IntroductionThe health, psychological and socioeconomic vulnerabilities of low-wage migrant workers have been magnified in the COVID-19 pandemic, especially in high-income receiving countries such as ...Singapore. We aimed to understand migrant worker concerns and coping strategies during the COVID-19 pandemic to address these during the crisis and inform on comprehensive support needed after the crisis.MethodsIn-depth semi-structured interviews were carried out with migrant workers diagnosed with COVID-19. The participants were recruited from a COVID-19 mass quarantine facility in Singapore through a purposive sampling approach. Interviews were transcribed verbatim and thematic analysis performed to derive themes in their collective experience during the crisis.ResultsThree theme categories were derived from 27 interviews: migrant worker concerns during COVID-19, coping during COVID-19 and priorities after COVID-19. Major stressors in the crisis included the inability to continue providing for their families when work is disrupted, their susceptibility to infection in crowded dormitories, the shock of receiving the COVID-19 diagnosis while asymptomatic, as well as the isolating conditions of the quarantine environment. The workers coped by keeping in contact with their families, accessing healthcare, keeping updated with the news and continuing to practise their faith and religion. They looked forward to a return to normalcy after the crisis with keeping healthy and having access to healthcare as new priorities.ConclusionWe identified coping strategies employed by the workers in quarantine, many of which were made possible through the considered design of care and service delivery in mass quarantine facilities in Singapore. These can be adopted in the set-up of other mass quarantine facilities around the world to support the health and mental well-being of those quarantined. Our findings highlight the importance of targeted policy intervention for migrant workers, in areas such as housing and working environments, equitable access to healthcare, and social protection during and after this crisis.
A 54-year-old man on maintenance hemodialysis with recurrent catheter-related bloodstream infections due to Staphylococcus aureus was admitted. Multiple prior transthoracic echocardiograms failed to ...reveal any vegetation. Subsequently on transesophageal echocardiography a mass consistent with fibrin sheath vegetations was identified and a follow-up diagnostic computed tomography (CT) venogram confirmed the presence of a fibrin sheath with vegetations.
BACKGROUND Electrocardiography (ECG) may be performed as part of preparticipation sports screening. Recommendations on screening of athletes to identify individuals with previously unrecognized ...cardiac disease are robust; however, data guiding the preparticipation screening of unselected populations are scarce. T wave inversion (TWI) on ECG may suggest an undiagnosed cardiomyopathy. This study aims to describe the prevalence of abnormal TWI in an unselected young male cohort and the outcomes of an echocardiography-guided approach to investigating these individuals for structural heart diseases, focusing on the yield for cardiomyopathies. METHODS AND RESULTS Consecutive young male individuals undergoing a national preparticipation cardiac screening program for 39 months were studied. All underwent resting supine 12-lead ECG. Those manifesting abnormal TWI, defined as negatively deflected T waves of at least 0.1 mV amplitude in any 2 contiguous leads, underwent echocardiography. A total of 69 714 male individuals with a mean age of 17.9±1.1 years were studied. Of the individuals, 562 (0.8%) displayed abnormal TWI. This was most frequently observed in the anterior territory and least so in the lateral territory. A total of 12 individuals (2.1%) were diagnosed with a cardiomyopathy. Cardiomyopathy diagnoses were significantly associated with deeper maximum TWI depth and the presence of abnormal TWI in the lateral territory, but not with abnormal TWI in the anterior and inferior territories. No individual presenting with TWI restricted to solely leads V
to V
, 2 inferior leads or both was diagnosed with a cardiomyopathy. CONCLUSIONS Cardiomyopathy diagnoses were more strongly associated with certain patterns of abnormal TWI. Our findings may support decisions to prioritize echocardiography in these individuals.
This study aims to investigate the prevalence of undiagnosed cardiovascular risk factors in patients with ischaemic heart disease (IHD).
We assessed the prevalence of previously undiagnosed ...cardiovascular risk factors, including elevated lipoprotein(a) Lp(a), among consenting patients with IHD who were admitted to hospital. Clinical information, including dietary history, from patients with newly diagnosed IHD and known IHD were compared.
Of the 555 patients, 82.3% were males and 48.5% of Chinese ethnicity. Overall, 13.3% were newly diagnosed with hypertension, 14.8% with hypercholesterolemia, and 5% with type 2 diabetes (T2DM). Patients with newly diagnosed IHD, compared to those with known IHD, had a higher prevalence of new diagnoses of hypercholesterolemia (29.1% vs. 2.0%,
< 0.001), hypertension (24.5% vs. 3.4%,
< 0.001) and T2DM (7.3% vs. 3.1%,
= 0.023). Active smoking was prevalent in 28.3% of patients, and higher in newly diagnosed IHD (34.1% vs. 23.2%,
= 0.005). Elevated Lp(a) of ≥120 nmol/L was detected in 15.6% of all patients, none of whom were previously diagnosed. Dietary habits of >50% of patients in both groups did not meet national recommendations for fruits, vegetables, wholegrain and oily fish intake. However, patients with known IHD had a more regular omega-3 supplement intake (23.4% vs. 10.3%,
= 0.024).
Increased detection efforts is necessary to diagnose chronic metabolic diseases (hypertension, hypercholesterolemia, T2DM) especially among patients at high risk for IHD. Cardiovascular risk factors, in particular elevated Lp(a), smoking, and suboptimal dietary intake in patients with IHD deserve further attention.
To develop an electronic surveillance system that provides prompt in-depth situational infectious disease risk and linkage analysis for inpatients in a tertiary hospital.
All patients admitted to ...Singapore General Hospital (SGH), a 1900-bedded tertiary care hospital, are included in routine surveillance. The 3-Dimensional Disease Outbreak Surveillance System (3D-DOSS) was developed to spatiotemporally represent inpatient surveillance data on a “digital twin” of SGH and evaluated for performance in surveillance, contact tracing, and outbreak investigations. This study was conducted over a 12 month period (October 1, 2020 to September 30, 2021).
The 3D-DOSS surveillance module identified an influenza cluster of 10 inpatients in November 2018, mapping retrospective data between September 2018 and December 2018. Seventy-six clusters of 2 or more linked patients with health care–associated Klebsiella pneumoniae carbapenemase–type carbapenemase-producing Enterobacteriaceae were detected in SGH in 2 years (2018 and 2019). The 3D-DOSS contact tracing module promptly identified 44 primary and 162 secondary inpatient contacts, after exposure to a health care worker with coronavirus disease 2019 in April 2021. For outbreak mapping, 24 patients with OXA-48 were mapped on October 22, 2020, using 3D-DOSS to determine their spatiotemporal distribution.
The integration of health care data and representation on a virtual hospital digital twin is a useful tool in an outbreak alert and response framework. Infectious disease surveillance systems, which are syndrome-based, that can access real-time data, and can incorporate movement networks, can potentially enhance health care–associated infection prevention and preparedness for disease X.
Resumo Fundamento A síndrome de Wolff-Parkinson-White (WPW) é uma condição pró-arrítmica que pode exigir restrição de atividades extenuantes e é caracterizada por sinais de ECG, incluindo ondas ...delta. Observamos casos de padrões intermitentes de WPW apresentando-se como QRS alternante (‘WPW alternante’) em uma grande coorte de triagem de ECG pré-participação de homens jovens que se candidataram ao recrutamento militar. Objetivos Nosso objetivo foi determinar o padrão de WPW alternante, as características do caso e a prevalência de outros diagnósticos diferenciais relevantes apresentando-se como alternância de QRS em um ambiente de pré-participação. Métodos Cento e vinte e cinco mil cento e cinquenta e oito recrutas militares do sexo masculino prospectivos foram revisados de janeiro de 2016 a dezembro de 2019. Uma revisão de prontuários médicos eletrônicos identificou casos de WPW alternante e padrões ou síndrome de WPW. A revisão de prontuários médicos eletrônicos identificou casos de diagnósticos diferenciais relevantes que podem causar alternância de QRS. Resultados Quatro indivíduos (2,2%) apresentaram WPW alternante em 184 indivíduos com diagnóstico final de padrão ou síndrome de WPW. Dois desses indivíduos manifestaram sintomas ou achados eletrocardiográficos compatíveis com taquicardia supraventricular. A prevalência geral de WPW alternante foi de 0,003%, e a prevalência de WPW foi de 0,147%. As WPW alternantes representaram 8,7% dos indivíduos com QRS alternantes, e QRS alternantes tiveram prevalência de 0,037% em toda a população. Conclusões A WPW alternante é uma variante da WPW intermitente, que compreendeu 2,2% dos casos de WPW em nossa coorte de triagem pré-participação. Não indica necessariamente um baixo risco de taquicardia supraventricular. Deve ser reconhecido na triagem de ECG e distinguido de outras patologias que também apresentam QRS alternantes.
Abstract
Background
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are known to compromise patient outcomes and increase healthcare costs. Previous evidence on the ...prolongation of length of stay due to MRSA infections in Singapore is limited by methodology, including time-dependent bias. We used a multistate model to estimate the expected attributable mortality, length of stay, and healthcare costs of MRSA infections in Singapore.
Methods
We conducted a retrospective case-cohort study in patients admitted to a Singapore tertiary hospital from 2018 – 2022. Patients with MRSA infections were matched to those without infections in a 1: 3 ratio, by age and admitting specialty. We used a multistate model to derive excess length of stay (Fig 1). Attributable cost of MRSA infections from the healthcare perspective (in 2023 Singapore dollar) was estimated by multiplying excess length of stay with the monetary value of a bed-day and MRSA incidence. Cox regression with adjustment of confounders was used to derive hazard ratios (HR) for mortality estimates.
Results
We matched 752 patients with MRSA infections to 2,256 patients without MRSA infections. The most common MRSA infections were skin and soft tissue infections (44.5%) and bacteraemia (18.9%). From the multistate model, the excess length of stay of a MRSA infection was 3.02 days (95% CI, 1.90 – 4.13 days). This translated to an excess healthcare cost of $594,128 (95% CI, $375,111– $813,144) per 100,000 admissions. MRSA skin and soft tissue infections had the longest length of excess stay (3.98 days; 95% CI, 2.50 – 5.46 days) and contributed most to health-care costs ($348,788 per 100,000 admissions; 95% CI, $219,099 – $478,476). After adjusting for potential confounders, the mortality risk of all MRSA infections compared to patients without infection was 1.40 (95% CI, 0.94 – 2.08). Among the different infection types, pneumonia (HR, 4.28; 95% CI, 1.25 – 14.57) and bacteraemia (HR, 2.60; 95% CI, 1.33 – 5.08) had the high mortality risk compared to patients without infection.
Conclusion
Patients with MRSA pneumonia and bacteraemia had highest mortality risk. MRSA skin and soft tissue infections were associated with the highest healthcare costs. Coordinated efforts to reduce these infections may save lives and free valuable resources.
Disclosures
Sean Whiteley, BSc (IT), Axomem: Board Member|Axomem: Fees received for service and software licenses
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