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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. 预测亚洲急诊科胸痛患者不良心脏事件的症状和冠状动脉危险因素:本地预测评分的必要性。
Pub Date : 2024-07-01 Epub Date: 2024-07-08 DOI: 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.

导言临床评估是诊断急性冠状动脉综合征的关键。我们的研究旨在确定亚洲人群中可预测重大心脏不良事件(MACE)的临床特征,并得出MACE的风险评分:方法:招募因胸痛和 12 导联心电图无法确诊而到急诊科(ED)就诊的患者。根据预先设计的模板记录临床病史。除连续肌钙蛋白外,还进行了随机血糖和直接低密度脂蛋白测量。我们根据多变量分析结果得出了年龄、冠状动脉危险因素(CRF)、性别和症状(ACSS)风险评分,考虑了年龄、冠状动脉危险因素、性别和症状,并将患者的 MACE 风险分为极低、低、中和高风险。我们将其与急诊室胸痛评估评分(EDACS)和病史、心电图、年龄、风险因素、肌钙蛋白(HEART)评分进行了比较。我们还根据已确定的 CRF 对 HEART 评分进行了修改。结果为 30 天和 1 年 MACE:共有 1689 名患者,其中分别有 172 人(10.2%)和 200 人(11.8%)发生 30 天和 1 年 MACE。可预测 MACE 的症状包括中心性胸痛、向下颌/颈部放射、伴有肢体酸痛,以及因劳累而加重且三硝酸甘油可缓解的症状。ACSS 评分对 30 天和 1 年 MACE 的曲线下面积分别为 0.769(95% 置信区间 [CI]:0.735-0.803)和 0.760(95% 置信区间 [CI]:0.727-0.793),优于 EDACS。极低风险组和低风险组的患者有结论:ACSS 风险评分显示了在当地急诊室或初级保健环境中使用的潜力,有可能减少不必要的心脏检查和入院治疗。
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引用次数: 0
Electrocardiographic manifestations of cardiac disorders in rheumatological conditions. 风湿病患者心脏功能紊乱的心电图表现。
Pub Date : 2024-07-01 Epub Date: 2024-07-08 DOI: 10.4103/singaporemedj.SMJ-2024-084
Elinor Tan, Samuel Shang Ming Lee, Kian-Keong Poh, Chuanhui Xu, Ching-Hui Sia
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引用次数: 0
Advances and challenges in cardiology. 心脏病学的进步与挑战。
Pub Date : 2024-07-01 Epub Date: 2024-07-08 DOI: 10.4103/singaporemedj.SMJ-2024-128
Ching-Hui Sia, Kian-Keong Poh
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引用次数: 0
Genomic sequencing: ending the diagnostic odyssey for a child with microcephaly and dystonia with a perioperative challenge. 基因组测序:结束小头畸形和肌张力障碍患儿的诊断奥德赛,迎接围手术期的挑战。
Pub Date : 2024-06-28 DOI: 10.4103/singaporemedj.SMJ-2023-134
Duo-Tong Cheng, Tong Hong Yeo, Michaela Su-Fern Seng, Oon Hoe Teoh, Sumin Lee, Ai Ling Koh
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引用次数: 0
Access to dental care and caries experience among children with cerebral palsy: a Singapore experience. 脑瘫儿童获得牙科护理的机会和龋齿经历:新加坡的经验。
Pub Date : 2024-06-19 DOI: 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.

导言:脑瘫(CP)是最严重的儿童神经发育残疾之一,是由于发育中的大脑受到非进行性损伤所致。我们旨在报告新加坡 CP 儿童的牙科就诊情况、龋齿患病率以及影响牙科就诊的因素:本研究纳入了 1994 年或之后出生的确诊为 CP 的患者。我们回顾了从 2017 年 9 月至 2020 年 5 月新加坡 CP 登记处(SingCPR)招募的所有 151 名患者的数据。SingCPR于2017年9月启动,旨在帮助新加坡规划未来的CP服务和资源:患者的平均年龄为 7.8 岁,四分位数范围为 3 岁零 8 个月至 10 岁零 10 个月。只有 41.7% 的患者表示曾经看过牙医,25.4% 的患者表示患有龋齿。年龄是影响获得牙科保健的唯一有统计学意义的因素。在 2 岁以下的儿童中,没有人接受过任何牙科护理,而在 2-6 岁的患儿中,有 20% 曾经接受过牙科护理。牙科就诊比例最高的年龄段是 7-12 岁,曾接受过牙科治疗的比例高达 44.0%。我们认为,由于许多儿童没有接受过任何牙科护理,因此可能存在未被发现的龋齿,因此龋齿的患病率被低估了:结论:CP 儿童的牙科护理应及早进行,以预防和发现龋齿。
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引用次数: 0
Impact of the COVID-19 'circuit breaker' on emergency orthopaedic admissions in a local tertiary teaching hospital. COVID-19 "断路器 "对当地一家三级教学医院骨科急诊入院的影响。
Pub Date : 2024-06-19 DOI: 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
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引用次数: 0
Association between social support and health-related outcomes among older adults with type 2 diabetes mellitus in a primary care setting. 基层医疗机构中 2 型糖尿病老年人的社会支持与健康相关结果之间的关系。
Pub Date : 2024-06-19 DOI: 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}
引用次数: 0
An approach to neck pain in primary care. 初级保健中的颈部疼痛治疗方法。
Pub Date : 2024-06-01 Epub Date: 2024-06-04 DOI: 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}
引用次数: 0
Congratulations to the 2023 SMJ Best Research Paper Award Winners. 祝贺 2023 年度 SMJ 最佳研究论文奖获得者。
Pub Date : 2024-06-01 DOI: 10.4103/singaporemedj.SMJ-2024-117
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引用次数: 0
Bowel and mesenteric injuries in blunt abdominal injury. 腹部钝伤中的肠道和肠系膜损伤。
Pub Date : 2024-06-01 Epub Date: 2024-06-04 DOI: 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}
引用次数: 0
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