Book Review: An Illustrious Heritage: The History of Tan Tock Seng and Family

This thesis is an examination of the reconciliation of “modernity” and “tradition” in healthcare in Singapore between the 1890s and 1911, amid the advent of infectious diseases. The impact of infectious diseases redefined medical practices not only in colonial Singapore, but also across the expansive Chinese medical network. These diseases prompted a re-evaluation of medicine and medical practices, reshaping the landscape of healthcare in multiple regions. In colonial Singapore, there was a notable shift towards reconciling "modern" Western medical systems with "traditional" Chinese medical practices in response to evolving healthcare needs. This reconciliation of Chinese and Western medical systems was exhibited in many spaces, one of which was in the Kwong Wai Shiu Free Hospital (KWSFH). Established in 1911, the KWSFH stands out as the first modern Chinese hospital in Singapore to offer both Western and Chinese medicine. The establishment of the hospital challenges prevailing narratives of contention between medical systems, revealing a collaborative spirit amid local healthcare and broader Cantonese medical developments. Hence, this thesis seeks to locate the place of KWSFH within the shifting healthcare landscape of colonial Singapore and the broader Cantonese diaspora by examining the circumstances leading to its establishment.

Risk factors of lung cancer unrelated to smoking are not well-studied, especially among women. Family history has been shown to play a role in predisposing individuals to lung cancer, but this relationship has not been investigated in the Southeast Asian population. A total of 1159 women were recruited in a case–control study conducted in public hospitals in Singapore from 2005 to 2008. After excluding participants with incomplete family history information, 374 cases and 785 controls remained in the final analysis. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using logistic regression, adjusting for potential confounders. Overall, family history of lung cancer was associated with a higher risk for lung cancer (aOR 2.08, 95% CI 1.25–3.47). When stratified by smoking status, a significant association was observed among never-smokers (aOR 2.78, 95% CI 1.57–4.90). Further stratification by fruit consumption identified a significant association between family history of lung cancer and higher risk of lung cancer among never-smokers who had low fruit consumption (aOR 3.09, 95% CI 1.37–7.01). Our findings suggest that family history of lung cancer is a significant risk factor for lung cancer in Singaporean Chinese women, especially among never-smokers.

With completion of the human genome sequence, expectations are rising that a detailed catalogue will soon be available of all important common genetic susceptibility variants for human diseases, including coronary heart disease (CHD) and related atherosclerotic cardiovascular disease (CVD).1 In light of this seminal event in medical research, it is curious that the family history of CHD has not been accorded a more central role in risk prediction and disease prevention by clinicians and public health professionals. A positive family history of CHD is present in the majority of cases of premature-onset CHD.2 In cases of familial hypercholesterolemia and other rare forms of premature-onset CVD, CHD clearly segregates in a mendelian fashion. For most cases of premature-onset CHD, the mode of genetic transmission in families is less clear. Although the family history of CHD has been considered a putative risk factor for decades, it has not been incorporated along with other established risk factors such as hyperlipidemia, hypertension, and cigarette smoking in some widely applied multivariable risk algorithms,3 though other risk algorithms do incorporate family history information.4 See p 2150 This cautious approach to widespread application of family history information is not due to insufficient evidence. Risks for CHD death are greatest in monozygotic (identical) compared with dizygotic (nonidentical) twins, particularly when there is a premature (eg, <65 years) age of onset in the initially affected twin.5 In multiple prospective studies involving hundreds of thousands of men and women, a parental history of premature CHD is a significant risk factor for CVD even after multivariable adjustment. Relative risk estimates generally range from 1.2 to 2.0, as noted in the Physician’s Health Study and Women’s Health Study,6 although the estimated magnitude of risk associated with early-onset parental disease is substantially higher in some studies.7 …

Chapter 8 - Fracture Liaison Services in South East Asia: Notes From a Large Public Hospital in Singapore

Snakebite by the Shore Pit Viper (Trimeresurus purpureomaculatus) Treated With Polyvalent Antivenom

SIU Scholarship: Dr. Azfar Uddin Shaikh

Since the advent of genotyping, recognition of heritable disease has been perceived as an opportunity for genetic diagnosis or new gene identification studies to advance understanding of pathogenesis. Until recently, however, clinical application of DNA-based testing was confined largely to Mendelian disorders. Even within this remit, predictive testing of relatives is cost-effective only in diseases in which the majority of families harbor mutations in known causal genes, such as adult polycystic kidney disease and hypertrophic cardiomyopathy, but not dilated cardiomyopathy. Confirmatory genetic testing of index cases with borderline clinical features may be economic in the still smaller subset of diseases with limited locus heterogeneity, such as Marfan syndrome. Furthermore, Mendelian diseases account for ≈5% of total disease burden.1 Genome-wide association studies have made headway in elucidating the genetic contribution to the more common, complex diseases, and high throughput techniques promise to facilitate integration of genetic analysis into clinical practice. Nevertheless, many genes remain to be identified and implementation of genomic profiling as a population screening tool would not be cost-effective at present. The implications of heredity, however, extend beyond serving as a platform for genetic analysis, influencing diagnosis, prognostication, and treatment of both index cases and relatives, and enabling rational targeting of genotyping resources. This review covers acquisition of a family history, evaluation of heritability and inheritance patterns, and the impact of inheritance on subsequent components of the clinical pathway. Eliciting a family history is the first step to determining whether a known diagnosis is heritable or symptoms of unknown etiology have a hereditary basis. Both narrative and diagrammatic approaches are integral to data collection, the former including questioning for diseases that recur within the family and the latter involving construction of a pedigree or family tree. Incorporation of psychosocial and interactional data, such as emotional relationships (harmony, apathy, …

Introduction. Multiple studies show the presence of interconnection between co-morbidity and psychomotor development disorders in children. The aim of the study. To identify the relationships between the problems with somatic health in preschool children (3-7 years old) and disorders of their psychomotor development. Materials and methods. Clinical and laboratory examination of 70 children was carried out in a randomized manner with preliminary stratification according to the presence of psychomotor development disorders regarding the somatic and infectious diseases and birth defects they had at the time of the examination and in the anamnesis. The examined group consisted of 70 children of preschool age (3-7 years) with psychomotor development disorders. Statistical processing included calculations using R. E. Fisher’s angular transformation and correlation analysis. Results. The results of the multiple conducted researches prove that the frequency of comorbidities, primarily somatic, in children with psychomotor development disorders is higher than in the general population. The combined influence of adverse environmental conditions, perinatal factors, nutritional disorders, nutritional behavior, reduced motor activity, neuroinflammation, immune response disorders, abnormalities in the quantitative and qualitative species composition of the intestinal microbiota, the phenomenon of an abnormally high microbial load on the organism, violations of interaction in the brain-gut axis, autonomic and mitochondrial dysfunctions, oxidative stress, sensory hypersensitivity, behavioral problems, sleep disorders, increased anxiety and irritability inherent in this children, can be the main reason for this. It is also worth to mention the presence of atopy and dyspeptic manifestations in many examined children, which, presumably, can be components of the food allergy complex of symptoms. It is worth noting, that in most of the subgroups we selected, there were children with physical development disorders, in all subgroups cases of infectious diseases were found in the anamnesis of children, as well as burdened family and allergic anamnesis, which can be caused by both adverse environmental factors and peculiarities, inherent in children with psychomotor development disorders. Among somatic diseases, respiratory ailments dominate in all studied subgroups. There is also a significant share of children with a burdened family and allergy history, atopic dermatitis, lesions of the ears and throat. We found full dependence, as well as medium strength and weak direct reliable correlation between somatic and infectious diseases, present in a significant part of the examined children with psychomotor development disorders, burdened allergic anamnesis and burdened family anamnesis (which conforms with a higher susceptibility to allergic diseases in children with psychomotor development disorders, in particular with mental retardation and ASD) in all subgroups, and also physical development disorders. It is necessary to include a personalized approach into the complex of rehabilitation of children with psychomotor development disorders, with simultaneous correction of existing comorbid pathological symptoms and neurological disorders, inherent in this category of children. Conclusions. Correlation between respiratory infections and a number of somatic and infectious diseases, disorders of physical development, burdened allergic and family history among the examined children in all the subgroups selected by us, which consists in the detection of complete dependence and a reliable correlation of varying strength, have been established.

Eligibility Criteria and Genetic Testing Results from a High-Risk Cohort for Hereditary Breast and Ovarian Cancer Syndrome in Southeastern Ontario

There is limited literature on lifestyle and health factors related to primary open-angle glaucoma amongst Asians. This study evaluated the association of primary open-angle glaucoma with smoking, health and ocular factors amongst Chinese Singaporeans. Case-control study. The study used 711 primary open-angle glaucoma patients from a Singapore hospital and 2788 population-based controls. Subjects underwent clinical examination and completed a questionnaire with details on family history of glaucoma, comorbidities, smoking and alcohol consumption. Glaucoma cases were subclassified as normal or high-tension glaucoma according to their untreated intraocular pressures. The association of various health and lifestyle factors, with normal-tension and high-tension glaucoma was evaluated. Using multiple logistic regression, primary open-angle glaucoma was associated with older age (odds ratio 1.12 per year older; 95% confidence interval 1.10-1.15; P < 0.001), family history of glaucoma (odds ratio 7.86; 95% confidence interval 4.48-13.79; P < 0.001), higher intraocular pressure (odds ratio 1.75 per 1 mmHg; 95% confidence interval 1.64-1.87; P < 0.001) and thinner central corneal thickness (odds ratio 1.01; 95% confidence interval 1.01-1.02; P < 0.001). Myopes were more likely to have primary open-angle glaucoma (P < 0.001). A current smoking habit was protective against normal-tension glaucoma (odds ratio 0.30; 95% confidence interval 0.10-0.92; P = 0.035). Older age, family history of glaucoma, higher intraocular pressure, thinner central corneal thickness and myopia were significantly associated with primary open-angle glaucoma amongst Chinese Singaporeans.

The Peranakan Chinese are culturally unique descendants of immigrants from China who settled in the Malay Archipelago ∼300–500 years ago. Today, among large communities in Southeast Asia, the Peranakans have preserved Chinese traditions with strong influence from the local indigenous Malays. Yet, whether or to what extent genetic admixture co-occurred with the cultural mixture has been a topic of ongoing debate. We performed whole-genome sequencing (WGS) on 177 Singapore (SG) Peranakans and analyzed the data jointly with WGS data of Asian and European populations. We estimated that Peranakan Chinese inherited ∼5.62% (95% confidence interval [CI]: 4.76–6.49%) Malay ancestry, much higher than that in SG Chinese (1.08%, 0.65–1.51%), southern Chinese (0.86%, 0.50–1.23%), and northern Chinese (0.25%, 0.18–0.32%). A sex-biased admixture history, in which the Malay ancestry was contributed primarily by females, was supported by X chromosomal variants, and mitochondrial (MT) and Y haplogroups. Finally, we identified an ancient admixture event shared by Peranakan Chinese and SG Chinese ∼1,612 (95% CI: 1,345–1,923) years ago, coinciding with the settlement history of Han Chinese in southern China, apart from the recent admixture event with Malays unique to Peranakan Chinese ∼190 (159–213) years ago. These findings greatly advance our understanding of the dispersal history of Chinese and their interaction with indigenous populations in Southeast Asia.

Human bocavirus (HBoV) is a parvovirus, belonging to the genus Bocavirus. The virus was identified recently in Sweden, and has now been detected in several different countries. Although it is associated with lower respiratory tract infections in pediatric patients, the incidence of HBoV infection in a developed country in South East Asia, has not been examined. The objective of this study was to determine the importance of HBoV as a cause of lower respiratory tract infections among children admitted to hospital in Singapore. Five hundred nasopharyngeal swabs were collected from anonymized pediatric patients admitted to the Kandang Kerbau Women's and Children's Hospital for acute respiratory infections. The specimens were tested for the presence of HBoV using polymerase chain reactions. HBoV was detected in 8.0% of the patients tested, and a majority of these HBoV patients exhibited lower respiratory tract infections. A significant level of coinfection with respiratory syncytial viruses and rhinoviruses was also observed in these HBoV patients. The data suggest that HBoV is an important cause of lower respiratory tract infections among children admitted to hospital in Singapore, and is the first study examining the incidence of HBoV infection in a developed country in South East Asia. J. Med. Virol. 81:82–89, 2009. © 2008 Wiley‐Liss, Inc.

Proper roles for government and market in addressing policy problems may be assessed by considering the duality between market imperfections and government imperfections. The potential of government interventions or market mechanisms as core policy instruments can be eroded by fundamental deficiencies deeply rooted in either government or market as social institutions. The impacts of such deficiencies are much more extensive than postulated by the existing theories. Analysis here, based on policy innovations in land transport and health care in Singapore, suggests how policy mixes might become the norm of response for addressing policy problems found in a range of sectors. The analytical framework presented may help to distinguish among different policy mixes according to their effectiveness, but also provides some useful guiding principles for policy design.

Introduction: Individuals with prehypertension are at an increased risk of developing hypertension. Family history is one of the paramount non modifiable risk factors for developing hypertension. Hence, it becomes mandatory to assess the cardiac autonomic functions, which play an important role in the regulation of Blood Pressure (BP), in prehypertensive individuals with a family history. Aim: To compare the variations in parameters of cardiac autonomic function tests in prehypertensive individuals with and without a family history of hypertension. Materials and Methods: This cross-sectional study was conducted at the Institute of Physiology and Experimental Medicine, Madras Medical College, Chennai, Tamil Nadu, India from October 2020 to October 2021. The study included 30 prehypertensive individuals without a family history of hypertension and 30 prehypertensive individuals with a family history of hypertension, aged between 20 and 50 years, of both genders. They were recruited from the non communicable diseases Outpatient Department (OPD) at Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. The prehypertensive range refers to a Systolic Blood Pressure (SBP) of 120-139 mmHg or a Diastolic Blood Pressure (DBP) of 80-89 mmHg. After obtaining informed consent, baseline parameters such as resting Heart Rate Variability (HRV) using AD instruments powerlab recorder, deep breathing test, Valsalva maneuver, isometric handgrip test, and Cold Pressor Test (CPT) were evaluated. The data obtained was statistically analysed using a Student’s t-test. Results: The mean age of prehypertensive individuals without a family history was 36.90±4.6 years, and in prehypertensive individuals with a family history, it was 36.43±5.3 years. The male to female ratio was higher. The resting SBP and DBP, as well as the basal heart rate, were significantly increased in the prehypertensive subjects with a family history. Time domain variables such as the mean RR, Root Mean Square of Successive Difference (RMSSD), and pRR50 were reduced in prehypertensive individuals with a family history. Among the frequency domain variables, the total power was reduced, while the low-frequency component and LF:HF ratio were significantly increased. The E/I ratio and Valsalva Ratio (VR) were also significantly reduced in prehypertensive individuals with a family history. Thus, the results emphasise that there is significant autonomic dysfunction in prehypertensive individuals with a family history of hypertension compared to prehypertensive individuals without a family history. Conclusion: Cardiac autonomic function tests in prehypertensive individuals with a family history indicate a definite sympathovagal imbalance in the form of sympathetic overactivity. This may substantiate the role of genetic predisposition in them. Chronic activation of the sympathetic nervous system makes them more prone to developing early hypertension.

Association of Blood Type with Von Willebrand Disease Severity Among Patients at an Academic Hemophilia Treatment Center