Pub Date : 2024-09-13DOI: 10.4103/singaporemedj.SMJ-2023-150
Seong-Mi Yang, Seung Eun Song, Ji-Yoon Jung, Jae-Woo Ju, Jin Young Sohn, Ho-Jin Lee, Won Ho Kim
Introduction: Maintaining adequate preload during kidney transplantation (KT) is important for graft function. We evaluated whether a high or low normal target for a dynamic preload index of stroke volume variation (SVV) would impact graft function during living donor KT.
Methods: We compared haemodynamic management algorithms using two different targets of SVV: SVV6% group (n = 30) versus SVV12% group (n = 30). Crystalloids were administered to achieve SVV less than the assigned target. Neutrophil gelatinase-associated lipocalin (NGAL) level at the end of surgery was compared. We also compared the incidence of delayed graft function (DGF), daily serum creatinine level and glomerular filtration rate (GFR) until 2 weeks postoperatively.
Results: The total amount of crystalloids administered was significantly different between the SVV6% and SVV12% groups (median [interquartile range] 2,250 [1,700-3,600] vs. 1,350 [1,050-1,900], P < 0.001). There was no significant difference in NGAL level at the end of the operation between the SVV6% and SVV12% groups (395 [234-560] vs. 518 [346-654], P = 0.115). The incidence of DGF was not significantly different, and there was no significant difference in the postoperative serum creatinine levels or GFR between the groups.
Conclusions: Our randomised trial demonstrated that an SVV target of either 6% or 12% could be adequate as a preload management target for postoperative graft function during living donor KT. However, given the low incidence of DGF in living donor KT and type II error, our study should be interpreted carefully and further studies for deceased donor KT are required.
导言:肾移植(KT)期间保持足够的前负荷对移植物功能非常重要。我们评估了搏出量变化(SVV)这一动态前负荷指标的正常目标值过高或过低是否会影响活体肾移植过程中的移植物功能:我们比较了使用两种不同 SVV 目标的血流动力学管理算法:SVV6% 组(n = 30)和 SVV12% 组(n = 30)。使用晶体液使 SVV 小于指定目标。比较了手术结束时中性粒细胞明胶酶相关脂质体(NGAL)的水平。我们还比较了移植功能延迟(DGF)的发生率、每日血清肌酐水平以及术后两周前的肾小球滤过率(GFR):结果:SVV6%组和SVV12%组的晶体液总用量有显著差异(中位数[四分位距]2,250 [1,700-3,600] vs. 1,350 [1,050-1,900], P <0.001)。手术结束时,SVV6% 组和 SVV12% 组的 NGAL 水平无明显差异(395 [234-560] vs. 518 [346-654],P = 0.115)。DGF的发生率无明显差异,术后血清肌酐水平或GFR在两组间也无明显差异:我们的随机试验表明,6%或12%的SVV目标可以作为活体供体KT术后移植物功能的前负荷管理目标。然而,鉴于活体供体 KT 的 DGF 发生率较低且存在 II 型误差,因此应谨慎解释我们的研究,并需要对死亡供体 KT 进行进一步研究。
{"title":"Comparison of two different preload targets of stroke volume variation during kidney transplantation: a randomised controlled trial.","authors":"Seong-Mi Yang, Seung Eun Song, Ji-Yoon Jung, Jae-Woo Ju, Jin Young Sohn, Ho-Jin Lee, Won Ho Kim","doi":"10.4103/singaporemedj.SMJ-2023-150","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-150","url":null,"abstract":"<p><strong>Introduction: </strong>Maintaining adequate preload during kidney transplantation (KT) is important for graft function. We evaluated whether a high or low normal target for a dynamic preload index of stroke volume variation (SVV) would impact graft function during living donor KT.</p><p><strong>Methods: </strong>We compared haemodynamic management algorithms using two different targets of SVV: SVV6% group (n = 30) versus SVV12% group (n = 30). Crystalloids were administered to achieve SVV less than the assigned target. Neutrophil gelatinase-associated lipocalin (NGAL) level at the end of surgery was compared. We also compared the incidence of delayed graft function (DGF), daily serum creatinine level and glomerular filtration rate (GFR) until 2 weeks postoperatively.</p><p><strong>Results: </strong>The total amount of crystalloids administered was significantly different between the SVV6% and SVV12% groups (median [interquartile range] 2,250 [1,700-3,600] vs. 1,350 [1,050-1,900], P < 0.001). There was no significant difference in NGAL level at the end of the operation between the SVV6% and SVV12% groups (395 [234-560] vs. 518 [346-654], P = 0.115). The incidence of DGF was not significantly different, and there was no significant difference in the postoperative serum creatinine levels or GFR between the groups.</p><p><strong>Conclusions: </strong>Our randomised trial demonstrated that an SVV target of either 6% or 12% could be adequate as a preload management target for postoperative graft function during living donor KT. However, given the low incidence of DGF in living donor KT and type II error, our study should be interpreted carefully and further studies for deceased donor KT are required.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.4103/singaporemedj.SMJ-2023-088
Yingxian Natalie Ong, Yi Ling Eileen Koh, Ngiap Chuan Tan
{"title":"Usage of patient portals among primary healthcare professionals: a cross-sectional study.","authors":"Yingxian Natalie Ong, Yi Ling Eileen Koh, Ngiap Chuan Tan","doi":"10.4103/singaporemedj.SMJ-2023-088","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-088","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.4103/singaporemedj.SMJ-2023-281
Shuen-Loong Tham, Audrey Jia Yi Lee, Koh Kuan Cheryl Tan, Alfred Wai Ping Seng
Introduction: Platypnoea-orthodeoxia syndrome (POS) is an uncommon clinical entity characterised by dyspnoea and platypnoea (oxygen desaturation that follows the assumption of an upright position from recumbency). Since the coronavirus disease 2019 (COVID-19) outbreak, increasing reports of COVID-19-related POS and its associated morbidity have been reported around the world. We aimed to study the characteristics of COVID-19-related POS and orthodeoxia (including associations leading to a more prolonged orthodeoxia), and the postdischarge functional outcomes of patients with COVID-19-related POS.
Methods: An observational cohort study was conducted in a tertiary hospital that managed post-COVID-19 patients. Twenty-four participants with severe-to-critical COVID-19 disease/pneumonia and POS, who received inpatient pulmonary rehabilitation, were enrolled. Descriptive analysis of the data was performed to describe POS/orthodeoxia characteristics and functional outcomes in these participants. Correlation analyses were carried out to identify significant factors associated with a prolonged orthodeoxia.
Results: The mean duration of POS and orthodeoxia was 12.9 ± 8.3 days and 28.5 ± 14.6 days, respectively. All participants demonstrated resolution of POS and orthodeoxia by hospital discharge. On multivariable analysis, intensive care unit admission and maximal level of respiratory support were significantly associated with a prolonged duration of orthodeoxia. One participant was lost to follow-up. The remaining 23 participants achieved independence in self-care. With the exception of one patient, who was recovering from a hip fracture, the rest achieved independence in ambulation and independent community access.
Conclusion: Resolution of orthodeoxia was observed in all our participants with COVID-19-related POS. Good functional outcome can be attained with timely and effective rehabilitation interventions.
{"title":"Characteristics and outcomes of reversible platypnoea-orthodeoxia syndrome in COVID-19 pneumonia.","authors":"Shuen-Loong Tham, Audrey Jia Yi Lee, Koh Kuan Cheryl Tan, Alfred Wai Ping Seng","doi":"10.4103/singaporemedj.SMJ-2023-281","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-281","url":null,"abstract":"<p><strong>Introduction: </strong>Platypnoea-orthodeoxia syndrome (POS) is an uncommon clinical entity characterised by dyspnoea and platypnoea (oxygen desaturation that follows the assumption of an upright position from recumbency). Since the coronavirus disease 2019 (COVID-19) outbreak, increasing reports of COVID-19-related POS and its associated morbidity have been reported around the world. We aimed to study the characteristics of COVID-19-related POS and orthodeoxia (including associations leading to a more prolonged orthodeoxia), and the postdischarge functional outcomes of patients with COVID-19-related POS.</p><p><strong>Methods: </strong>An observational cohort study was conducted in a tertiary hospital that managed post-COVID-19 patients. Twenty-four participants with severe-to-critical COVID-19 disease/pneumonia and POS, who received inpatient pulmonary rehabilitation, were enrolled. Descriptive analysis of the data was performed to describe POS/orthodeoxia characteristics and functional outcomes in these participants. Correlation analyses were carried out to identify significant factors associated with a prolonged orthodeoxia.</p><p><strong>Results: </strong>The mean duration of POS and orthodeoxia was 12.9 ± 8.3 days and 28.5 ± 14.6 days, respectively. All participants demonstrated resolution of POS and orthodeoxia by hospital discharge. On multivariable analysis, intensive care unit admission and maximal level of respiratory support were significantly associated with a prolonged duration of orthodeoxia. One participant was lost to follow-up. The remaining 23 participants achieved independence in self-care. With the exception of one patient, who was recovering from a hip fracture, the rest achieved independence in ambulation and independent community access.</p><p><strong>Conclusion: </strong>Resolution of orthodeoxia was observed in all our participants with COVID-19-related POS. Good functional outcome can be attained with timely and effective rehabilitation interventions.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.4103/singaporemedj.SMJ-2023-155
Jinghao Nicholas Ngiam, Matthew Chung Yi Koh, Priscillia Lye, Tze Sian Liong, Lizhen Ong, Paul Anantharajah Tambyah, Jyoti Somani
Introduction: Tuberculous meningitis (TBM) can be difficult to diagnose. Elevated cerebrospinal fluid (CSF) adenosine deaminase (ADA) is often seen in TBM, but its reliability has been questioned. A previous meta-analysis in 2017 had demonstrated the diagnostic utility of CSF ADA in TBM versus non-TBM. We sought to update this meta-analysis with more recent studies, to determine whether CSF ADA could be used to aid in the early recognition of TBM.
Methods: Electronic searches were performed in PubMed and Scopus on studies published from 2016 to 2022. Ten additional studies were identified and added to 20 studies (from 2000 to 2016) from a previous meta-analysis. Meta-analysis was conducted using the random effects method, estimating the pooled diagnostic odds ratio (DOR) for elevated CSF ADA in the diagnosis of TBM.
Results: Of the 30 studies included, 16/30 (53.3%) used the Giusti method for measuring ADA. Fourteen (46.7%) studies used an ADA cut-off of 10 IU/L, and 11 (36.7%) studies used an even lower cut-off. The pooled DOR for elevated CSF ADA in the diagnosis of TBM was 45.40 (95% confidence interval [CI] 31.96-64.47, I2 = 44%). When only studies using the Giusti method were considered, DOR was 44.21 (95% CI 28.37-68.91, I2 = 40%). Among the studies that used a cut-off of 10 IU/L, DOR was 58.09 (95% CI 33.76-99.94, I2 = 41%).
Conclusion: Studies remain heterogeneous but demonstrate that CSF ADA can differentiate TBM from non-TBM. In line with most studies, CSF ADA >10 IU/L supports the diagnosis of TBM in a patient with compatible symptoms and high-risk epidemiology.
介绍:结核性脑膜炎(TBM)很难诊断。脑脊液(CSF)腺苷脱氨酶(ADA)升高经常见于TBM,但其可靠性一直受到质疑。之前在 2017 年进行的一项荟萃分析表明了 CSF ADA 在 TBM 与非 TBM 中的诊断效用。我们试图用更多的最新研究来更新这项荟萃分析,以确定 CSF ADA 是否可用于帮助早期识别 TBM:在 PubMed 和 Scopus 上对 2016 年至 2022 年发表的研究进行了电子检索。在之前的一项荟萃分析的20项研究(2000年至2016年)的基础上,又确定了10项研究。采用随机效应法进行荟萃分析,估算TBM诊断中CSF ADA升高的集合诊断几率比(DOR):在纳入的 30 项研究中,16/30(53.3%)采用朱斯蒂法测量 ADA。14项(46.7%)研究使用的 ADA 临界值为 10 IU/L,11 项(36.7%)研究使用的临界值更低。诊断 TBM 时 CSF ADA 升高的汇总 DOR 为 45.40(95% 置信区间 [CI] 31.96-64.47,I2 = 44%)。如果只考虑使用朱斯蒂方法的研究,DOR 为 44.21(95% 置信区间 28.37-68.91,I2 = 40%)。在使用 10 IU/L 临界值的研究中,DOR 为 58.09(95% CI 33.76-99.94,I2 = 41%):结论:研究结果仍不尽相同,但证明 CSF ADA 可以区分 TBM 和非 TBM。与大多数研究结果一致的是,CSF ADA >10 IU/L 可支持对症状符合且流行病学风险较高的患者进行 TBM 诊断。
{"title":"Role of cerebrospinal fluid adenosine deaminase measurement in the diagnosis of tuberculous meningitis: an updated systematic review and meta-analysis.","authors":"Jinghao Nicholas Ngiam, Matthew Chung Yi Koh, Priscillia Lye, Tze Sian Liong, Lizhen Ong, Paul Anantharajah Tambyah, Jyoti Somani","doi":"10.4103/singaporemedj.SMJ-2023-155","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-155","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculous meningitis (TBM) can be difficult to diagnose. Elevated cerebrospinal fluid (CSF) adenosine deaminase (ADA) is often seen in TBM, but its reliability has been questioned. A previous meta-analysis in 2017 had demonstrated the diagnostic utility of CSF ADA in TBM versus non-TBM. We sought to update this meta-analysis with more recent studies, to determine whether CSF ADA could be used to aid in the early recognition of TBM.</p><p><strong>Methods: </strong>Electronic searches were performed in PubMed and Scopus on studies published from 2016 to 2022. Ten additional studies were identified and added to 20 studies (from 2000 to 2016) from a previous meta-analysis. Meta-analysis was conducted using the random effects method, estimating the pooled diagnostic odds ratio (DOR) for elevated CSF ADA in the diagnosis of TBM.</p><p><strong>Results: </strong>Of the 30 studies included, 16/30 (53.3%) used the Giusti method for measuring ADA. Fourteen (46.7%) studies used an ADA cut-off of 10 IU/L, and 11 (36.7%) studies used an even lower cut-off. The pooled DOR for elevated CSF ADA in the diagnosis of TBM was 45.40 (95% confidence interval [CI] 31.96-64.47, I2 = 44%). When only studies using the Giusti method were considered, DOR was 44.21 (95% CI 28.37-68.91, I2 = 40%). Among the studies that used a cut-off of 10 IU/L, DOR was 58.09 (95% CI 33.76-99.94, I2 = 41%).</p><p><strong>Conclusion: </strong>Studies remain heterogeneous but demonstrate that CSF ADA can differentiate TBM from non-TBM. In line with most studies, CSF ADA >10 IU/L supports the diagnosis of TBM in a patient with compatible symptoms and high-risk epidemiology.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Population health research in Singapore: the experience of a research centre.","authors":"Eunice Huiying Tong, Lynn Yi-Ching Ho, Gladis Jing Lin, Chien Earn Lee, Lian Leng Low","doi":"10.4103/singaporemedj.SMJ-2023-196","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-196","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.4103/singaporemedj.SMJ-2023-081
Ashiley Annushri Thenpandiyan, Ryan Ruiyang Ling, Robert Grignani, Megan Ruien Ling, Arthena Anushka Thenpandiyan, Bee Choo Tai, Jyoti Somani, Kollengode Ramanathan, Swee Chye Quek
Introduction: Myopericarditis is a rare but serious coronavirus disease 2019 (COVID-19) vaccine-related adverse event primarily affecting adolescents. Given recent approvals for childhood vaccination, we performed a meta-analysis investigating myopericarditis following messenger ribonucleic acid COVID-19 vaccination in children aged <19 years, focusing on its overall risk and high-risk subgroups.
Methods: We searched MEDLINE via PubMed, Embase and Scopus from inception to 1 August 2022 for observational studies reporting myopericarditis in temporal relation to paediatric COVID-19 vaccination. We conducted random-effects meta-analyses (DerSimonian and Laird) on myopericarditis (primary outcome), myocarditis and pericarditis (secondary outcomes).
Results: Of 2115 studies, 12 (59,229,160 doses) studies were included in our analysis. There were 19.8 (95% confidence interval [CI]: 10.4-37.6) myopericarditis cases reported per million doses in children, compared to 23.7 (95% CI: 12.2-46.1) cases in adults (eight studies, 376,899,888 doses; P = 0.70). Compared to the second dose (34.4, 95% CI: 15.2-77.8), the number of cases post-first dose was significantly lower (9.1, 95% CI: 4.4-18.8; P = 0.017), while the number of cases post-third dose was not higher than that of post-second dose (28.4, 95% CI: 10.4-61.8; P = 0.57, global P = 0.031). Males were at higher risk of myopericarditis (67.4, 95% CI: 36.5-124.5) than females (6.9, 95% CI: 3.1-15.3; P < 0.0001). Finally, the number of cases was higher (overall P < 0.0001) among children aged ≥12 years (39.9, 95% CI: 24.1-66.0) than among children aged <12 years (3.0, 95% CI: 2.3-3.9).
Conclusion: Our meta-analysis showed 19.8 cases of myopericarditis per million doses among children, not significantly different from that of adults. Higher risk subgroups included adolescents, males, and those receiving their second dose of vaccination.
{"title":"Myopericarditis following COVID-19 vaccination in children: a systematic review and meta-analysis.","authors":"Ashiley Annushri Thenpandiyan, Ryan Ruiyang Ling, Robert Grignani, Megan Ruien Ling, Arthena Anushka Thenpandiyan, Bee Choo Tai, Jyoti Somani, Kollengode Ramanathan, Swee Chye Quek","doi":"10.4103/singaporemedj.SMJ-2023-081","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-081","url":null,"abstract":"<p><strong>Introduction: </strong>Myopericarditis is a rare but serious coronavirus disease 2019 (COVID-19) vaccine-related adverse event primarily affecting adolescents. Given recent approvals for childhood vaccination, we performed a meta-analysis investigating myopericarditis following messenger ribonucleic acid COVID-19 vaccination in children aged <19 years, focusing on its overall risk and high-risk subgroups.</p><p><strong>Methods: </strong>We searched MEDLINE via PubMed, Embase and Scopus from inception to 1 August 2022 for observational studies reporting myopericarditis in temporal relation to paediatric COVID-19 vaccination. We conducted random-effects meta-analyses (DerSimonian and Laird) on myopericarditis (primary outcome), myocarditis and pericarditis (secondary outcomes).</p><p><strong>Results: </strong>Of 2115 studies, 12 (59,229,160 doses) studies were included in our analysis. There were 19.8 (95% confidence interval [CI]: 10.4-37.6) myopericarditis cases reported per million doses in children, compared to 23.7 (95% CI: 12.2-46.1) cases in adults (eight studies, 376,899,888 doses; P = 0.70). Compared to the second dose (34.4, 95% CI: 15.2-77.8), the number of cases post-first dose was significantly lower (9.1, 95% CI: 4.4-18.8; P = 0.017), while the number of cases post-third dose was not higher than that of post-second dose (28.4, 95% CI: 10.4-61.8; P = 0.57, global P = 0.031). Males were at higher risk of myopericarditis (67.4, 95% CI: 36.5-124.5) than females (6.9, 95% CI: 3.1-15.3; P < 0.0001). Finally, the number of cases was higher (overall P < 0.0001) among children aged ≥12 years (39.9, 95% CI: 24.1-66.0) than among children aged <12 years (3.0, 95% CI: 2.3-3.9).</p><p><strong>Conclusion: </strong>Our meta-analysis showed 19.8 cases of myopericarditis per million doses among children, not significantly different from that of adults. Higher risk subgroups included adolescents, males, and those receiving their second dose of vaccination.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.4103/singaporemedj.SMJ-2022-119
Tony Yi Wei Li, Wai Chi Loh, Toon Wei Lim
{"title":"Evaluation of the accuracy of a single-lead adhesive electrocardiogram patch monitoring device (S-PATCH3-Cardio) in patients post-myocardial infarction: a pilot study.","authors":"Tony Yi Wei Li, Wai Chi Loh, Toon Wei Lim","doi":"10.4103/singaporemedj.SMJ-2022-119","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2022-119","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.4103/singaporemedj.SMJ-2023-063
Wan-Yun Sabrina Liu, Kaavya Narasimhalu, Fung Peng Woon, John Carson Allen, Deidre Anne De Silva
Introduction: Intracranial large artery disease (ICLAD) is a common cause of ischaemic stroke and is associated with the risk of recurrent vascular events in the short term. We compared the incidence of various long-term vascular outcomes between ischaemic stroke patients with and without ICLAD.
Methods: This was a longitudinal observational study of acute ischaemic stroke patients who were followed up serially for recurrent stroke, myocardial infarction or vascular death up to a median of 86 months. Transcranial colour-coded Doppler was used in the diagnosis of ICLAD.
Results: Among the 581 ischaemic stroke patients studied (median age 63 ± 11 years, male 71%), 354 (60.9%) had ICLAD. In regression analyses adjusting for covariates, patients with ICLAD were more likely to have long-term composite vascular outcomes (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.02-2.03, P = 0.041), myocardial infarction (HR 2.89, 95% CI 1.71-4.91, P < 0.001) and vascular death (HR 3.52, 95% CI 1.67-7.52, P = 0.001) but not recurrent stroke (HR 1.10, 95% CI 0.72-1.70, P = 0.652), at a median of 86 months as compared to patients without ICLAD.
Conclusion: Our findings of poor prognostic impact of ICLAD on long-term recurrent vascular events after ischaemic stroke provide evidence for the need of specific, emphasised screening and secondary prevention, especially for coronary artery disease in this high-risk group.
{"title":"Association of intracranial large artery disease with long-term prognosis after ischaemic stroke.","authors":"Wan-Yun Sabrina Liu, Kaavya Narasimhalu, Fung Peng Woon, John Carson Allen, Deidre Anne De Silva","doi":"10.4103/singaporemedj.SMJ-2023-063","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-063","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial large artery disease (ICLAD) is a common cause of ischaemic stroke and is associated with the risk of recurrent vascular events in the short term. We compared the incidence of various long-term vascular outcomes between ischaemic stroke patients with and without ICLAD.</p><p><strong>Methods: </strong>This was a longitudinal observational study of acute ischaemic stroke patients who were followed up serially for recurrent stroke, myocardial infarction or vascular death up to a median of 86 months. Transcranial colour-coded Doppler was used in the diagnosis of ICLAD.</p><p><strong>Results: </strong>Among the 581 ischaemic stroke patients studied (median age 63 ± 11 years, male 71%), 354 (60.9%) had ICLAD. In regression analyses adjusting for covariates, patients with ICLAD were more likely to have long-term composite vascular outcomes (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.02-2.03, P = 0.041), myocardial infarction (HR 2.89, 95% CI 1.71-4.91, P < 0.001) and vascular death (HR 3.52, 95% CI 1.67-7.52, P = 0.001) but not recurrent stroke (HR 1.10, 95% CI 0.72-1.70, P = 0.652), at a median of 86 months as compared to patients without ICLAD.</p><p><strong>Conclusion: </strong>Our findings of poor prognostic impact of ICLAD on long-term recurrent vascular events after ischaemic stroke provide evidence for the need of specific, emphasised screening and secondary prevention, especially for coronary artery disease in this high-risk group.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-06DOI: 10.4103/singaporemedj.SMJ-2021-382
Amanda Loke, Lee Gan Goh, Rajeev Ramachandran
{"title":"Primary care management of allergic rhinitis in children.","authors":"Amanda Loke, Lee Gan Goh, Rajeev Ramachandran","doi":"10.4103/singaporemedj.SMJ-2021-382","DOIUrl":"10.4103/singaporemedj.SMJ-2021-382","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-06DOI: 10.4103/singaporemedj.SMJ-2023-212
Weiling Lim, Tunn Ren Tay
{"title":"Approach to pulmonary embolism for frontline clinicians.","authors":"Weiling Lim, Tunn Ren Tay","doi":"10.4103/singaporemedj.SMJ-2023-212","DOIUrl":"10.4103/singaporemedj.SMJ-2023-212","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}