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Introduction: Inappropriate attendances (IAs) at emergency departments (ED) are contributed by patients with mild or moderate medical conditions that can be effectively managed by primary care physicians. IAs strain limited ED resources and have an adverse impact on efficiency. This study aimed to identify factors associated with IA at the ED of a tertiary hospital in Singapore., Methods: We conducted a retrospective cohort study of all eligible visits to the aforementioned ED between 1 January 2015 and 31 December 2015. The appropriateness of each attendance was estimated using criteria based on investigations or procedures that were performed on the attendee and the discharge type of that attendance. IAs were then compared against appropriate attendances in these areas: attendee demographics; referral source; time of ED visit; proximity to ED and 24-hour general practitioner clinics; and history of ED visits in 2014. Multivariate analysis was performed on significant variables associated with IAs., Results: Among 120,606 attendances, 11,631 (9.6%) were IAs. Multivariate analysis showed that gender, ethnicity, referral source, time of ED visit, nationality and history of frequent visits to the ED were factors associated with IAs. Moreover, the odds of IA were found to be higher among attendees who were younger, were self-referred, or had at least one IA in 2014., Conclusion: This study identified subgroups in the population who were more likely to contribute to IAs at the ED. These findings offer relevant insights into future research directions and strategies that might potentially reduce avoidable IAs., (Copyright: © Singapore Medical Association.)

This study was based on anti-toxoplasma serotitres obtained from 80 normal healthy adults and 103 consecutive patients with anterior, posterior and panuveitis over a 42 month period. Twelve out of 80 (15%) normal healthy sera were found to have low titres (1:64 to 1:256), while 3 (3.8%) had high titres (1:1024 or higher). The distribution of serotitres in patients with clinical toxoplasmosis was significantly different from the population sample (p less than 0.001, chi-squared test). Similarly, the distribution of serotitres in patients with posterior uveitis (of which 28 out of 54 were clinically ocular toxoplasmosis) having serotitres of 1:1024 or greater, was found to be significantly different from the normal population (p less than 0.001, Chi-squared test), but not statistically different from those with clinical ocular toxoplasmosis. Hence, anti-toxoplasma serotitre is useful as a diagnostic screening tool only in patients with posterior uveitis. It is also useful in confirming cases of suspected clinically positive ocular toxoplasmosis in our local population.

Serum specimens for anti-nuclear fluorescence tests are routinely received in our laboratory. Four specimens were spotted to be negative for anti-nuclear fluorescence but positive for fluorescence characteristic of that caused by anti-golgi antibodies. (a) Patient A had acute glomerulonephritis; (b) Patient B had acute viral hepatitis; (c) Patient C had deep vein thrombosis; and (d) Patient D had non-Hodgkin's lymphoma. The relevance and possible aetiology of anti-golgi antibodies are also discussed.

The aims of this study are to determine for the 3 main ethnic groups in Singapore: a) the ABO phenotype distribution in 1987 b) the A, B and O gene frequencies c) the proportion of A and B group individuals who are homozygous using (i) temporal studies (trial & error) (ii) the derived A and B gene frequencies This paper presents the method of study and the results obtained using a sample of 39,019 blood donors in 1987. The opportunity has also been taken to compare the data derived in this study with that quoted in 2 previous studies.

The P blood-group system was discovered by Landsteiner and Levine in 1927. This study delineates: a) The ethnic group specific distribution patterns of the P1 blood group antigen in the population of Singapore. b) The occurrence rate of the anti-P1 antibody in the same population. In the blood donor population, the estimated incidence of the P1-negative phenotype was calculated to be 75%. Though the percentage of P1-negative individuals among the Chinese did not differ significantly from that for the Malays, it was significantly higher than that for the Indians (P less than 0.01). The weighted average incidence of anti-P1 in the blood-donor population over the period 1982-1987 was calculated to be 9.14 per 100,000. For the patients, the average incidence of the anti-P1 antibody was calculated to be about 13.9 per 100,000 patients. The Malays were noted to have the highest incidence of anti-P1 antibody despite the occurrence of a higher proportion of P1-negatives among the Chinese.

The purpose of this retrospective study is to delineate: a) The ethnic group specific distribution patterns of the various Lewis phenotypes in our population in Singapore. b) The occurrence rates of the various anti-Lewis antibodies in our population. The approximate frequencies of the Lewis A-B-, Lewis A-B+ and Lewis A + B- phenotypes in the blood-donor population were estimated to be about 10%, 48% and 42% respectively. It was evident that frequency of the Lewis A-B- phenotype was highest among the Malays, being almost 3 times more frequent than it was among the Chinese (P less than 0.01). The anti-Lewis antibodies were noted to be the commonest irregular antibodies seen in our blood donor population, with an occurrence rate of about 127 per 100,000. Likewise, from 1982 to 1987, the anti-Lewis antibodies were also noted to be the most frequently encountered antibodies in our patient population, accounting for nearly 60% of all cases. Although the Malays comprised only about 15% of the Singaporean population, they accounted for as much as 42.9% of all patients with anti-Lewis antibodies. Similarly, out of all 76 blood donors in 1987 with anti-Lewis antibodies, 50% were found to be Malays although they comprised only 14.28% of the donor population. It was also interesting to note that a sizeable proportion of all patients with anti-Lewis antibodies were pregnant women with or without obstetric complications.