Singapore medical journal最新文献

Introduction: Physical activity has been shown to offer numerous benefits in improving mortality and morbidity outcomes. However, the specifics of advising and/or prescribing exercise in patient management may not be taught comprehensively in undergraduate and postgraduate medical curriculum. This study aimed to evaluate primary care physicians' habits in advising and/or prescribing exercise to their patients.

Methods: Primary care physicians practising in all public primary care clinics in Singapore were invited via email and posters to participate in an anonymous online questionnaire. The questionnaire explored physicians' habits in advising and/or prescribing exercise to their patients.

Results: Results showed that 95.9% of primary care physicians gave patients advice on exercise. However, only 24.7% prescribed exercise (specific written instructions) to their patients. Time constraint is the top barrier cited by primary care physicians for not giving exercise advice and/or prescription. The top three conditions for which exercise advice and/or prescription was given by physicians were diabetes mellitus, dyslipidaemia and hypertension. Physicians who cited insufficient expertise/knowledge as a barrier were more likely to have never attended an exercise prescription course.

Conclusion: Most primary care physicians in Singapore advised exercise as part of the management plan for their patients. However, a much lower proportion gave specific exercise prescription. The most commonly cited barrier to advising or prescribing exercise is time constraint, while lack of expertise or knowledge may stem from not having received relevant training. Future efforts could focus on providing primary care physicians with targeted training to overcome the barrier of insufficient expertise or knowledge in exercise advice and prescription.

Introduction: Ischaemic stroke is a major health burden. The aim of this observational study was to compare the incidence of ischaemic stroke between Muslims and non-Muslims living in southern Thailand.

Methods: Patients with nonrecurrent computed tomography-proven ischaemic stroke admitted to Yala Regional Hospital during the Hijri years (AH) 1435-1439 were recruited for the study. Demographic, religious and risk factor data (hypertension, diabetes mellitus), smoking and atrial fibrillation) were collected. The study was divided into three periods using AH months as follows: baseline (months 1-4), pre-Ramadan (months 5-8) and Ramadan (months 9-12). Poisson regression was performed to explore the association between the time periods and rates of ischaemic stroke.

Results: Smoking was more common in Muslims than non-Muslims, with a higher incidence of 10.7 per 100,000 vs. 4.9 per 100,000 (P = 0.016). In relation to the three time periods, the incidence of ischaemic stroke was higher among Muslims than non-Muslims during Ramadan (13.5 vs. 5.4, P = 0.032), but not during the other time periods. For Muslims, the incidence rate ratio was higher during Ramadan (1.07; P = 0.049) than at baseline and pre-Ramadan (1.00 and 0.97, respectively; P = 0.576), whereas the ratios remained unchanged in the non-Muslim group.

Conclusion: There was a higher incidence of ischaemic stroke exclusively among Muslims during the Ramadan.

Abstract: Patients with symptomatic atherosclerotic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions face a high risk of recurrent ischaemic stroke despite best medical therapy. Previous trials of extracranial-intracranial (EC-IC) bypass surgery showed no benefit for stroke prevention in this population, but they may have been underpowered. This study evaluates the efficacy of EC-IC bypass surgery in reducing the risk of the composite outcome of stroke or death within 30 days or ipsilateral ischaemic stroke beyond 30 days through 2 years. Following a PROSPERO-registered protocol (CRD42023457824), we conducted a systematic review of PubMed, Embase and Cochrane Library for randomised trials, comparing the use of EC-IC bypass surgery plus medical therapy versus medical therapy alone. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischaemic stroke beyond 30 days through 2 years after randomisation. One-stage and two-stage meta-analyses using reconstructed individual patient data in hazard ratios (HRs) were performed. Four trials (2102 participants) were included. No statistically significant differences were observed between the two groups in the one-stage (HR 1.019, 95% confidence interval [CI] 0.860-1.209, P = 0.06) and two-stage (HR 0.954, 95% CI 0.841-1.241, P = 0.21) meta-analyses. Rates of ipsilateral ischaemic stroke, any stroke or death, and any stroke were also similar between groups at 2 years. In symptomatic ICA or MCA occlusion, adding bypass surgery to medical therapy does not significantly lower the risk of the composite outcome of stroke or death compared to medical therapy alone.

Introduction: Febrile infants often undergo septic workups, with urinary tract infection (UTI) being the most common serious bacterial infection. However, lumbar puncture practices vary, and the rate of concurrent meningitis remains uncertain. This systematic review and meta-analysis aimed to determine the rate of concomitant bacterial meningitis in febrile infants with UTI.

Methods: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and conference proceedings from inception to August 2023 were searched. Included studies involved febrile infants ≤90 days old with UTI and no clear infection source, where ≥10 infants underwent lumbar puncture. Studies with localising symptoms of another diagnosis or premature infants were excluded. Studies were independently reviewed and data were extracted. Meta-analysis was performed using random-effects models with heterogeneity tests. Study quality was assessed via the Newcastle-Ottawa Scale.

Results: Thirty-nine observational studies met the eligibility criteria. The prevalence of concomitant definite bacterial meningitis in febrile infants with UTI was 0.3% (95% confidence interval [CI] 0.1%-0.4%). Between-studies comparison suggested this rate may be higher in neonates (≤28 days) than older infants (29-90 days old) (pooled estimate 0.7%, 95% CI 0.3%-1.1% vs. 0.2%, 0.0%-0.3%), while within-studies comparison showed no risk difference between the two groups. No association between bacterial meningitis and bacteraemia in infants with febrile UTI was observed.

Conclusion: In clinically well febrile infants without symptoms or signs suggesting meningitis, a screening urine sample should be recommended instead of a routine full septic workup.