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Introduction: Although trauma is often seen in the young, there is a recent shift in this trend as more elderly patients are hospitalised for traumatic injuries. This study examined serious trauma in young and elderly patients and hypothesised that the increase in incidence of elderly serious trauma has led to greater burden of care in hospitals and health services., Materials and Methods: Details of trauma patients admitted with an Injury Severity Score ≥9 or to the intensive care unit or high dependency unit of a tertiary acute hospital between 2004 and 2015 were retrospectively reviewed. Patients ≥65 years old who sustained low-impact trauma that resulted from same-level falls with isolated hip fractures or compression fractures of the vertebral column were excluded. Patients were classified as either elderly (≥65 years old, n = 5074) or young (<65 years old, n = 9088) and their baseline characteristics, complications rate and length of hospital stay were evaluated., Results: Elderly patients ≥65 years old accounted for 51.2% of seriously injured patients after 2014 and their numbers are increasing at an annual rate of 16.5%. They also experienced longer hospital stay in the general ward than younger patients., Conclusion: The number of elderly trauma patients were thrice that of all trauma patients seen and they also required longer hospitalisation. This trend has led to greater burden of care in hospitals and health services in Singapore.

Mesophotic coral ecosystems (MCEs) have received increasing attention in recent years in recognition of their unique biodiversity and also their potential importance as refuges from disturbance events. However, knowledge of the composition of MCEs and how they vary in space is lacking in many regions, particularly the Coral Triangle biodiversity hotspot. Here, we compared the benthic components and coral genera composition between shallow-water reefs (SWRs, 8-13 m depth) and upper MCEs (30-40 m) in four locations in the Philippines that are exposed to differing environmental conditions. Coral cover, abundance, and generic diversity were lower in MCEs than SWRs at three of the four locations. Benthic composition and coral generic composition also varied significantly among locations for both shallow and deep sites. Differences in benthic composition among sites was due primarily to variation in hard corals, macroalgae, sand and silt, while variation in coral assemblage was due to differences in abundance of encrusting Porites, branching Acropora, branching Seriatopora. Our results showed that the composition of MCE communities varied significantly from adjacent shallow reefs, but also among MCEs in differing geographic locations. Furthermore, our results suggest disturbances affecting shallow-water reefs, particularly sedimentation, also negatively impact MCEs, and that depth therefore provides no potential refuge from these disturbances. We recommend that conservation of MCEs consider spatial variability in community composition among sites, and urge further research to better understand the spatial variation in the composition of MCE communities in the Philippines., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction/background: Occult pneumothorax (OPTX) is defined as air within the pleural cavity that is undetectable on normal chest X-rays, but identifiable on computed tomography. Currently, consensus is divided between tube thoracostomy and conservative management for OPTX., Methods: The aim of this retrospective study is to determine whether OPTX can be managed conservatively and whether any adverse events occur under conservative management. Data on all trauma patients from 1 Jan 2010 to 31 December 2012 were obtained from our hospital's trauma registry. All patients with occult pneumothorax who had chest X-ray (CXR) and any CT scan visualizing the thorax were included. The exclusion criteria included those with penetrating wounds; CXR showing pneumothorax, hemothorax, or hemopneumothorax; those with prophylactic chest tube insertion before CT; and those with no CT diagnosis of OPTX. The complications of these patients were analyzed to determine if tube thoracostomy is necessary for OPTX and whether not inserting it would alter the outcome significantly., Results: A total of 1564 cases were reviewed and 83 patients were included. Of these 83 patients, 35 (42.2 %) had tube thoracostomy after OPTX detection and 48 (57.8 %) were observed initially. Patients who had tube thoracostomy had similar ISS compared to those without (median ISS 17 vs. 18.5, p = 0.436). Out of the 48 patients who did not have tube thoracostomy on detection of an OPTX, 4 (8.3 %) had complications. In the group of 35 patients who had tube thoracostomy on detection of an OPTX, 7 (20 %) had complications. Of the 83 patients, a total of 12 patients had IPPV, of which 7 (58.3 %) had tube thoracostomy and 5 (41.7 %) did not. Patients who had tube thoracostomy under our care have a statistically significant likelihood of experiencing any complication compared to those without tube thoracostomy (odds ratio 9.92. The median length of stay was also longer (13 days) in those who had tube thoracostomy compared to those without (5 days) (p value = 0.008)., Conclusions: Our study suggests that patients with OPTX can be managed conservatively with close monitoring, but only in areas with ready access to emergency facilities should any adverse events occur.

Background: Ethnic disparities in trauma mortality outcomes have been demonstrated in the United States according to the US National Trauma Data Bank. The aim of this study was to determine the effect of race/ethnicity on trauma mortality in Singapore., Methods: This was a retrospective review of patients aged 18-64 years with an injury severity score (ISS) ≥ 9 in the Trauma Registry of Tan Tock Seng Hospital, a 1,300-bed trauma center in Singapore, from 2006 to 2010. Chinese, Malay, and Indian patients were compared with patients of other ethnic groups. Multiple logistic regression analyses determined differences in survival rates after adjusting for demographics, anatomic and physiologic ISS and revised trauma score, mechanism or type of injury., Results: A total of 4,186 patients (66.4 % of the database) met the inclusion criteria. Most patients were male (76.3 %) and young (mean age 40 years). Using Chinese as the reference group, we found no statistically significant differences in unadjusted or adjusted mortality rates among the ethnic groups. Independent predictors of mortality included age [odds ratio (OR) 1.05, 95 % confidence interval (CI) 1.03-1.06, p < 0.0001], presence of severe head injury (OR 1.75, 95 % CI 1.13-2.69, p = 0.012), and increasing ISS (p < 0.0001)., Conclusions: Ethnicity is not an independent predictor of trauma mortality outcomes in the Singapore population. Our findings contrast with those from the United States, where race/ethnicity (Black and Hispanic) remains a strong independent risk factor for trauma mortality. This study attests to the success of the Singapore health care/trauma system in delivering the same quality of care regardless of ethnicity.

Introduction: This study aimed to characterise interpersonal violence victims admitted to a major trauma centre., Materials and Methods: A retrospective cohort study of interpersonal violence victims who were admitted to our centre from 1 January 2001 to 31 December 2010 was conducted. Data were obtained from our trauma registry., Results: Interpersonal violence victims constituted 444 (90.1% males and 9.9% females) out of a total of 8561 trauma admissions in the same time period. The average age was 36.6 years (range, 14 to 83 years). Majority were Chinese (53.4%) and Singaporeans (77.3%). The number of cases increased from 10 per year to 96 per year in the first 8 years, then decreased in the last 2 years (55 in year 2010). Time of injury was predominantly 0000 to 0559 hours (72.3%). Interpersonal violence mostly occurred in public spaces for both genders (88.7%). However, the number of females who were injured at home was significantly higher than males (P = 0.000). Blunt trauma (58.3%) was more common than penetrating trauma (41.7%). The average injury severity score (ISS) was 13.5 (range, 1 to 75); 34.9% of patients had major trauma (ISS >15). The average Glasgow coma scale (GCS) score was 13.5 (range, 3 to 15); 16.4% of patients had moderate-to-severe brain injury (GCS 3-8). Blunt trauma was significantly more likely to cause major trauma than penetrating trauma (P = 0.003). The sole case of firearm assault caused most morbi-mortality. Overall mortality was 4.5%. Major trauma (OR: 25.856; P = 0.002) and moderate-to-severe brain injury (OR: 7.495; P = 0.000) were independent risk factors of mortality., Conclusion: There has been no prior published data on interpersonal violence locally. This study is thus useful as preliminary data for future population-based studies. It also provides data for authorities to formulate preventive and intervention strategies.

Background and Aims: Angio-embolisation in trauma is a relatively new technique that is gaining popularity and recognition in identifying and arresting bleeding in trauma patients. We studied the possibility whether angio-embolisation using the Digital Subtraction Angiography (DSA), in the operating theatre (OT) could achieve successful haemostasis in trauma patients. We further studied the feasibility of using this technique as part of trauma resuscitation/damage control., Methods: A retrospective study of trauma patients, with Injury Severity Score (ISS ≥ 9), admitted to Tan Tock Seng Hospital (TTSH) from January 2004 to December 2008 was done. Patients who had received angio-embolisation in the OT or angiography suite were evaluated in terms of age, gender, ISS, the site and type of angioembolisation used. The primary end point was to assess the success rate of angioembolisation using the C-Arm DSA in the OT, and whether there were any complications necessitating a repeat procedure or surgical intervention. The secondary end points of the study were aimed at studying the cost effectiveness of this technique, logistical feasibility and evaluating this technique as part of the initial trauma resuscitative efforts., Results: A total of 43 trauma patients received angioembolisation. 32 patients had the angio-embolisation done using the C-Arm DSA in the OT (n = 32). None of the patients who received angioembolisation in the operating theatre (n = 32) had any re-bleeding. 15 out of 32 survived. There were no complications related to the angio-embolisation procedure. The majority of angio-embolisations done were for pelvic fractures., Conclusion: The success of angio-embolisation in the OT using the C-Arm DSA for a trauma patient and its complication rates are similar to that done in a dedicated angio-graphic suite. We conclude that angio-embolisation in the operating theatre using the C-Arm DSA is feasible, cost effective and can be a modality in the initial trauma resuscitation/damage control in any lead lined operating theatre. We believe that we are the first to describe this method of angio-embolisation using the C-Arm DSA in a conventional lead lined trauma operating theatre and its use as a feasible option in a trauma resuscitation/damage control algorithm., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Introduction: Major workplace related accidents pose a significant healthcare resource challenge in Singapore., Materials and Methods: Our study looks at the epidemiology of patients who were admitted for workplace related accidents, in a single institution, with an Injury Severity Score of >9., Results: There were 196 cases of major workplace related accidents admitted between January 2006 and December 2007. The median age of patients admitted was 37 years with a large percentage being males (95.4%) and non-residents (57.1%). The most common ethnic group was Chinese (53.1%) followed by Indians (23.5%). The most common mechanism of injury was fall from height (66.3%) followed by injuries as a result of falling objects at work (21.9%). The percentage of patients who required surgical intervention was 69.9%. Patients admitted for major workplace related accidents had a median length of stay of 5 days in the hospital, a median length of 24 days of medical leave (ML), certifying them unfit for duty and the average cost of stay for each patient was S$11,000., Conclusions: We have a better understanding of the epidemiology and socio-economic impact of workplace related accidents through this study. Workplace related accidents result in significant number of man-days lost from work and monetary cost to employers, medical insurance and the hospital. With an improved understanding, we propose methods to prevent and reduce such accidents in future. A direct consequence of which will be the possible reduction of hospitalisation costs and better allocation of healthcare resources in the future.

The crystal structures and conformations of bisdigitoxosides of digitoxigenin (I), gitoxigenin (II) and digoxigenin (III and IV) have been determined using single-crystal X-ray crystallographic techniques. Crystals of (I), (II) and (IV) were grown from ethyl acetate solutions of the glycosides while (III) was grown from a solution of the digitoxoside in ethanol. As in other cardiac glycosides the ring junctions A-B and C-D are cis. The D ring in these structures shows different conformations while the A, B and C rings remain conformationally similar. Although digitoxigenin bisdigitoxoside and gitoxigenin bisdigitoxoside differ from each other in the absence and presence of a hydroxyl group at C(16) of the D ring, these two biosides crystallize in the space group P2(1)2(1)2 [corrected] and are isomorphous. The presence of the hydroxyl group at C(16) does not affect the orientation of the lactone ring and the conformation of the molecule. Digoxigenin bisdigitoxoside crystallizes in two different crystal systems with four molecules of water in the orthorhombic form and one molecule of ethyl acetate in the triclinic form. In both forms the hydroxyl at C(3') of the first sugar forms a hydrogen bond with the ring oxygen of the second sugar. This has also been observed in the trioside digoxin. The torsion angle C(13)-C(17)-C(20)-C(22) in the two forms differs by 7 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)