Singapore medical journal最新文献

Introduction: The clinical outcomes of open-wedge high-tibial osteotomy (HTO) combined with bone marrow stimulation techniques (BMSTs) (microfracture [MF], subchondral drilling [SD], microdrilling [MD] and abrasion arthroplasty[AA]) in patients with knee osteoarthritis are unclear. The aim of this systematic review was to present an up-to-date summary of the clinical outcomes associated with HTO combined with BMST in patients with knee osteoarthritis.

Methods: A systematic database search on PubMed, Embase, Web of Science, and CINAHL was performed from inception up to 3 March 2024 in accordance with the PRISMA guideline. A narrative synthesis was undertaken to complement the quantitative analysis done.

Results: A total of 11 studies involving 516 patients were included. Six studies reported HTO with MF, one reported HTO with SD, two reported HTO with MD, one reported HTO with AA, and one reported HTO with chondral resurfacing. The average mean follow-up period was 33 months (range 12-120). Overall, most of the studies reported an improvement in cartilage regeneration and clinical scores above the minimal clinically important difference.

Conclusion: While HTO with BMST shows good clinical outcomes and postoperative cartilage regeneration, the reported outcomes are highly heterogeneous. More comparative studies are needed to establish whether HTO with BMST should be recommended over isolated HTO in practice.

Introduction: Deprescribing antihypertensives is recommended when the treatment risks outweigh benefits, but evidence on the long-term outcomes in real-world multimorbidity populations remains limited. This study examined the clinical effects of deprescribing antihypertensives on blood pressure (BP) control and safety outcomes at 3 and 12 months of follow-up.

Methods: From January 2021 to December 2022, we conducted a retrospective review of 108 polyclinic patients aged ≥60 years who had antihypertensives deprescribed. The primary outcome was the proportion of patients who remained within individualised BP targets. Secondary outcomes were maintenance of deprescribing and changes in absolute BP, number of antihypertensives and pill count. Safety outcomes assessed included giddiness, postural hypotension, falls and hospital admissions.

Results: Among the 108 patients (mean age 77.3 years, 54.6% female, 80.6% Chinese), 93.5% and 69.4% maintained deprescribing at 3 and 12 months, respectively. There was no difference in the proportion who remained within BP targets at 12 months (86.1% vs. 94.4%, P = 0.0636) despite an initial decrease in the proportion at 3 months (74.1% vs. 94.4%, P < 0.0001). Systolic BP increased from a baseline of 124.2 mmHg to 133.9 mmHg at 3 months, stabilising at 133.5 mmHg by 12 months. The proportion with postural hypotension decreased ( P = 0.0009), while giddiness ( P = 0.0872) and falls ( P = 0.2100) showed no difference at 12 months. Hospital admissions increased marginally in the study population ( P = 0.0490) but not in the subgroup that maintained deprescribing.

Conclusion: There was no difference in BP control at 12 months after deprescribing despite a transient decline at 3 months. This supports the feasibility of deprescribing antihypertensives in older adults in primary care. Further research is needed to evaluate the safety outcomes in larger populations with specific cardiovascular comorbidities.

Abstract: Post-intensive care syndrome (PICS) refers to a constellation of chronic symptoms and deficits experienced by both adult and paediatric survivors of critical illness. These may include impairment in physical, cognitive and mental domains several months after admission to the intensive care unit. Affected patients may experience chronic pain, sleep disturbances and swallowing dysfunction, which may impact their quality of life. Beyond the medical consequences, PICS poses psychological and financial challenges to both patients and their caregivers. This state-of-the-art review provides a comprehensive overview of current evidence on PICS, including key risk factors, screening instruments and potential treatment strategies. Future efforts should prioritise standardised data collection, family-centred care and restoration of health-related quality of life.

Introduction: Interstitial lung disease (ILD) in systemic sclerosis (SSc) is heterogeneous with varied progression rate. This study aimed to identify the baseline clinical characteristics associated with ILD progression within 1, 3 and 5 years of the diagnosis of ILD.

Methods: This was a prospective, multicentre study - Systematic Sclerosis Cohort Singapore - conducted from January 2008 to February 2021, which included SSc patients with ILD diagnosed by high-resolution computed tomography. Progression of ILD was defined by forced vital capacity (FVC) decline ≥10% predicted or FVC decline 5%-9% predicted, with diffusing lung capacity of carbon monoxide decline ≥15% from the time of ILD diagnosis. Multivariable logistic and Cox regression analyses, adjusting for malignancy and treatment, were performed to determine independent risk factors of ILD progression.

Results: Of 124 SSc patients with ILD, 47.6% had limited cutaneous SSc, 33.9% had diffuse SSc and 18.5% had SSc-overlap. Progression of ILD was seen in 6%, 15% and 23% of patients within 1, 3 and 5 years, respectively. After adjusting for malignancy and treatment, anti-La was associated with ILD progression within 1 year (odds ratio [OR] 6.94, 95% confidence interval [CI]: 1.14-42.2; P = 0.04) and 3 years (OR 5.98, 95% CI: 1.31-27.4; P = 0.02), and anti-Scl-70 was associated with ILD progression within 5 years (OR 2.54, 95% CI: 1.05-6.12; P = 0.04). Analysing time to ILD progression as an outcome, anti-La was significantly associated with higher risk of ILD progression (hazard ratio 3.47, 95% CI: 1.18-10.2; P = 0.02). Time to ILD progression was 1.4 years in patients with anti-La versus 6.9 years in patients without anti-La ( P = 0.02), and 4.7 years in patients with anti-Scl-70 versus 8.9 years in patients without anti-Scl-70 ( P = 0.12).

Conclusion: In this Asian cohort of SSc patients, autoantibodies may help to predict ILD progression rates.