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Pregnancy-associated venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with increased risk of maternal mortality and morbidity. This study aimed to assess potential risk factors for pregnancy-associated VTE. In this case-control study, women with pregnancy-associated VTE were identified via International Classification of Diseases codes and included if they had been objectively diagnosed with VTE during pregnancy or within six weeks postpartum, from 2004 to 2016, at KK Women's and Children's Hospital or Singapore General Hospital in Singapore. Controls, i.e. pregnant women without VTE, were selected from a prospective longitudinal study. The odds ratio (OR) for VTE was computed for a range of maternal and obstetric factors. From 2004 to 2016, 89 cases of pregnancy-associated VTE and 926 controls were identifed and analysed using logistic regression. The most significant risk factors for pregnancy-associated VTE were smoking (OR 5.44, p=0.0002) and preterm delivery (OR 5.06, p=0.023). Malay race, multiparity, non-O blood group and caesarean section, were also identified to be of higher risk. These risk factors should be useful in the development of thromboprophylaxis strategies for pregnancy and the postpartum period, especially in Singapore. [ABSTRACT FROM AUTHOR]

Background: MRSA has caused enormous burden to affected Western patients and society. However, only limited study results originated from the Asia-Pacific populations. Aim: To assess the burden of Methicillin-resistant S. aureus infections (MRSA) among patients from a large tertiary care hospital in Singapore. Methods: Retrospective study using data from the hospital discharge database to identify patients with MRSA and Methicillin-sensitive S. aureus infections (MSSA) using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes. Findings: Amongst 543,068 hospitalized patients between 2004 and 2010, 8,664(1.6%) were infected with S. Aureus, including 4,868(0.9%) with MRSA. Compared with uninfected controls, MRSA patients had longer hospital stay (geometric mean, GM, 12.2 vs. 3.0 days), higher hospitalization costs (GM, $6294.7 vs. $2295.7), higher in-hospital mortality rate (7.8% vs. 2.8%) and higher 30-day all-cause unscheduled readmission rate (36.3% vs. 23.7%, all p<0.001). The difference still existed after adjustment for age groups, gender, ethnicity, medical management, and Charlson comorbidity index. Similarly, MRSA patients had longer hospital stay, higher hospitalization costs, higher in-hospital mortality rate and 30-day all-cause unscheduled readmission rate compared with patients with MSSA. Conclusion: MRSA infection was associated with poor clinical outcomes and higher economic burden in this population. Prevention and control measures should be implemented both inside and outside the hospital setting. [ABSTRACT FROM AUTHOR]

Background: Chronic liver disease (CLD) has been suggested to be associated with venous thromboembolism (VTE) in western populations. However, little is known about the risk effects of CLD on VTE among Asians. Objective: To compute the prevalence of VTE among hospitalised Asian patients, and to evaluate the pattern and scale of risk effects of CLD on VTE occurrence. Method: Retrospective study of hospital discharge database from 2004 to 2011 to identify patients with VTE and CLD using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes. Results: Of 199904 medically managed inpatients during the 8 years, 1744 (0.9%) patients had VTE. Patients with CLD had significant higher prevalence of VTE (non-cirrhosis CLD 1.5%, cirrhosis 2.0%) than patients without CLD (0.8%, p < 0.001). In the logistic regression analyses, non-cirrhosis CLD (odds ratio, OR 1.4, 95% CI 1.2-1.7, p < 0.001) and cirrhosis (OR 1.5, 95% CI 1.2-2.0, p = 0.002) were significant predictors of VTE after adjustment for age, gender, ethnicity, hospital long stayer, cancer, infectious disease, and other comorbid conditions such as diabetic mellitus, anaemia, and cardiovascular, cerebrovascular, renal and pulmonary diseases. Conclusion: CLD, particular liver cirrhosis, increases the risks of VTE in hospitalised Asian patients. As CLD patients are perceived to be at risks of bleeding due to the prolonged clotting times and thrombocytopenia, the results of this study brings attention to opposite end of the haemostatic pendulum in patients with chronic liver disease. [ABSTRACT FROM AUTHOR]

We describe a review of human adenovirus (HAdV) infections occurring among adults in a tertiary hospital in Singapore from February to May 2013. A similar increase in cases was observed among children and military personnel during the same time period. The majority of isolates were identified as HAdV-7, likely an emerging pathogen in Asia. [ABSTRACT FROM AUTHOR]

Background: Hospital readmissions are serious and costly events, and readmission rates are considered to be an indicator of quality in health care management. Several models to identify patients at risk of unplanned readmissions have been developed in Western countries, but little is known about their performance in other countries. This paper reports the possible utility of one such model developed in Canada, the LACE index, in patients in a tertiary hospital in Singapore. Methods: We used administrative data from Singapore General Hospital for patients admitted between 1st January 2006 and 31st December 2010. Data such as demographic and clinical data including disease codes were extracted. The patient cohort was divided into two groups with a LACE index of 10 as the cutoff. Multivariate logistic regression analysis models were used to compare the outcomes between the two groups of patients with adjustment for age, sex, ethnicity, year of discharge, intensive care unit admission, and admission ward class. Results: Overall, 127 550 patients were eligible for analysis. Patients with a LACE index ≥ 10 had a higher risk of 30-day unplanned readmission after index discharge (odds ratio [OR]: 4.37; 95% confidence interval [CI]: 4.18-4.57). After adjustment, the risk remained significant (OR: 4.88; 95% CI: CI 4.57-5.22). The C-statistic for the adjusted model was 0.70 (P < 0.001). Similar results were shown for 90-day unplanned readmission and emergency visits after the same adjustment. Conclusion: The use of the LACE index may have significant application in identifying medical patients at high risk of readmission and visits to the Emergency Department in Singapore. [ABSTRACT FROM AUTHOR]

Objectives: Pregnancy-associated venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with increased risk of maternal mortality and morbidity. This study aimed to assess potential risk factors for pregnancy-associated VTE., Methods: In this case-control study, women with pregnancy-associated VTE were identified via International Classification of Diseases codes and included if they had been objectively diagnosed with VTE during pregnancy or within six weeks postpartum, from 2004 to 2016, at KK Women's and Children's Hospital or Singapore General Hospital in Singapore. Controls, i.e. pregnant women without VTE, were selected from a prospective longitudinal study. The odds ratio (OR) for VTE was computed for a range of maternal and obstetric factors., Results and Conclusions: From 2004 to 2016, 89 cases of pregnancy-associated VTE and 926 controls were identifed and analysed using logistic regression. The most significant risk factors for pregnancy-associated VTE were smoking (OR 5.44, p=0.0002) and preterm delivery (OR 5.06, p=0.023). Malay race, multiparity, non-O blood group and caesarean section, were also identified to be of higher risk. These risk factors should be useful in the development of thromboprophylaxis strategies for pregnancy and the postpartum period, especially in Singapore., (© 2020 Sandra Lynn Jaya-Bodestyne et al., published by De Gruyter, Berlin/Boston.)