Pub Date : 2024-07-01Epub Date: 2024-07-08DOI: 10.4103/singaporemedj.SMJ-2023-260
Ziwei Lin, Swee Han Lim, Qai Ven Yap, Cheryl Shumin Kow, Yiong Huak Chan, Siang Jin Terrance Chua, Anantharaman Venkataraman
Introduction: Clinical assessment is pivotal in diagnosing acute coronary syndrome. Our study aimed to identify clinical characteristics predictive of major adverse cardiac events (MACE) in an Asian population and to derive a risk score for MACE.
Methods: Patients presenting to the emergency department (ED) with chest pain and non-diagnostic 12-lead electrocardiograms were recruited. Clinical history was recorded in a predesigned template. Random glucose and direct low-density lipoprotein measurements were taken, in addition to serial troponin. We derived the age, coronary risk factors (CRF), sex and symptoms (ACSS) risk score based on multivariate analysis results, considering age, CRF, sex and symptoms and classifying patients into very low, low, moderate and high risk for MACE. Comparison was made with the ED Assessment of Chest Pain Score (EDACS) and the history, electrocardiogram, age, risk factors, troponin (HEART) score. We also modified the HEART score with the CRF that we had identified. The outcomes were 30-day and 1-year MACE.
Results: There were a total of 1689 patients, with 172 (10.2%) and 200 (11.8%) having 30-day and 1-year MACE, respectively. Symptoms predictive of MACE included central chest pain, radiation to the jaw/neck, associated diaphoresis, and symptoms aggravated by exertion and relieved by glyceryl trinitrate. The ACSS score had an area under the curve of 0.769 (95% confidence interval [CI]: 0.735-0.803) and 0.760 (95% CI: 0.727-0.793) for 30-day and 1-year MACE, respectively, outperforming EDACS. Those in the very-low-risk and low-risk groups had <1% risk of 30-day MACE.
Conclusion: The ACSS risk score shows potential for use in the local ED or primary care setting, potentially reducing unnecessary cardiac investigations and admission.
{"title":"Symptoms and coronary risk factors predictive of adverse cardiac events in chest pain patients in an Asian emergency department: the need for a local prediction score.","authors":"Ziwei Lin, Swee Han Lim, Qai Ven Yap, Cheryl Shumin Kow, Yiong Huak Chan, Siang Jin Terrance Chua, Anantharaman Venkataraman","doi":"10.4103/singaporemedj.SMJ-2023-260","DOIUrl":"10.4103/singaporemedj.SMJ-2023-260","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical assessment is pivotal in diagnosing acute coronary syndrome. Our study aimed to identify clinical characteristics predictive of major adverse cardiac events (MACE) in an Asian population and to derive a risk score for MACE.</p><p><strong>Methods: </strong>Patients presenting to the emergency department (ED) with chest pain and non-diagnostic 12-lead electrocardiograms were recruited. Clinical history was recorded in a predesigned template. Random glucose and direct low-density lipoprotein measurements were taken, in addition to serial troponin. We derived the age, coronary risk factors (CRF), sex and symptoms (ACSS) risk score based on multivariate analysis results, considering age, CRF, sex and symptoms and classifying patients into very low, low, moderate and high risk for MACE. Comparison was made with the ED Assessment of Chest Pain Score (EDACS) and the history, electrocardiogram, age, risk factors, troponin (HEART) score. We also modified the HEART score with the CRF that we had identified. The outcomes were 30-day and 1-year MACE.</p><p><strong>Results: </strong>There were a total of 1689 patients, with 172 (10.2%) and 200 (11.8%) having 30-day and 1-year MACE, respectively. Symptoms predictive of MACE included central chest pain, radiation to the jaw/neck, associated diaphoresis, and symptoms aggravated by exertion and relieved by glyceryl trinitrate. The ACSS score had an area under the curve of 0.769 (95% confidence interval [CI]: 0.735-0.803) and 0.760 (95% CI: 0.727-0.793) for 30-day and 1-year MACE, respectively, outperforming EDACS. Those in the very-low-risk and low-risk groups had <1% risk of 30-day MACE.</p><p><strong>Conclusion: </strong>The ACSS risk score shows potential for use in the local ED or primary care setting, potentially reducing unnecessary cardiac investigations and admission.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556337","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 : 2024-07-01Epub Date: 2024-07-08DOI: 10.4103/singaporemedj.SMJ-2024-084
Elinor Tan, Samuel Shang Ming Lee, Kian-Keong Poh, Chuanhui Xu, Ching-Hui Sia
{"title":"Electrocardiographic manifestations of cardiac disorders in rheumatological conditions.","authors":"Elinor Tan, Samuel Shang Ming Lee, Kian-Keong Poh, Chuanhui Xu, Ching-Hui Sia","doi":"10.4103/singaporemedj.SMJ-2024-084","DOIUrl":"10.4103/singaporemedj.SMJ-2024-084","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556334","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 : 2024-07-01Epub Date: 2024-07-08DOI: 10.4103/singaporemedj.SMJ-2024-128
Ching-Hui Sia, Kian-Keong Poh
{"title":"Advances and challenges in cardiology.","authors":"Ching-Hui Sia, Kian-Keong Poh","doi":"10.4103/singaporemedj.SMJ-2024-128","DOIUrl":"10.4103/singaporemedj.SMJ-2024-128","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556332","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 : 2024-06-28DOI: 10.4103/singaporemedj.SMJ-2023-134
Duo-Tong Cheng, Tong Hong Yeo, Michaela Su-Fern Seng, Oon Hoe Teoh, Sumin Lee, Ai Ling Koh
{"title":"Genomic sequencing: ending the diagnostic odyssey for a child with microcephaly and dystonia with a perioperative challenge.","authors":"Duo-Tong Cheng, Tong Hong Yeo, Michaela Su-Fern Seng, Oon Hoe Teoh, Sumin Lee, Ai Ling Koh","doi":"10.4103/singaporemedj.SMJ-2023-134","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-134","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141474412","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 : 2024-06-19DOI: 10.4103/singaporemedj.SMJ-2022-022
Joanne Mui Ching Tan, Yebeen Ysabelle Boo, Logan Manikam, Tong Hong Yeo, Jeremy Bingyuan Lin, Ruixiang Yee, Zhi Min Ng
Introduction: Cerebral palsy (CP) is one of the most severe childhood neurodevelopmental disabilities resulting from non-progressive insult to the developing brain. We aimed to report our experience regarding dental visit attendance, caries prevalence and factors affecting dental access in children with CP in Singapore.
Methods: Patients diagnosed with CP who were born in or after 1994 were included in this study. We reviewed the data of all 151 patients recruited under the CP Registry in Singapore (SingCPR) from September 2017 to May 2020. The SingCPR was launched in September 2017 to assist in future planning of services and resources for CP in Singapore.
Results: The mean age of the patients was 7.8 years, with the interquartile range being 3 years and 8 months-10 years and 10 months. Only 41.7% reported a visit to the dentist ever, with 25.4% reporting presence of dental caries. Age was the only statistically significant factor influencing access to dental care. None of the children less than 2 years old ever received any dental care, and 20% of the children with CP aged 2-6 years had received dental care before. Age range with the highest percentage of dental visits was 7-12 years, with up to 44.0% having ever received dental care. We believe the prevalence of dental caries was underreported as many children did not receive any dental care and therefore may have undetected dental caries.
Conclusion: Dental care in children with CP should be advocated early for prevention and detection of caries.
{"title":"Access to dental care and caries experience among children with cerebral palsy: a Singapore experience.","authors":"Joanne Mui Ching Tan, Yebeen Ysabelle Boo, Logan Manikam, Tong Hong Yeo, Jeremy Bingyuan Lin, Ruixiang Yee, Zhi Min Ng","doi":"10.4103/singaporemedj.SMJ-2022-022","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2022-022","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral palsy (CP) is one of the most severe childhood neurodevelopmental disabilities resulting from non-progressive insult to the developing brain. We aimed to report our experience regarding dental visit attendance, caries prevalence and factors affecting dental access in children with CP in Singapore.</p><p><strong>Methods: </strong>Patients diagnosed with CP who were born in or after 1994 were included in this study. We reviewed the data of all 151 patients recruited under the CP Registry in Singapore (SingCPR) from September 2017 to May 2020. The SingCPR was launched in September 2017 to assist in future planning of services and resources for CP in Singapore.</p><p><strong>Results: </strong>The mean age of the patients was 7.8 years, with the interquartile range being 3 years and 8 months-10 years and 10 months. Only 41.7% reported a visit to the dentist ever, with 25.4% reporting presence of dental caries. Age was the only statistically significant factor influencing access to dental care. None of the children less than 2 years old ever received any dental care, and 20% of the children with CP aged 2-6 years had received dental care before. Age range with the highest percentage of dental visits was 7-12 years, with up to 44.0% having ever received dental care. We believe the prevalence of dental caries was underreported as many children did not receive any dental care and therefore may have undetected dental caries.</p><p><strong>Conclusion: </strong>Dental care in children with CP should be advocated early for prevention and detection of caries.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428641","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 : 2024-06-19DOI: 10.4103/singaporemedj.SMJ-2020-490
Tzong-Yee Colin Wang, Hamid Rahmatullah Bin Abd Razak, Yilun Huang, Keng-Lin Francis Wong, Bing-Howe Lee, Merng-Koon Wong
{"title":"Impact of the COVID-19 'circuit breaker' on emergency orthopaedic admissions in a local tertiary teaching hospital.","authors":"Tzong-Yee Colin Wang, Hamid Rahmatullah Bin Abd Razak, Yilun Huang, Keng-Lin Francis Wong, Bing-Howe Lee, Merng-Koon Wong","doi":"10.4103/singaporemedj.SMJ-2020-490","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2020-490","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428643","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 : 2024-06-19DOI: 10.4103/singaporemedj.SMJ-2023-121
Keith Dihao Tan, Shu Yun Tan, Hui Li Koh, Edwin Fueng Chee Liang, Sabrina Kay Wye Wong
{"title":"Association between social support and health-related outcomes among older adults with type 2 diabetes mellitus in a primary care setting.","authors":"Keith Dihao Tan, Shu Yun Tan, Hui Li Koh, Edwin Fueng Chee Liang, Sabrina Kay Wye Wong","doi":"10.4103/singaporemedj.SMJ-2023-121","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-121","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428642","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 : 2024-06-01Epub Date: 2024-06-04DOI: 10.4103/singaporemedj.SMJ-2021-288
Raina Hui Wen Loh, Adriel Zhijie Leong, Sein Lwin, Lee Gan Goh
{"title":"An approach to neck pain in primary care.","authors":"Raina Hui Wen Loh, Adriel Zhijie Leong, Sein Lwin, Lee Gan Goh","doi":"10.4103/singaporemedj.SMJ-2021-288","DOIUrl":"10.4103/singaporemedj.SMJ-2021-288","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249312","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 : 2024-06-01DOI: 10.4103/singaporemedj.SMJ-2024-117
{"title":"Congratulations to the 2023 SMJ Best Research Paper Award Winners.","authors":"","doi":"10.4103/singaporemedj.SMJ-2024-117","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-117","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249314","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 : 2024-06-01Epub Date: 2024-06-04DOI: 10.4103/singaporemedj.SMJ-2022-023
Hui Lin Wong, Haiyuan Shi, Wey Chyi Teoh, Joel Jingkai Liu
{"title":"Bowel and mesenteric injuries in blunt abdominal injury.","authors":"Hui Lin Wong, Haiyuan Shi, Wey Chyi Teoh, Joel Jingkai Liu","doi":"10.4103/singaporemedj.SMJ-2022-023","DOIUrl":"10.4103/singaporemedj.SMJ-2022-023","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249313","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}
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