Staying at home and ordering in (a pizza) your medications.

The DTAP Experience
A DTAP Stay Home Series Part 1


The recent COVID-19 infection has gripped the world. With countries such as China, South Korea, Iran, Italy and the cruise ship Princess Diamond all badly hit. The infection rate has been fast and furious with global infections soaring to more than 85,000 cases and nearly 3000 deaths worldwide as of 1st March 2020.

On the local front, Singapore has been fortunate to keep the total cases at 102. With zero deaths, more than 72 discharged from hospital and less than 1 third remaining in hospital. 

These encouraging numbers in Singapore are brought about by Quarantine Orders (QO) – to isolate suspected carriers or close contact of carriers and also Stay Home Notices (SHN) – for Singaporeans, PRs and Long term pass holders who have been in mainland China, Daegu or Cheongdo in South Korea in the last 14 days, to stay at home at all times. 

On the ground, how this has translated to us as a healthcare group on the ground has been a lot of behind the scenes hard work, sweat and meticulous changes.

I remember when news first disseminated on the night before CNY eve (23rd Jan) that Singapore had its first case, I stayed up late into the middle of the night to review the facts and prepare our team as best as we can operationally. 

Being at the frontline of Singapore’s healthcare provider community, our core priority was to protect our patients, protect our staff and most importantly the general public.


Everyone that stepped through the doors were asked travel screening questions –  especially travel to China then, had their temperature taken and given a mask. 

And if they had done so in the last 14 days and exhibited symptoms of fever, cough or breathlessness, they would be brought to a separate isolation room for assessment to prevent mingling with other patients. On our own, we also would have taken precautions with personal protective equipment. And if they were suspected to be infected, we would then call an ambulance for transfer to the NCID.

We had also increased the number of hand sanitizers across the waiting areas for our patients and complete sanitization of the isolation room after each patient and for our own consult rooms. I personally wiped down the door handles, seat and table surfaces regularly after each patient.

This period of uncertainty resulted in 3 distinct situations. The first one resulted in a surge of patients coming for a longer duration of the refill of their prescriptions. 

The second situation saw an increased number of patients coming in to get their Fever and Flu symptoms checked out (i’ll share more on this in the next article, a patient’s journey in getting their Flu or recurrent sneezing symptoms checked out and even the benefits of a Flu/Pneumonia vaccination). These were patients who often self medicated previously and rested but were now worried during the COVID 19 situation. 

And the third situation was one where our patients, especially those who worked from home during this period, did not want to mingle too much in public, contacted us for an offsite refill of their medication prescriptions.

We put in place many measures to protect our patients. From the stringent operational changes, proactive screening of our patients, minimizing the mingling of patients – spacing out of patient appointments, to increased regular sanitization of the clinic. 

But there was still the third situation and group of patients who needed their medications but were not willing or able to come down to the clinics.  And we had to do right by them and not allow their health to suffer in light of the COVID 19 Dorscon Orange precautions.

We thus took the active step at team DTAP to put in place a robust medication delivery system – DTAP Delivery. This system is aligned with the Singapore Standards – SS644 guidelines for the supply and delivery of medication. This robust framework ensures the a) integrity of the medication delivered b) confidentiality of one’s medical records, medications and c) ease and accessibility for our patients. Here at team DTAP, we spared no expense to ensure that our patients always received the medical care that they need and in a timely manner.

You can explore our medication delivery service further here: DTAP Delivery

DTAP Delivery Service

Last but not least, in view of the recent COVID19 happening during the Chinese New Year, I will leave with you my dear readers a short acronym H.U.A.T to stay safe during this heightened medical situation.

Help keep a lookout for your friends and family. If they are unwell with a cough flu or cold, encourage them to put on a mask and seek medical attention

Understand news from the right channels. Alot of fake news out there aimed to cause panic. Gov.sg has a whatsapp account with regular updates

Avoid fear mongering, keep calm and carry on life as per usual

Take necessary precautions – Hand sanitizing, Putting on Masks

Take Care!



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Low Testosterone & Low Libido

Having low levels of testosterone or Testosterone Deficiency Syndrome is common and can occur in about 1 in every 200 men under the age of 60 and 1 in 10 men over the age of 60. Commonly the symptoms may be subtle and thus can be easily overlooked as “Oh, it’s just part of aging.”

As men age, levels of testosterone drop by about 1-1.5% each year after age of 30 but not all males experience the drop in levels. It is known from studies that the more overweight you are, the faster the decline in the levels of testosterone. In addition, it has been shown in studies that low testosterone levels are associated with cardiovascular risks like coronary arterial disease and metabolic syndrome including type 2 diabetes.


Effects of having low testosterone:

  • Regression of some features of male sexual characteristics
  • Low mood or irritability
  • Poor concentration
  • Low energy, feeling tired
  • Hot flushes and sweats
  • Decreased libido
  • Reduced beard or body hair growth
  • Low semen volume
  • Gynecomastia
  • Reduced muscle strength
  • Fracture (osteoporosis)
  • Erectile dysfunction

It has been shown in some studies that supplementation of testosterone in those with low testosterone levels can increase their libido. 


Causes of low testosterone

Generally the causes of low testosterone can be classified into testicular (Primary) and Hypothalomo-pituitary (Secondary) causes.

Primary

  • Age-Related Testosterone Deficiency
  • Chromosomal: Klinefelter syndrome – Congenital;
  • Undescended testes
  • Surgery: bilateral orchiectomy
  • Trauma
  • Infection: mumps orchitis
  • Radiotherapy/chemotherapy/drugs (spironolactone, ketoconazole)

Secondary

  • Idiopathic hypogonadotropic hypogonadism
  • Pituitary microadenoma (<1 cm) or macroadenoma (>1 cm)
    • Functional or non-functional: in men typically macroprolactinoma
  • Other causes of hypothalamic pituitary damage: surgery, radiotherapy, trauma, infiltrative disease such as haemochromatosis

Treatment options

Lifestyle modifications – diet and exercise

It has been shown in studies that resistance weight training can increase levels of testosterone. Reducing body fat has also been shown to increase levels of testosterone. There are some studies show high-intensity interval training (HIIT) is more effective in reducing body fat than steady-state cardio.

Medications: Testosterone Replacement

There are several formulations available for replacing testosterone. The choice of which formulation to use is largely patient preference.

  1. Slow releasing formulation injections – generally given every 10-12 weeks as an intramuscular injection. Some people prefer that as they only need to get 1 injection once every 3 months or so rather than to take medication daily.
  2. Short acting formulation injections – these injections are given once every 1 to 3 weeks. Most of the time, patients learn to inject themselves.
  3. Gels or capsules – generally capsules are taken twice daily and gels are applied once daily. Gels are preferred by some as it is only used once daily and also in some cases, those who used the injectable form experience swings in their symptoms especially when it approaches the time for the next dose. But as the gel is applied daily, the levels of testosterone remain relatively stable and thus avoid the swing. However, gels may not be suitable for a person with an active lifestyle as the testosterone in the gel may not have enough time to be absorbed before they commence their exercise or when they shower after the exercise.

Next read: 7 TESTOSTERONE BOOSTING FOODS THAT YOU CAN FIND IN THE SUPERMARKET

Watch next: HOW DO YOU INJECT CAVERJECT


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10 things you didn’t know about this STD: Mycoplasma Genitalium

Mycoplasma Genitalium is a common STI (sexually transmitted infection). It can be transmitted by different forms of sexual contact including vaginal, anal and oral intercourse. The symptoms experienced can include painful urination, penile/vaginal discharge, and, specifically in women; pain during sex, bleeding after sex, inter-menstrual bleeding, and lower pelvic pains.

Mycoplasma Genitalium is not as well known as Chlamydia or Gonorrhoea. The key reason for this, is the difficulty in testing for the infection and also a lack of awareness about the condition.


Here are 10 interesting things that you didn’t know about Mycoplasma Genitalium

1. Mycoplasma Genitalium was first identified in the 1980s

The bacteria was first isolated in the urogenital tract of humans in 1981, and was recognised as a new species of Mycoplasma in 1983. As it is still relatively recent that Mycoplasma Genitalium was identified, there is lack of sufficient data and research, and perhaps more of the condition that we do not yet know about.


2. Mycoplasma Genitalium is one of the smallest free living microorganisms capable of self-replication

The Mycoplasma species are the smallest bacterial cells yet discovered, with sizes ranging from 0.2 to 0.7 micrometres. In fact, Mycoplasma Genitalium is too small to be visible under a light microscope, and the first detailed study of its structure was conducted under a transmission electron microscope (TEM). 

3. Mycoplasma Genitalium is one out of the 15 (known so far) named Mycoplasma species of the human origin

Hundreds of Mycoplasma species are known to infect animals and plants. Of these, about 15 are pathogenic in humans. Mycoplasma Genitalium was the 12th to be identified.

4. Mycoplasma Genitalium is more common than Gonorrhoea and is the second most prevalent STI after Chlamydia

Since its discovery around 30 years ago, Mycoplasma Genitalium is now recognized as an important cause of male urethritis. The US Centers for Disease Control and Prevention (CDC) states that it is more common than Gonorrhoea but less common than Chlamydia, and is responsible for approximately 15%–20% of non-gonococcal urethritis (NGU), 20%–25% of non-chlamydial NGU, and approximately 30% of persistent or recurrent urethritis.

5. It is possible to have Mycoplasma Genitalium and not know it, and there is a high chance that your partner is also infected

Infection with Mycoplasma Genitalium can cause the symptoms as mentioned earlier, but can also be asymptomatic. Studies have shown that in heterosexual couples where the male partner was tested positive, up to 30% of the female partners were positive for the bacteria. If the female was first tested positive, up to 50% of their male partners tested positive as well. In men who have sex with men, up to 40% of their partners tested positive for the bacteria in the rectum. This points to the fact that if a person is tested positive for the bacteria there is a good chance that their partner is also infected.

6. Mycoplasma Genitalium, like Chlamydia and Gonorrhoea, can lead to more serious complications with long term health consequences

Data suggests that Mycoplasma Genitalium can cause Pelvic Inflammatory Disease (PID) in females, as the bacteria is found in the cervix and/or endometrium of women with PID more often than in women without PID. Women with tubal factor infertility are more likely to have antibodies to Mycoplasma Genitalium than fertile women, suggesting that this organism might cause female infertility. Two studies have shown that infection with Mycoplasma Genitalium is associated with an increased risk of preterm delivery in pregnant women.

It remains unknown whether Mycoplasma Genitalium can cause male infertility. However, the organism has been detected in men with epididymitis in a limited number of cases.

7. Mycoplasma Genitalium is a slow growing bacteria; this leads to diagnostic challenges

Mycoplasma Genitalium is a fastidious, slow-growing organism. This makes detection and subsequent isolation of the bacteria extremely difficult. Culture can take up to 6 months, and only a few laboratories in the world are able to recover clinical isolates.

Therefore, the preferred method of testing is by Nucleic Acid Amplification Test (NAAT), typically using Polymerase Chain Reaction (PCR). NAAT detects genetic materials (DNA or RNA) rather than antigens or antibodies, and is highly accurate. Testing can be done on urine, urethral, vaginal, and cervical swabs and endometrial biopsy. However, to date there is no diagnostic test for Mycoplasma Genitalium that has been approved for use by the US Food and Drug Administration (FDA).

8. Mycoplasma Genitalium does not have a cell wall

The Mycoplasma Genitalium bacteria lacks a cell wall, which makes treatment of the infection more difficult as certain classes of antibiotics that work by targeting bacterial cell walls are ineffective against this organism.

9. You can get reinfected with Mycoplasma Genitalium even after you have been treated for it 

Much like many other STIs, it is possible to get reinfected with Mycoplasma Genitalium even after one has been successfully treated for it. Therefore, safe sexual practices including using barrier protection, reducing your number of sexual partners and knowing your partners’ infection status is important in keeping yourself safe and healthy.

10. It is possible for vertical transmission of Mycoplasma Genitalium to occur?

Although uncommon, it is possible for vertical transmission of Mycoplasma Genitalium from mother to baby to occur, as previously reported in one case. 

Next read: MYCOPLASMA GENITALIUM (MG) – STD SCREENING, TESTING & TREATMENT


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Health Suites: Intermittent Fasting – Fab or Fad

[National Radio Interview – MONEY FM 89.3]
MONEY FM 89.3 is a 24 hours National Business and Personal Finance Radio Station in Singapore.

Date: 18th November 2019

Health Suites: Intermittent Fasting – Fab or Fad

Dr Chester LanResident Doctor, DTAP Clinic Group speaks with Claressa Monteiro from MONEY FM 89.3 on whether intermittent fasting is effective in lose weight or if it is just a myth. Listen to the podcast.

Coronavirus, Cold Or The Flu?

How do you tell if you have the Coronavirus, cold or the flu?

It is very difficult to tell the difference between the coronavirus, cold and the flu clinically as the symptoms of all three infections can be quite similar.

Some of the symptoms include:

  • Fever
  • Chills
  • Respiratory symptoms e.g. (cough, sore throat, nasal obstruction/discharge and breathlessness)
  • Body aches
  • Headaches
  • Lethargy 
  • Loss of appetite

As symptoms can range from mild to severe, do not try to diagnose yourself. If you are unwell, please seek medical attention immediately.

As of now, in Singapore, the Ministry of Health has defined what the criterion for a suspect case is, and primary care doctors are using these criteria to send patients to hospital for further management. If you have symptoms described above, and have been to mainland China in the past 14 days, or had frequent or close contact with recent travellers from mainland China, please seek medical attention and your doctor can decide if you should be sent for further testing. 

There have been cases of nCoV with barely any/mild symptoms. Because of this, it is unwise to generalize and say definitively that the nCoV will have this symptoms and the common cold will not. However, the common cold is much less likely to result in death as compared to nCoV. Influenza, on the other hand, can result in death from complications as well.

Also read: FAQS ON THE NOVEL CORONAVIRUS (2019-NCOV)

What are the common symptoms of the Coronavirus and how long before one will start showing symptoms of the Coronavirus?

Common symptoms noted for 2019-nCoV infection include fever, cough and shortness of breath. Other common symptoms noted in coronavirus infections include runny nose, sore throat, headache and malaise. Some less typical symptoms can include diarrhoea, nausea, chest pain, and vomiting. The median duration for the incubation period is about 3 days. The incubation period can range from as little as 2 days to as long as 24 days in rare cases.

Please speak to your doctor if you are feeling unwell.

Next read: WHAT YOU NEED TO KNOW ABOUT WUHAN VIRUS – 2019 NOVEL CORONAVIRUS (2019-NCOV)


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Boosting Your Immunity

Our Immune System

Our immune system is our body’s defence against disease-causing microorganisms like bacteria, viruses, fungus, and parasites found in the environment. It is essential for our survival. Without an immune system, our bodies will be open to attack, and falling sick might turn out to be a deadly event. 

The idea of boosting our immunity is familiar to everyone. Your parents might have given you some advice, and the forums on the internet might have provided you with some information – yet the answer to the question of how one is able to boost his immunity still seems elusive. The immune system is extremely complex, and is made out of many parts interacting with each other.

To-date, we still do not fully understand all the parts of the immune system function exactly, but to function well, the immune system requires balance. While there is no scientifically proven link between lifestyle and an enhanced immune function, researchers are at present exploring the effects of diet, exercise, age, psychological stress, and other factors on the immune response. As such, until there is a breakthrough in the research on the immune system, general healthy-living strategies are a good way to start giving your immune system the upper hand.


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Does having a balanced diet help in boosting immunity?

A classification called The NOVA food classification system categorizes food into 4 categories – unprocessed and minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. It is known that processed and ultra processed foods, when consumed regularly, are unhealthy for you. They have been linked to conditions such as metabolic syndrome, heart attacks, strokes, early death and even cancer. Processed foods are typically high in calories, salt, sugar, and fat which we all know are not good for you.

Our bodies were evolved to consume unprocessed foods such as vegetables, fruits, whole grains, seeds, nuts and unprocessed meats. We were not designed to regularly eat foods processed in a laboratory that can last 5 years sitting on a shelf. 

It would be ideal if everyone tries to move one’s diet towards less processed foods. While this will definitely require you to invest more time in meal preparations and planning, it is the best way to inject quality nutrition in our lives. Quality nutrition is made up more than just the calories – the macronutrients, vitamins and minerals all contribute to good health and thus a healthy immune system.

Having a varied and balanced diet ensures our body stays healthy and strong.

Does insufficient protein intake directly affect our body’s self-repair and immunity system?

The repair of cells in our body requires protein synthesis which in turn requires us to ingest dietary protein, be it from animal or plant sources. Insufficient protein intake over an extended period of time can cause changes in body composition such as reduced muscle mass, strength and function. Protein and amino acid deficiency has also been linked to repression of the immune system. 

How much protein should we have daily? What are the foods rich in proteins that we should consume?

The recommended amount of protein daily is about 0.8 grams of protein per kilogram of body weight. This amounts to: 56 grams per day for the average sedentary man. 46 grams per day for the average sedentary woman. That is about 200g of meat or about 300g of soybeans.

Some protein rich food include lean meat, poultry and fish, eggs, dairy products like milk, yoghurt and cheese, seeds and nuts, beans and legumes (such as lentils and chickpeas) and soy products like tofu. It is always advisable to get your protein intake from a variety of sources, and the preparation of these proteins should preferably involve less frying. 

Does consuming 5 to 7 servings of fruits and vegetables of various different colours per day: especially red, orange or yellow vegetables, which contain a large amount of beta-carotene, which will be converted into vitamin A that play a critical role in enhancing immune function?

It is always advisable to increase your intake of fruits and vegetables, and the less processing they have undergone, the better. Beta carotene is a red-orange pigment found in plants and fruits, especially carrots and colourful vegetables. Many epidemiological studies have shown an association between diets rich in carotenoids and a reduced incidence of many forms of cancer, and it has been suggested that the antioxidant properties of these compounds are a causative factor.

Since the immune system plays a major role in cancer prevention, it has been suggested that beta-carotene may enhance immune cell function. The theory is that beta-carotene is converted to vitamin A, an essential nutrient, which has antioxidant activity, and helps to protect cells from damage. It is recommended that people get beta-carotene and other antioxidants from food instead of supplements, at least until research finds out whether supplements offer the same benefits. Eating 5 servings of fruits and vegetables daily provides 6-8 mg of beta-carotene.

Is drinking 8 glasses of water a day the standard recommendation to maintain a healthy immune system? Should the amount of water drunk be determined by age or daily activity?

Studies have produced varying recommendations over the years. But your individual water needs depend on many factors, including your health, how active you are and where you live. You’ve probably heard the advice to drink eight 8-ounce glasses of water a day. That’s easy to remember, and it’s a reasonable goal but it is rather arbitrary. Other health professionals recommend drinking till your urine is colourless or a light yellow.

Most healthy people can stay hydrated by drinking water and other fluids whenever they feel thirsty. For some people, fewer than eight glasses a day might be enough. But other people might need more. For the majority of people, there probably isn’t any need to worry about water intake. The thirst instinct is very reliable and it is safe to recommend drinking just beyond the point of thirst. 

There is no best way to stay hydrated. Hydration can even come from foods such fruits, vegetables or soups. However, plain water seems to be the cheapest and most direct way to stay well hydrated. Beware of sports drinks, isotonic drinks and energy drinks though – they may contain more sugar than you might otherwise need to stay hydrated. Whether or not you want to add a slice or lemon or some herbs to your water is purely a personal preference. 

It is important to have a well balanced, varied diet that encompasses many different types of food. The idea that a particular food is linked to a particular benefit is more in line with Traditional Chinese Medicine. However, Western Medicine is indeed catching up to this idea, as more chemical compounds are being found in various foods that may indeed help boost immunity and can be beneficial for the body. 


Food

Mushrooms contain polysaccharides that can regulate and improve the immune function.

Mushrooms do indeed have high levels of polysaccharides (specifically Beta-glucans) contained within their cell walls. This class of therapeutically active compounds are widespread within the mushroom kingdom, and within our bodies they interact with specific polysaccharide receptors on our immune cells, possibly modulating and regulating our immune response. Mushrooms also are low in fat, highly nutritious, high in antioxidants and are very tasty!

Garlic and ginger: studies have found that garlic can be used as a powerful antioxidant and antibiotic which can help in combating viruses and it can also shorten the time when having a cold. Ginger can warm the stomach and relieve the cold as well.

Ginger and garlic have both been used for millennia in cooking preparations all around the world, and both are high in bioactive compounds which have anti-inflammatory and antioxidant effects. Scientists are still studying the many biochemical compounds and metabolites of ginger and garlic and their properties. While no studies have proven directly that they can shorten a cold, many people do report feeling symptomatically better after drinking ginger teas or garlic preparations. 

Fermented food: Due to their high probiotic content, fermented foods can give your immune system a boost and reduce your risk of infections like the common cold.

The bacteria that live in your gut have a significant impact on your immune system. Due to their high probiotic content, fermented foods can give your immune system a boost by activating various receptors of cells with certain proteins that spur the immune system into action. Fermented foods are eaten all over the world and include foods like Yoghurts, Cheeses, Kefir, Sauerkraut, Tempeh, Natto, Kombucha, Miso and Kimchi. 

Lotus root is rich in vitamin C polyphenols and dietary fiber, it goes a long way towards improving and strengthening the immune system.

Lotus root has been a part of the cuisines of numerous Asian countries for thousands of years. Lotus roots are indeed rich in vitamin C. Vitamin C is a potent antioxidant and a cofactor for a family of biosynthetic and gene regulatory enzymes. Vitamin C contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. Lotus root is also rich in dietary fibre, which contributes to healthy bowel habits and in turn, a healthy gut microbiome which aids in innate immunity. 

In conclusion..

It is important to have a well balanced, varied diet that encompasses many different types of food. Eat different types of vegetables and fruits and experiment with different recipes from various cultures. That way, you can experience and enjoy these foods in many different ways and flavours. 


Lifestyle tips

Exercise helps in boosting immunity! What examples of exercises are recommended for this period with danger of getting coronavirus?

Exercise improves your overall fitness, and acute exercise has been shown to be an immune system adjuvant that improves defense activity and metabolic health. Various studies support a clear inverse relationship between moderate exercise training and illness risk. Exercise training has an anti-inflammatory influence mediated through multiple pathways. However, too much exercise is also a stressor on the body, and overly intensive training has been linked with a higher illness risk. 

The novel coronavirus has been shown to be capable of community spread and some people are choosing to limit their exposure by avoiding crowded public places. Some activities that you can do at home include weights training, body weight exercises and aerobic activities like skipping or jumping. 

Emotional stress also has a detrimental effect on our immunity.

Maintaining a positive mood can enhance the immune system and having good stress relieving methods helps in improving our immunity as well. Researchers have found a wealth of evidence that positive emotions can enhance the immune system, while negative emotions can suppress it.

Scientists don’t yet fully understand the biological mechanisms at work, but they know that negative feelings like stress, sadness, and worry cause a spike stress hormones including adrenaline and cortisol, which in turn suppresses the immune system. Stress also can over activate the immune system, resulting in an increased risk of autoimmune diseases such as arthritis and multiple sclerosis. Skin conditions such as psoriasis, eczema, hives and acne also may worsen, and stress can trigger asthma attacks. 

Some simple ways you can relieve stress include exercising, relaxing by yourself, spending time with friends and family, doing the things you like to do and getting adequate rest and sleep. 

Sleep & Immunity

The lack of sleep can affect your immune system negatively. Sleep is the body’s way to repair itself and the immune system is essential in the restoration of cells. Studies show that people who don’t get quality sleep or enough sleep are more likely to get sick after being exposed to a virus, such as a common cold virus. Lack of sleep can also affect how fast you recover if you do get sick. During sleep, your immune system releases proteins called cytokines, some of which help promote sleep. Certain cytokines need to increase when you have an infection or inflammation, or when you’re under stress.

Sleep deprivation may decrease production of these protective cytokines. In addition, infection-fighting antibodies and cells are reduced during periods when you don’t get enough sleep. The lack of sleep is not just associated with physical health problems, it is associated with mental health problems as well. 

Both quality and quantity of sleep are equally important, and sleep is important for all groups of people – from the young, to the old, and everyone in between. The problem with society today is that many of us are sleep deprived. This is something that our parents have been right all along, that sleep is essential for a healthy life. 

Vaccines for immunity strengthening?

A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. When introduced to the body, the body sees the antigen as a foreign substance and develops the mechanisms needed to eliminate this threat. With these mechanisms, the body is able to fight off this infection in future easily should it be exposed to it again. 

Different vaccines have different dosing schedules and many have been given to us as part of the National Immunization Schedule. Some vaccines like the influenza vaccine have to be given every year, some vaccines like measles vaccine may only have to be given once in your lifetime. Speak to your doctor about what vaccines you require and what their dosing regimes are like.

In conclusion..

The most important thing to remember about immunity is maintaining a healthy and balanced life. This can be achieved with various lifestyle choices in diet and your day to day activities. During this time of concern with the Novel Coronavirus on everyone’s minds, it is important that we be socially responsible and try our best to be as healthy as we can be. Hopefully the above discussion can help in that. 


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Circumcision Healing

Circumcision Healing

“I have been performing circumcision for men for many years now,” says Dr Taufiq, resident doctor, DTAP (Dr. Tan & Partners) clinic.

One of the common fears that is stopping or holding them back from going through the procedure is the fear of pain or complications during the recovery process. Let me reassure you with our current method, having complications or pain is much less than before. However, I have compiled a list of tips to help you to optimize your recovery based on my experience and my patients’ feedback.

Also read: HOW DOES SUTURELESS CIRCUMCISION​ TECHNIQUE (SHANG RING) WORK?


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1. Have adequate rest

Especially during the first few days up to a week after the procedure, it is best to have adequate rest to allow your body to focus on healing. I will usually provide medical leave for up to a week to ensure that you have adequate rest at home.

2. Avoid strenuous activities

I know some men may get restless or feel uncomfortable with lack of physical activity especially when they are used to exercising regularly. However, this is important as well to help with recovery and avoid complications like bleeding or swelling. I had a few patients who started brisk walking within a few days of procedure and ended up with swelling around the wound area. It is advised to avoid strenuous activity for 4 weeks. Normal day to day walking is allowed so don’t have to worry about this procedure affecting your daily activities. 

3. Keep it clean

After the procedure, with the ring still intact, you are allowed to shower as per normal. To keep the wound area clean, you just need to let the soap and water from your body to run down to the area. No need to specifically rub, apply soap and it. If there is an obvious liquid or residue on it you can wash it off with water. By keeping the area clean it helps to allow the wound to heal faster.

4. Keep it dry

After cleaning, the ring tends to retain water or moisture. It is advised to dry it properly before putting on your clothes. You can use a soft towel to dab dry or a hairdryer using normal temperature to dry the area. If the wound stays we may promote infection or increase serous discharge production. So make sure it is dry before you put on your pants.

5. Antibiotic powder

After the procedure, you will be prescribed antibiotic powder. This is very helpful to keep the wound dry and also prevent infection. Apply at least once to twice a day.

6. Sleep on your side

One of the common causes of discomfort after circumcision is erection. For men, erections occur naturally at night or early morning. So this sometimes causes discomfort. Sleeping on your side may help to reduce the frequency of erections at night while you’re sleeping thus minimizing discomfort.

7. Ice pack

Another effective way to minimize erections is by applying ice pack. You can standby an ice pack or a pack of frozen peas by your bedside. If in the case of an erection that is causing pain, you can apply the ice pack on your scrotum. The cold will help to reduce your erection. 

Take as soon as you start to feel discomfort.

Next read: WHAT ARE THE TOP 7 REASON MEN UNDERGO CIRCUMCISION

Next read: CIRCUMCISION REDUCES BACTERIA AND RISK OF STDS

For more information: HOW IS THE ADULT CIRCUMCISION (FORESKIN REMOVAL) PROCEDURE DONE?

Speak to your doctor if you have any questions regarding circumcision.


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FAQs on the Novel Coronavirus (2019-nCoV)

FAQs on COVID-19 the Novel Coronavirus (2019-nCoV)


1. What is the Novel Coronavirus (COVID-19)? 

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Named for the crown-like spikes on their surfaces, they infect mostly bats, pigs and small mammals. They mutate easily and can spread from animals to humans, and from one human to another.

2. What do we know about the Novel Coronavirus (COVID-19) so far?

The outbreak is understood to have originated in December 2019 in Huanan Seafood Wholesale Market in Wuhan, the largest city in central China with a population of 11 million people. It is thought that wild animals are the source of the virus. 

Chinese scientists believe that the virus might have jumped from bats to snakes, which were then sold in the market, and subsequently transmitted to humans. However, some scientists are skeptical of this conclusion. The market has since been shut down and disinfected, which makes it more difficult to identify the source animal.

3. How does the Novel Coronavirus (COVID-19) spread?

According to the US Centres for Disease Control and Prevention (CDC), it is still unclear how easily or sustainably this virus is spreading between people. It is thought that the virus is likely to be spread via respiratory droplets produced by an infected person. Therefore, the spread can occur from close contact (approximately 2 metres) with an infected person over a period of 30 minutes or more.

4. Can the Novel Coronavirus (COVID-19) be transmitted by someone with no symptoms (asymptomatic)? 

It seems likely so. On Sunday (26th Jan 2020), Chinese Health Minister Ma Xiaowei said at a press briefing that they had found that people could spread the virus while asymptomatic. Two days later, a Chinese doctor repeated this at a press conference. The most recent case comes from Germany; German researchers described four business associates who became infected through asymptomatic transmission.

5. How long does the Novel Coronavirus (COVID-19) remain on surfaces such as tables, seats on public transport or gym equipment etc?

According to the US CDC, Coronaviruses generally do not survive long on inanimate surfaces. These viruses typically only survive on a surface for a few hours.

6. How different is this virus to a common case of influenza?

The virus strains are completely different. The Wuhan virus is a coronavirus whereas influenza (the flu) is caused by the influenza virus. There is an annual influenza vaccine available, but there is no vaccine against the Wuhan virus. 

This means that it is more difficult for vulnerable members of the population, such as elderly people or those with existing respiratory or immune problems, to protect themselves. There are antiviral medications eg. tamiflu is available to treat influenza, but there is no specific treatment for the Wuhan virus or pneumonia. Treatment is supportive.

7. What symptoms should we be monitoring for at home, prior to visiting a GP?   

The symptoms are the same as that of normal pneumonia.

  • Fever
  • Runny nose
  • Cough
  • Sore throat
  • Breathlessness

8. How to protect yourself against the Novel Coronavirus (COVID-19)?

  • Frequently clean hands by using alcohol-based hand rub or soap and water;
  • When coughing and sneezing cover mouth and nose with flexed elbow or tissue – throw tissue away immediately and wash hands;
  • Avoid close contact with anyone who has fever and cough;
  • If you have fever, cough and difficulty breathing seek medical care early and share previous travel history with your healthcare provider;
  • When visiting live markets in areas currently experiencing cases of novel coronavirus, avoid direct unprotected contact with live animals and surfaces in contact with animals;
  • The consumption of raw or undercooked animal products should be avoided. Raw meat, milk or animal organs should be handled with care, to avoid cross-contamination with uncooked foods, as per good food safety practices;
  • Wear a surgical mask if you have flu-like respiratory symptoms (you may wear the surgical mask even without any display of symptoms to protect yourself);
  • It is advised that surgical masks will suffice and there is no need to use N95 masks;
  • If you choose to wear a face mask, ensure the mask covers both your mouth and nose.

9. Are there any substitutes for hand sanitisers given that many places are sold out?

According to the US CDC, washing your hands with plain soap and water is the best way to maintain hygiene and prevent the spread of infections. If you wish to use hand sanitiser, you should use alcohol-based hand sanitisers, not just any regular ones. Alternatives would be alcohol (eg. isopropyl 70% or ethyl alcohol 70%) or bleach to disinfect surfaces.

10. Is it safe to travel to China? Is there anything we can do to protect ourselves when travelling?

Avoid non-essential travel, especially to China. Otherwise, the protective measures are exactly the same as mentioned above.


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ZIKA IS AN STD!! – Battling the STD Stigma

The Zika virus gained notoriety in Brazil when it was blamed for causing a spate of birth defects known as microcephaly. Babies born with microcephaly had abnormally small heads and often also suffered concurrent problems with brain development. Some children born to Zika infected mothers had normal sized heads but their heads would fail to develop normally. These are obviously horrible consequences for both the mother and child. 


Zika is a virus that is spread by mosquitoes very much like Dengue. However, it was soon discovered that Zika was also sexually transmitted. And that consistent and correct use of condoms protected pregnant women from the Zika virus and consequently their unborn children to the devastating effects of Congenital Zika Syndrome.  

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But wait a minute? Does that mean Zika is an STD? Technically it seems to fit. STD is an acronym for Sexually Transmitted Disease. Zika is a disease that is sexually transmitted. But it is predominantly transmitted via the bite from an infected mosquito. So is it an STD? If Zika is an STD then is raises other uncomfortable questions like: if a person catches chickenpox from his/her partner because they had sex, is chickenpox then an STD too? Or even the common Flu, which is spread as an airborne virus, can also easily be caught via sexual intercourse. So the common Flu is an STD!


I’ve had this discussion many times with my patients when they have been diagnosed with an infection and they ask me “is it an STD?” Sometimes, this is rather easy to answer. If they have, for example, an infection of Gonorrhoea of the penis, one can be confident to say that they caught it from a sexual contact. But at times, things get murky. A good example is an infection with Ureaplasma Urealyticum. We know this tiny bacteria can be sexually transmitted. We also know that it can seem to appear out of nowhere in mutually monogamous couples. We also know that it can be just a commensal and not a disease causing pathogen. So when a patient with an infection of his urinary tract caused by Ureaplasma asks me “is this an STD?” I am unable to give a direct black and white answer. 


The same goes for what I would describe as the most feared STD by many, and that is HIV. For a fact, the commonest way that HIV is transmitted is via sexual contact. However, we also know for a fact that HIV can be transmitted by sharing needles, contaminated surgical instruments, transfusion of contaminated blood and transplant of contaminated organs. Albeit the last 2 hardly happens anymore due to increased awareness, better infection screening protocols and technology advancement. But let’s be honest, if and when we find out someone is infected with HIV, getting injured by surgical instruments is not likely the first reason to pop into our heads.


And therein lies the issue. Answering the question “is this an STD?” does not in any way contribute to the clinical management of the disease except perhaps for contact tracing. For partner protection, the same advice will be given if the disease can be transmitted sexually regardless of whether or not it is called an “STD”. The issue, I believe, is stigma. To be labelled as having an “STD” is to be labelled as a moral or sexual deviant. But should this really be the case? Infections are caused by microorganisms invading our bodies and using our resources to make more of themselves. Drawing on resources around them to reproduce is hardcoded into the genetic material of all living things, humans being the best and worst examples. Microorganisms do not care how they are transmitted or where they infect as long as the environment they are in supports their reproduction. Microorganisms do not care about our textbooks and whether or not we call them STDs.


Consequently, some infections although predominantly transmitted by sex, can also be transmitted by other means. And some that can easily be caught via sex, are for some reason not given the label “STD”. I do hope we can eventually drop this label and treat infections for what they are – infections. Treat the patient, prevent reinfection, protect partners. Labels are useless. 

Next read: WHAT IS ANTIBIOTIC RESISTANT GONORRHEA OR SUPER GONORRHEA?


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新型冠状病毒知多少?- 新型冠状病毒

[See English Version of What You Need to Know About WuHan Virus]

目前,我们都听说了中国爆发了一种新的病毒,它已经感染了超过600人,且夺走了至少17个生命,同时疫情也在向其他国家蔓延。截至写这篇文章(1月24日)时,新加坡已经有3例被确诊为新型冠状病毒的患者。其他确诊了病例的国家和地区包括日本、韩国、泰国、美国、台湾地区、沙特阿拉伯和越南。伦敦帝国理工学院的疾病建模专家在周三(1月22日)发表的一份报告中指出,中国所报告的病例数量是较为保守的数目,目前可能有大约4000人被感染。

这一病例在我国的出现加剧了人们对致命流行病的恐惧,使人们联想起了2003年的SARS、2009年的H1N1流感和2012年的MERS。

以下是一些可能对你有帮助的信息:

这个新型冠状病毒是什么?它是如何发生的?

这个被称为新型冠状病毒的病毒属于冠状病毒的一种,冠状病毒家族中也包含着SARS和MERS。这些病毒由于其表面有冠状突起而被命名为冠状病毒,主要会感染蝙蝠、猪和小型的哺乳动物。但是这些病毒很容易变异,它可以从动物传染给人,也可以在人与人之间传播。

据了解,这一次的疫情早在去年12月就已在武汉的华南海鲜批发市场爆发。武汉是中国中部一个拥有着1100万人口的大规模城市,同时也是湖北省的省会。人们认为该病毒的来源是野生动物。中国科学家认为,病毒可能不是蝙蝠而是蛇,是由在市场上被售卖的野生动物传染给人类的。

新型冠状病毒 是如何进行传播的?

该病毒的传播方式与普通的流感相似,即通过飞沫和接触传播,比如咳嗽、接吻或者唾液接触。目前,病毒学家表示,该病毒的传染性可能比SARS弱,目前所报道的死亡率为2%。但有人担心这一病毒会进一步变异,从而变得更加致命。

新型冠状病毒有什么症状?什么情况下能够怀疑自己被感染?

如符合以下任何情况,请立即就医或前往急诊室:

1. 有发烧、咳嗽、上呼吸道症状或者呼吸困难的症状

2. 在过去14天内有去过中国大陆

3.  在发病前的14天内曾去过中国大陆的医院

4. 曾与新型冠状病毒的确诊者或者疑似病例有过密切接触

有什么可以治疗或者预防新型冠状病毒的药物或者疫苗吗?

目前还没有预防冠状病毒的疫苗。并且目前也没有可以治疗由冠状病毒引发的疾病的方法。患者将在医院接受支持性的治疗,通常会在一段时间后康复。

如果你要前往有确诊病例或者疑似病例的地区,应该考虑接种流感疫苗以防止出现流感的症状,以避免在温度检查点得到误导的结果。

我该如何保护自己?

1. 若有类似流感的呼吸道症状,应该戴上口罩

2. 即使没有任何症状,也可以在去公共场所和需要与人接触时时戴外科口罩

3. 使用外科口罩即可,无需使用N95口罩

4. 采取与预防流感相同的保护措施:勤用肥皂洗手,咳嗽或打喷嚏时用手或者纸巾捂住嘴,且远离病人

5. 感到身体不适时及时就医

我该取消前往中国的计划吗?

根据卫生部在1月23日发布的最新旅游建议,新加坡人应该避免前往武汉。中国已经对武汉进行了封城处理,所有出城的航班都已取消,火车、公共汽车和轮渡皆已经暂停运营。

卫生部提醒公众,在中国各地旅游时要保持谨慎,注意个人卫生。卫生部也建议所有旅客在返回新加坡后的两周内应该密切监控自己的健康状况,如有任何不适请立即就医,且告知医生相关的旅行史。

最后…

据世界卫生组织称,新型冠状病毒是中国的突发事件,但尚不是全球关注的突发公共健康事件。然而,随着疫情的迅速发展,所有人都应该继续跟进最新的情况和相关的新闻报道。

请保证自己的安全!

[See English Version of What You Need to Know About WuHan Virus]