Annals Academy of Medicine Singapore最新文献

英文中文

Multidisciplinary lung cancer clinic: An emerging model of care. 多学科肺癌临床:一种新兴的治疗模式。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-12-01 DOI: 10.47102/annals-acadmedsg.2022295

S. Saw, K. Chua, B. Ong, D. Lim, G. Lai, D. S. Tan, M. Ang

引用次数: 0

Idiopathic inflammatory myopathies: Not nearly the end of the road. 特发性炎症性肌病:还没有走到尽头。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-12-01

Nur Azizah Allameen, Anselm Mak

引用次数: 0

Low skeletal muscle mass predicts poor prognosis of elderly patients after emergency laparotomy: A single Asian institution experience. 低骨骼肌质量预测急诊剖腹手术后老年患者预后不良:一个亚洲机构的经验。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-12-01 DOI: 10.47102/annals-acadmedsg.2022158

E. Tan, Jia Yi Yeo, Yao Zong Lee, R. Lohan, W. W. Lim, D. J. Lee

INTRODUCTIONSarcopenia, defined as low skeletal muscle mass and poor muscle function, has been associated with worse postoperative recovery. This study aims to evaluate the significance of low muscle mass in the elderly who require emergency surgeries and the postoperative outcomes.METHODData from the emergency laparotomy database were retrieved from Khoo Teck Puat Hospital, Singapore, between 2016 and 2019. A retrospective analysis was performed on patients aged 65 years and above. Data collected included skeletal muscle index (SMI) on computed tomography scan, length of stay, complications and mortality. Low muscle mass was determined based on 25th percentile values and correlation with previous population studies.RESULTSA total of 289 patients were included for analysis. Low muscle mass was defined as L3 SMI of <22.09cm2/m2 for females and <33.4cm2/m2 for males, respectively. Seventeen percent of our patients were considered to have significantly low muscle mass. In this group, the length of stay (20.8 versus 16.2 P=0.041), rate of Clavien-Dindo IV complications (18.4% vs 7.5% P=0.035) and 1-year mortality (28.6% vs 14.6%, P=0.03) were higher. Further multivariate analysis showed that patients with low muscle mass had increased mortality within a year (odds ratio 2.16, 95% confidence interval 1.02-4.55, P=0.04). Kaplan-Meier analysis also shows that the 1-year overall survival was significantly lower in patients with low muscle mass.CONCLUSIONPatients with low muscle mass have significantly higher post-surgical complication rates and increased mortality.

骨骼肌减少症，定义为骨骼肌质量低和肌肉功能差，与较差的术后恢复有关。本研究旨在评估低肌肉量在需要急诊手术的老年人中的意义及术后结果。方法数据来自2016年至2019年新加坡Khoo Teck Puat医院的急诊剖腹手术数据库。对65岁及以上患者进行回顾性分析。收集的数据包括计算机断层扫描的骨骼肌指数(SMI)、住院时间、并发症和死亡率。低肌肉量是根据第25百分位值和与先前人群研究的相关性来确定的。结果289例患者纳入分析。低肌肉质量定义为L3 SMI，女性<22.09cm2/m2，男性<33.4cm2/m2。17%的患者被认为肌肉量明显不足。该组住院时间(20.8比16.2 P=0.041)、Clavien-Dindo IV期并发症发生率(18.4%比7.5% P=0.035)和1年死亡率(28.6%比14.6%，P=0.03)均较高。进一步的多因素分析显示，肌肉质量低的患者在一年内死亡率增加(优势比2.16,95%置信区间1.02-4.55,P=0.04)。Kaplan-Meier分析还显示，低肌肉量患者的1年总生存率明显较低。结论低肌量患者术后并发症发生率明显增高，死亡率明显增高。

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引用次数: 0

Drug interactions between common dermatological medications and the oral anti-COVID-19 agents nirmatrelvir-ritonavir and molnupiravir. 常见皮肤病药物与口服抗covid -19药物尼马特利韦-利托那韦和莫努匹拉韦的药物相互作用。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-12-01

Kathleen Shu En Quah, Xiaoling Huang, Laurent Renia, Hazel H Oon

Introduction: The oral antiviral agents nirmatrelvir-ritonavir (NMV/r) and molnupiravir are used to treat mild-to-moderate COVID-19 infection in outpatients. However, the use of NMV/r is complicated by significant drug-drug interactions (DDIs) with frequently prescribed medications. Healthcare professionals should be aware of the possible risk of DDIs, given the emergence of COVID-19 variants and the widespread use of oral COVID-19 treatments. We reviewed available data on DDIs between NMV/r, molnupiravir and common dermatological medications; summarised the potential side effects; and suggest strategies for safe COVID-19 treatment.

Method: A systematic review using PubMed was conducted on data published from inception to 18 July 2022 to find clinical outcomes of DDIs between NMV/r, molnupiravir and dermatological medications. We also searched the Lexicomp, Micromedex, Liverpool COVID-19 Drug Interactions database and the National Institutes of Health COVID-19 Treatment Guidelines for interactions between NMV/r and molnupiravir, and commonly used dermatological medications.

Results: NMV/r containing the cytochrome P-450 (CYP) 3A4 inhibitor ritonavir has DDIs with other medications similarly dependent on CYP3A4 metabolism. Dermatological medications that have DDIs with NMV/r include rifampicin, clofazimine, clarithromycin, erythromycin, clindamycin, itraconazole, ketoconazole, fluconazole, bilastine, rupatadine, dutasteride, ciclosporin, cyclophosphamide, tofacitinib, upadacitinib, colchicine and systemic glucocorticoids. With no potential DDI identified yet in in vitro studies, molnupiravir may be an alternative COVID-19 therapy in patients taking medications that have complicated interactions with NMV/r, which cannot be stopped or dose adjusted.

Conclusion: NMV/r has significant DDIs with many common dermatological medications, which may require temporary discontinuation, dosage adjustment or substitution with other anti-COVID-19 agents such as molnupiravir.

介绍:应用口服抗病毒药物尼马特利韦-利托那韦(NMV/r)和莫努匹拉韦治疗门诊轻中度COVID-19感染。然而，NMV/r的使用由于与常用处方药的显著药物相互作用(ddi)而变得复杂。鉴于COVID-19变体的出现和口服COVID-19治疗的广泛使用，卫生保健专业人员应意识到ddi的可能风险。我们回顾了NMV/r、莫努匹拉韦和常见皮肤病药物之间ddi的现有数据;总结潜在的副作用;并提出安全治疗COVID-19的策略。方法:利用PubMed系统回顾从成立到2022年7月18日发表的数据，以寻找NMV/r、molnupiravir与皮肤科药物之间ddi的临床结果。我们还检索了Lexicomp、Micromedex、利物浦COVID-19药物相互作用数据库和美国国立卫生研究院COVID-19治疗指南，以了解NMV/r与molnupiravir以及常用皮肤病药物之间的相互作用。结果:含有细胞色素P-450 (CYP) 3A4抑制剂利托那韦的NMV/r与其他类似依赖于CYP3A4代谢的药物具有ddi。具有NMV/r ddi的皮肤病药物包括利福平、氯法齐明、克拉霉素、红霉素、克林霉素、伊曲康唑、酮康唑、氟康唑、bilastine、鲁帕他定、杜他雄胺、环孢素、环磷酰胺、托法替尼、upadacitinib、秋水仙碱和全身糖皮质激素。由于体外研究尚未发现潜在的DDI，对于正在服用与NMV/r有复杂相互作用的药物的患者，molnupiravir可能是一种替代的COVID-19治疗方法，这些药物无法停药或调整剂量。结论:NMV/r与许多常见皮肤科药物存在显著的ddi，可能需要暂时停药、调整剂量或与其他抗covid -19药物(如莫努皮拉韦)替代。

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引用次数: 0

Diagnostic accuracy of multiparametric MRI in endometrial cancer and its adjunctive value in identifying high-risk women requiring surgical staging. 多参数MRI诊断子宫内膜癌的准确性及其在确定需要手术分期的高危妇女中的辅助价值。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-12-01

Lee Lian Chew, Bernard Ji Guang Chua, Inny Busmanis, Amos Zhi En Tay, Cindy Lim, Jack Junjie Chan, Kiattissa Sommat, Sun Kuie Tay, Tew Hong Ho, Jin Wei Kwek

引用次数: 0

Tozinameran (Pfizer-BioNTech COVID-19 vaccine)-induced AGEP-DRESS syndrome. Tozinameran (Pfizer-BioNTech COVID-19疫苗)诱导的AGEP-DRESS综合征。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-12-01 DOI: 10.47102/annals-acadmedsg.2022338

W. C. Tay, J. Lee, W. Chong

引用次数: 5

Lichen planus pemphigoides after pembrolizumab immunotherapy in an older man. 派姆单抗免疫治疗后的老年男性扁平苔藓类天疱疮。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-12-01 DOI: 10.47102/annals-acadmedsg.2022134

Siqing Ee, M. Liang, S. Tee, Dingyuan Wang

引用次数: 3

Meeting today's healthcare needs: Medicine at the interface. 满足当今的医疗保健需求:界面上的药物。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-12-01 DOI: 10.47102/annals-acadmedsg.2022196

J. Soong, D. Bell, M. Ong

The demographic of Singapore has undergone dramatic change. Historically, younger patients with communicable diseases predominated, whereas patients are now older with chronic multimorbidity and functional impairment. This shift challenges existing health and social care systems in Singapore, which must pivot to meet the changing need. The consequences of mismatched health and social care to patient needs are the fragmentation of care, dysfunctional acute care utilisation and increasing care costs. In Singapore and internationally, there is an inexorable rise in acute care utilisation, with patients facing the greatest point of vulnerability at transitions between acute and chronic care. Recently, innovative care models have developed to work across the boundaries of traditional care interfaces. These "Interface Medicine" models aim to provide a comprehensive and integrated approach to meet the healthcare needs of today and optimise value with our finite resources. These models include Acute Medical Units, Ambulatory Emergency Care, Extensivist-Comprehensivist Care, Virtual Wards, Hospital-at-Home and Acute Frailty Units. We describe these models of care across the acute care chain and explore how they may apply to the Singapore setting. We discuss how these models have evolved, appraise the evidence for clinical effectiveness, point out gaps in knowledge for further study and make recommendations for future progress.

新加坡的人口结构发生了巨大的变化。从历史上看，年轻的传染性疾病患者占主导地位，而现在的患者年龄较大，患有慢性多种疾病和功能障碍。这种转变对新加坡现有的卫生和社会保健系统提出了挑战，该系统必须适应不断变化的需求。卫生和社会护理与患者需求不匹配的后果是护理的碎片化、急性护理的不正常利用和护理成本的增加。在新加坡和国际上，急症护理的使用率不可避免地上升，患者在急症和慢性护理之间的过渡中面临着最大的脆弱性。最近，创新的护理模式已经发展到跨越传统护理界面的边界。这些“界面医疗”模式旨在提供全面和综合的方法，以满足当今的医疗需求，并利用有限的资源实现价值最大化。这些模式包括急症医疗单位、流动急诊护理、广泛综合护理、虚拟病房、居家医院和急症虚弱单位。我们在急性护理链中描述了这些护理模式，并探讨了它们如何适用于新加坡的环境。我们讨论了这些模型是如何演变的，评估了临床有效性的证据，指出了进一步研究的知识差距，并为未来的进展提出了建议。

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引用次数: 1

Erdheim-Chester disease: Imaging spectrum of multisystemic manifestations. 厄德海姆-切斯特病:多系统表现的影像谱。

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-11-01

Amos Hui Sheng Tan, Sunita Dhanda, Pooja Jagmohan, Pavel Singh, James Thomas Patrick Decourcy Hallinan, Swee Tian Quek

引用次数: 0

A recurring nasal mass. 反复出现的鼻肿块

IF 5.2 4区医学 Q2 Medicine

Annals Academy of Medicine Singapore

Pub Date : 2022-11-01

Javier Lek Wei Loo, Caroline Chun Yun Lee, Jeevendra Kanagalingam, Christopher G L Hobbs, Ming Yann Lim

引用次数: 0

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