Singapore medical journal最新文献

Introduction: Mental health research on elite athletes in Asian populations trails behind that of the West, especially in multiethnic societies such as Singapore. This study explored the prevalence and risk factors associated with mental health symptoms among national athletes in Singapore across various sports.

Methods: Singapore national athletes answered an internet-based questionnaire comprising validated screening tools for symptoms of four mental health conditions - athlete-specific psychological strain, depression, anxiety and disordered eating.

Results: A total of 356 athletes participated in the study. Of these, 70% of respondents reported 'high' to 'very high' levels of athlete-specific psychological strain, 41% reported clinically significant ('mild' to 'severe') depressive symptoms, 18% reported 'moderate' to 'severe' anxiety symptoms, and 16% were suspected for disordered eating. Females were more likely to have clinically significant depressive (adjusted odds ratio [aOR] 3.44, P < 0.001) and anxiety (aOR 2.59, P = 0.006) symptoms compared to males. Athletes of Indian ethnicity were more likely to have depressive (aOR 4.18, P = 0.018), anxiety (aOR 4.24, P = 0.032) and psychological strain (aOR 11.83, P = 0.021) symptoms than their Chinese counterparts. Athletes who recently underwent a change in school (aOR 8.89, P = 0.002) or major examinations (aOR 3.23, P = 0.014) were more likely to have depressive symptoms than those who did not. Respondents with a current injury were more likely to experience greater athlete-specific psychological strain (odds ratio 1.79, P = 0.031) compared to those who were not injured.

Conclusion: High-performance athletes from various sports in multiethnic Singapore carried a significant burden of poor mental health, comparable to both the local general population and Western sporting populations. Prioritisation of resources to target high-risk groups may serve to bridge the sizeable treatment gap.

Abstract: Neurogastroenterology and motility disorders of the upper gastrointestinal (GI) tract represent a complex and heterogeneous group of conditions that involve the interaction between the GI tract and the central nervous system. They constitute a significant number of outpatient gastroenterology visits, resulting in a high healthcare burden. These disorders often occur in the absence of identifiable structural causes on routine endoscopy and radiological imaging. A more targeted approach in the assessment of functional GI disorders is increasingly being integrated into routine clinical practice, given the recent advancements in technology and physiologic testing. When used in the appropriate clinical context, these tests not only elucidate the physiological basis for the patient's symptoms, but also prevent inappropriate treatment and repeated investigations. This review aims to summarise the advances in clinically available diagnostic tools for the evaluation of upper GI functional disorders.

Abstract: Endoscopic ultrasonography (EUS) has progressed beyond diagnostic imaging to include EUS-guided tissue acquisition and EUS-directed therapies. This review provides an update on EUS-guided drainage and anastomotic procedures, and other therapeutic procedures. Today, EUS-guided drainage of symptomatic walled-off pancreatic fluid collections is the norm, with endoscopic necrosectomy as an adjunct. For high-risk surgical patients unsuitable for cholecystectomy, EUS-guided gallbladder drainage of acute cholecystitis is an option. Additionally, EUS-guided drainage of obstructed biliary and pancreatic ductal system can be performed as salvage procedures after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Bariatric procedures such as Roux-en-Y gastric bypass alter the gastric anatomy, hindering access to the major papilla. This can be overcome by creating a conduit through the excluded stomach using EUS-directed transgastric ERCP. Gastric outlet obstruction and afferent loop syndrome can be treated using EUS-guided gastrojejunostomy. These therapeutic interventions are a major advancement in the field of interventional EUS, achieving significant clinical impact.

Abstract: Sarcopenia is the loss of muscle strength, mass and function. It is often exacerbated by chronic comorbidities such as cardiovascular diseases (CVDs). There is a bidirectional relationship between sarcopenia and CVD. Sarcopenia can lead to increased adiposity, insulin resistance and chronic inflammation, predisposing adults to developing cardiovascular events. Chronic inflammation and decreased physical activity observed in cardiac patients can lead to accelerated muscle loss and the development of sarcopenia. Sarcopenia is linked to faster CVD progression, higher mortality and reduced quality of life. The co-occurrence of obesity with sarcopenia is termed sarcopenic obesity (SO). This condition is associated with worse outcomes than either condition individually. Early detection is crucial, as interventions can slow or reverse sarcopenia and improve cardiovascular outcomes. This review summarises evidence on the interplay between CVD and sarcopenia, discusses diagnostic approaches and management strategies, and identifies knowledge gaps for future research.

Introduction: Acute severe ulcerative colitis (ASUC) is a significant cause of disease morbidity. One-third of patients with ASUC are steroid refractory. Rescue therapy may not successfully induce remission, necessitating colectomy. We aimed to identify predictors of rescue therapy and colectomy in ASUC assessed within 24 h of admission for early risk stratification.

Methods: We conducted a retrospective cohort study of 58 admissions for ASUC among 47 patients from August 2002 to January 2022. Serum biomarkers assessed were measured on admission. Primary outcomes were the need for rescue therapy during the same admission and colectomy within 1 year of admission.

Results: Rescue therapy (all with infliximab) was given in 20 (34.5%) of the admissions. Colectomy was done within 1 year for nine (15.5%) of the admissions. An elevated C-reactive protein (CRP) of >30 mg/L (relative risk [RR] 1.63), a CRP-albumin ratio of >0.85 (RR 1.63), and a composite factor of both CRP > 30 mg/L and age ≥60 years (RR 2.37) were significantly associated with the need for rescue therapy. Hypoalbuminaemia ≤ 25 g/L (RR 4.35) and the use of biologics at presentation (RR 1.54) were significantly associated with colectomy within 1 year of admission, while a CRP of ≥ 80 mg/L was a significant protective factor (RR 0.70).

Conclusion: Patients with ASUC who have elevated CRP or CRP-albumin ratio on admission should be considered at risk for steroid-refractory disease. Those with hypoalbuminaemia on admission and using biologics at presentation are more likely to require colectomy in the first year after admission for ASUC.