Pub Date : 2022-12-01DOI: 10.47102/annals-acadmedsg.2022125
L. Chew, Bernard Ji Guang Chua, I. Busmanis, A. Tay, C. Lim, Jack Junjie Chan, Kiattissa Sommat, S. Tay, T. Ho, J. Kwek
{"title":"Diagnostic accuracy of multiparametric MRI in endometrial cancer and its adjunctive value in identifying high-risk women requiring surgical staging.","authors":"L. Chew, Bernard Ji Guang Chua, I. Busmanis, A. Tay, C. Lim, Jack Junjie Chan, Kiattissa Sommat, S. Tay, T. Ho, J. Kwek","doi":"10.47102/annals-acadmedsg.2022125","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2022125","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12 1","pages":"801-803"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47752016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edmund Wooi Keat Tan, Jia Yi Yeo, Yao Zong Lee, Rahul Lohan, Woan Wui Lim, Daniel Jin Keat Lee
Introduction: Sarcopenia, 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.
Method: Data 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.
Results: A 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.
Conclusion: Patients 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，与术后较差的恢复有关。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:数据来自新加坡Khoo Teck Puat医院2016年至2019年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。低肌量定义为L3级SMI (P=0.041)， Clavien-Dindo IV期并发症发生率(18.4% vs 7.5% P=0.035)和1年死亡率(28.6% vs 14.6%， P=0.03)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:低肌肉量患者术后并发症发生率高，死亡率高。
{"title":"Low skeletal muscle mass predicts poor prognosis of elderly patients after emergency laparotomy: A single Asian institution experience.","authors":"Edmund Wooi Keat Tan, Jia Yi Yeo, Yao Zong Lee, Rahul Lohan, Woan Wui Lim, Daniel Jin Keat Lee","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcopenia, 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.</p><p><strong>Method: </strong>Data 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.</p><p><strong>Results: </strong>A 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 <i>P</i>=0.041), rate of Clavien-Dindo IV complications (18.4% vs 7.5% <i>P</i>=0.035) and 1-year mortality (28.6% vs 14.6%, <i>P</i>=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, <i>P</i>=0.04). Kaplan-Meier analysis also shows that the 1-year overall survival was significantly lower in patients with low muscle mass.</p><p><strong>Conclusion: </strong>Patients with low muscle mass have significantly higher post-surgical complication rates and increased mortality.</p>","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12","pages":"766-773"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10475780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.47102/annals-acadmedsg.2022278
C. Chua, Jia Zhen Low, W. Lim, M. Manghani
INTRODUCTION This study aimed to determine the clinical profile and outcome of anti-transcriptional intermediary factor 1 gamma autoantibody (anti-TIF1-γ Ab)-positive dermatomyositis patients and propose cancer screening programmes based on regional cancer trends. METHOD Data on history, physical findings and investigations were collected using chart review on dermatomyositis patients seen at a tertiary hospital in Singapore from 1 January 2015 to 30 June 2021. Comparisons were made between anti-TIF1-γ Ab-positive and anti-TIF1-γ Ab-negative dermatomyositis. RESULTS Ninety-six dermatomyositis patients were analysed and 36 patients were positive for anti-TIF1-γ Ab. Anti-TIF1-γ Ab-positive patients had more frequent heliotrope rashes, shawl sign, periungual erythema, holster sign, Gottron's papules, dysphagia and truncal weakness (P<0.05). They had less frequent interstitial lung disease, polyarthritis, cutaneous ulcers, palmar papules and mechanic's hands (P<0.05). After 48 months of follow-up, a higher proportion of anti-TIF1-γ Ab-positive patients developed cancer compared with Ab-negative patients (63.9% versus 8.5%; odds ratio 19.1, 95% confidence interval 6.1-59.8; P<0.001). Nasopharyngeal carcinoma (NPC) and breast cancer were the most common malignancies, followed by bowel, lung and non-Hodgkin lymphoma. Most malignancies (78.3%) occurred within 13 months prior to, or 4 months after the onset of dermatomyositis. The mortality rate for anti-TIF1-γ Ab-positive patients was significantly higher than Ab-negative patients (36.1% vs 16.7%, P=0.031), and Kaplan-Meier survival estimates at 24 months were 66% and 89%, respectively (P=0.0153). CONCLUSION These observational data support periodic screening of NPC and other malignancies in patients with anti-TIF1-γ Ab-positive dermatomyositis in Singapore.
{"title":"Characteristics of anti-transcriptional intermediary factor 1 gamma autoantibody-positive dermatomyositis patients in Singapore.","authors":"C. Chua, Jia Zhen Low, W. Lim, M. Manghani","doi":"10.47102/annals-acadmedsg.2022278","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2022278","url":null,"abstract":"INTRODUCTION\u0000This study aimed to determine the clinical profile and outcome of anti-transcriptional intermediary factor 1 gamma autoantibody (anti-TIF1-γ Ab)-positive dermatomyositis patients and propose cancer screening programmes based on regional cancer trends.\u0000\u0000\u0000METHOD\u0000Data on history, physical findings and investigations were collected using chart review on dermatomyositis patients seen at a tertiary hospital in Singapore from 1 January 2015 to 30 June 2021. Comparisons were made between anti-TIF1-γ Ab-positive and anti-TIF1-γ Ab-negative dermatomyositis.\u0000\u0000\u0000RESULTS\u0000Ninety-six dermatomyositis patients were analysed and 36 patients were positive for anti-TIF1-γ Ab. Anti-TIF1-γ Ab-positive patients had more frequent heliotrope rashes, shawl sign, periungual erythema, holster sign, Gottron's papules, dysphagia and truncal weakness (P<0.05). They had less frequent interstitial lung disease, polyarthritis, cutaneous ulcers, palmar papules and mechanic's hands (P<0.05). After 48 months of follow-up, a higher proportion of anti-TIF1-γ Ab-positive patients developed cancer compared with Ab-negative patients (63.9% versus 8.5%; odds ratio 19.1, 95% confidence interval 6.1-59.8; P<0.001). Nasopharyngeal carcinoma (NPC) and breast cancer were the most common malignancies, followed by bowel, lung and non-Hodgkin lymphoma. Most malignancies (78.3%) occurred within 13 months prior to, or 4 months after the onset of dermatomyositis. The mortality rate for anti-TIF1-γ Ab-positive patients was significantly higher than Ab-negative patients (36.1% vs 16.7%, P=0.031), and Kaplan-Meier survival estimates at 24 months were 66% and 89%, respectively (P=0.0153).\u0000\u0000\u0000CONCLUSION\u0000These observational data support periodic screening of NPC and other malignancies in patients with anti-TIF1-γ Ab-positive dermatomyositis in Singapore.","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12 1","pages":"755-765"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42115402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Tshon Yit Soong, Derek Bell, Marcus Eng Hock 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.
{"title":"Meeting today's healthcare needs: Medicine at the interface.","authors":"John Tshon Yit Soong, Derek Bell, Marcus Eng Hock Ong","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12","pages":"787-792"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10475776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.47102/annals-acadmedsg.2022455
N. A. Allameen, A. Mak
{"title":"Idiopathic inflammatory myopathies: Not nearly the end of the road.","authors":"N. A. Allameen, A. Mak","doi":"10.47102/annals-acadmedsg.2022455","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2022455","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12 1","pages":"750-751"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41313505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sylvia Chen, Wai Fook Leong, Sze Sing Lee, Balram Chowbay
{"title":"Pharmacokinetic and pharmacogenomic considerations in managing use of nirmatrelvir-ritonavir and molnupiravir and dermatological treatments.","authors":"Sylvia Chen, Wai Fook Leong, Sze Sing Lee, Balram Chowbay","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12","pages":"752-754"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10480579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikki Fong, Jiin Ying Lim, Breana Cham, Sylvia Kam, Chew Yin Goh, Heming Wei, Yuen Ming Tan, Hai Yang Law, Weng Khong Lim, Ee Shien Tan, Ene Choo Tan, Saumya Shekhar Jamuar
{"title":"Rapid exome sequencing to aid diagnostics in genetic disorders: Implementation and challenges in the Singapore context.","authors":"Nikki Fong, Jiin Ying Lim, Breana Cham, Sylvia Kam, Chew Yin Goh, Heming Wei, Yuen Ming Tan, Hai Yang Law, Weng Khong Lim, Ee Shien Tan, Ene Choo Tan, Saumya Shekhar Jamuar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12","pages":"798-800"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10480581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.47102/annals-acadmedsg.202252
Nikki Fong, J. Lim, B. Cham, Sylvia Kam, C. Goh, Heming Wei, Y. Tan, H. Law, W. K. Lim, E. Tan, E. Tan, S. Jamuar
{"title":"Rapid exome sequencing to aid diagnostics in genetic disorders: Implementation and challenges in the Singapore context.","authors":"Nikki Fong, J. Lim, B. Cham, Sylvia Kam, C. Goh, Heming Wei, Y. Tan, H. Law, W. K. Lim, E. Tan, E. Tan, S. Jamuar","doi":"10.47102/annals-acadmedsg.202252","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.202252","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12 1","pages":"798-800"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44219731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siqing Ee, Michelle Weiting Liang, Shang Ian Tee, Ding Yuan Wang
{"title":"Lichen planus pemphigoides after pembrolizumab immunotherapy in an older man.","authors":"Siqing Ee, Michelle Weiting Liang, Shang Ian Tee, Ding Yuan Wang","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12","pages":"804-806"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10480580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.47102/annals-acadmedsg.2022430
Sylvia Chen, W. Leong, Sze Sing Lee, B. Chowbay
{"title":"Pharmacokinetic and pharmacogenomic considerations in managing use of nirmatrelvir-ritonavir and molnupiravir and dermatological treatments.","authors":"Sylvia Chen, W. Leong, Sze Sing Lee, B. Chowbay","doi":"10.47102/annals-acadmedsg.2022430","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2022430","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":"51 12 1","pages":"752-754"},"PeriodicalIF":5.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46872093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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