switch to non-host plant species. Caterpillars that fed and pupated on non-host plant species also failed to eclose successfully as adults. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to evaluate the feasibility of anaerobic co-digestion of brown water (BW) [feces-without-urine] and food waste (FW) in decentralized, source-separation-based sanitation concept. An effort has been made to separate the yellow water (urine) and brown water from the source (using no-mix toilet) primarily to facilitate further treatment, resource recovery and utilization. Batch assay analytical results indicated that anaerobic co-digestion [BW+FW] showed higher methane yield (0.54–0.59L CH4/gVSadded) than BW or FW as a sole substrate. Anaerobic co-digestion was performed in the semi-continuously fed laboratory scale reactors viz. two-phase continuous stirred-tank reactor (CSTR) and single-stage sequencing-batch operational mode reactor (SeqBR). Initial 120d of operation shows that SeqBR performed better in terms of organic matter removal and maximum methane production. At steady-state, CODs, CODt, VS removals of 92.0±3.0, 76.7±5.1 and 75.7±6.6% were achieved for SeqBR at 16d HRT, respectively. This corresponds to an OLR of 2–3gCOD/Ld and methane yield of about 0.41L CH4/gVSadded. Good buffering capacity did not lead to accumulation of VFA, showing better process stability of SeqBR at higher loading rates. The positive findings show the great potential of applying anaerobic co-digestion of BW+FW for energy production and waste management. In addition, daily flush water consumption is reduced up to 80%. Decentralized, source-separation-based sanitation concept is expected to provide a practical solution for those countries experiencing rapid urbanization and water shortage issues, for instance Singapore. [Copyright &y& Elsevier]

Thermal stress drives the bleaching of reef corals, during which the endosymbiotic relationship between Symbiodiniaceae microalgae and the host breaks down. The endosymbiont communities are known to shift in response to environmental disturbances, but how they respond within and between colonies during and following bleaching events remains unclear. In 2016, a major global-scale bleaching event hit countless tropical reefs. Here, we investigate the relative abundances of Cladocopium LaJeunesse & H.J.Jeong, 2018 and Durusdinium LaJeunesse, 2018 within and among Pachyseris speciosa colonies in equatorial Singapore that are known to host both these Symbiodiniaceae clades. Bleached and unbleached tissues from bleaching colonies, as well as healthy colonies, during and following the bleaching event were sampled and analyzed for comparison. The nuclear ribosomal internal transcribed spacer (ITS) regions were separately amplified and quantified using a SYBR Green-based quantitative polymerase chain reaction (qPCR) method and Illumina high-throughput sequencing. We found Cladocopium to be highly abundant relative to Durusdinium. The relative abundance of Durusdinium, known to be thermally tolerant, was highest in post-bleaching healthy colonies, while bleached and unbleached tissues from bleaching colonies as well as tissue from healthy colonies during the event had depressed proportions of Durusdinium. Given the importance of Durusdinium for thermal tolerance and stress response, it is surprising that bleached tissue showed limited change over healthy tissue during the bleaching event. Moreover, colonies were invariably dominated by Cladocopium during bleaching, but a minority of colonies were Durusdinium-dominant during non-bleaching times. The detailed characterization of Symbiodiniaceae in specific colonies during stress and recovery will provide insights into this crucial symbiosis, with implications for their responses during major bleaching events. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported positive associations between out-of-hospital cardiac arrest (OHCA) and air pollutant concentrations, but there are inconsistencies across studies. We aimed to investigate the association between pollutant concentrations and the risk of OHCA in Singapore., Methods: We did a time series analysis of all cases of OHCA in Singapore reported between July 1, 2010, and Dec 31, 2018, to the Pan-Asian Resuscitation Outcomes Study (PAROS), a prospective, population-based registry. Using multivariable fractional polynomial modelling, we investigated the immediate (day 0) and lagged (up to 5 days after exposure) association between 10 μg/m 3 increases in concentrations of particulate matter with a diameter of 2·5 μm or smaller (PM 2·5 ), particulate matter with a diameter of 10 μm or smaller (PM 10 ), ozone (O 3 ), nitrogen dioxide (NO 2 ), and sulphur dioxide (SO 2 ) and 1 mg/m 3 increase in carbon monoxide (CO) and relative risk (RR) of OHCA., Findings: We extracted data for 18 131 cases of OHCA. The median age of this cohort of cases was 65 years (IQR 56-80), 6484 (35·8%) were female, 11 647 (64·2%) were male, 12 270 (67·7%) were Chinese, 2873 (15·8%) were Malay, and 2010 (11·1%) were Indian. Every 10 μg/m 3 increase in PM 2·5 was associated with increased risk of OHCA (RR 1·022 [95% 1·002-1·043]) over the next 2 days, which decreased over the subsequent 3 days (3-5 days after exposure; 0·976 [0·955-0·998]). For PM 10 , O 3 , NO 2 , and SO 2 , we did not observe any associations between increased concentration and risk of OHCA on day 0 or cumulative risk over time (ie, at 0-1 days, 0-2 days, 0-3 days, 0-4 days, 0-5 days, and 3-5 days after exposure). For CO, we observed a cumulative decreased risk of OHCA across 0-5 days after exposure (0·876 [0·770-0·997]) and at days 3-5 after exposure (0·810 [0·690-0·949]). We observed effect modification of the association between increasing PM 2·5 concentration and OHCA 0-2 days after exposure by cardiac arrest rhythm (non-shockable 1·027 [1·004-1·050] vs shockable 1·002 [0·956-1·051]) and location of OHCA (at home: 1·033 [1·008-1·057] vs not at home 0·955 [0·957-1·035]). In hypothetical modelling, the number of OHCA events associated with PM 2·5 could be reduced by 8% with a 1 μg/m 3 decrease in PM 2·5 concentrations and by 30% with a 3 μg/m 3 decrease in PM 2·5 concentrations., Interpretation: Increases in PM 2·5 concentration were associated with an initial increased risk of OHCA and a subsequent reduced risk from 3-5 days after exposure, suggesting a short-term harvesting effect. A decrease in PM 2·5 concentrations could reduce population demand for emergency health services., Funding: National Medical Research Council, Singapore, under the Clinician Scientist Award, Singapore and the Singapore Translational Research Investigator Award (MOH-000982-01)., Competing Interests: Declaration of interests MEHO reports funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation programme to their Community CPR Training Centre Research Program in Norway. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The association between days with similar environmental parameters and cardiovascular events is unknown. We investigate the association between clusters of environmental parameters and acute myocardial infarction (AMI) risk in Singapore. Using k-means clustering and conditional Poisson models, we grouped calendar days from 2010 to 2015 based on rainfall, temperature, wind speed and the Pollutant Standards Index (PSI) and compared the incidence rate ratios (IRR) of AMI across the clusters using a time-stratified case-crossover design. Three distinct clusters were formed with Cluster 1 having high wind speed, Cluster 2 high rainfall, and Cluster 3 high temperature and PSI. Compared to Cluster 1, Cluster 3 had a higher AMI incidence with IRR 1.04 (95% confidence interval 1.01-1.07), but no significant difference was found between Cluster 1 and Cluster 2. Subgroup analyses showed that increased AMI incidence was significant only among those with age ≥65, male, non-smokers, non-ST elevation AMI (NSTEMI), history of hyperlipidemia and no history of ischemic heart disease, diabetes or hypertension. In conclusion, we found that AMI incidence, especially NSTEMI, is likely to be higher on days with high temperature and PSI. These findings have public health implications for AMI prevention and emergency health services delivery during the seasonal Southeast Asian transboundary haze.

In May 2019, we investigated monkeypox in a traveler from Nigeria to Singapore. The public health response included rapid identification of contacts, use of quarantine, and postexposure smallpox vaccination. No secondary cases were identified. Countries should develop surveillance systems to detect emerging infectious diseases globally.