Introduction: Achieving optimal glycated hemoglobin (HbA1c), blood pressure (BP), and LDLCholesterol (LDL-C) in patients mitigates macro- and micro-vascular complications, which is the key treatment goal in managing type 2 diabetes mellitus (T2DM). This study aimed to determine the proportion of patients in an urban community with T2DM and the above modifiable conditions attaining triple vascular treatment goals based on current practice guidelines. Methods: A questionnaire was distributed to adult Asian patients with dyslipidemia at two primary care clinics (polyclinics) in northeastern Singapore. The demographic and clinical data for this sub-population with both T2DM and dyslipidemia were collated with laboratory and treatment information retrieved from their electronic health records. The combined data was then analyzed to determine the proportion of patients who attained triple treatment goals, and logistic regression analysis was used to identify factors associated with this outcome. Results: 665 eligible patients [60.5% female, 30.5% Chinese, 35% Malays, and 34.4% Indians] with a mean age of 60.6 years were recruited. Of these patients, 71% achieved LDL-C ≤2.6 mmol/L, 70.4% had BP <140/90 mmHg, and 40.9% attained HbA1c ≤7%. Overall, 22% achieved the triple treatment goals for glycemia, BP, and LDL-C control. The major determinants were the number of diabetic medications and intensity of statin therapy. Conclusion: Eight in ten patients with T2DM failed to achieve concurrent glycemic, BP, and LDL-C treatment goals, subjecting them to risks of vascular complications. Primary healthcare professionals can mitigate these risks by optimizing therapeutic treatment to maximize glycemia, dyslipidemia, and BP control.

Physical Activity Scale for the Elderly (PASE) is a simple, valid and reliable questionnaire that can be administered to quantify older adults’ physical activity levels during daily living. However, PASE in Malay language for use among older population is not available. The objective of our current study was to evaluate the reliability and validity of the Malay translated Physical Activity Scale for Elderly (PASE-M) for the use among older adults. Objective results of physical activity were obtained by wearing continuously an accelerometer for one week among a population of older adults in Malaysia who speak Malay language. Participants completed PASE-M twice, on day-8 (PASE-M1) and day-15 (PASE-M2). Concurrent validity between PASE-M1 and accelerometer results was assessed using Spearman’s rank correlation coefficient. Test-retest reliability for one week interval of PASE-M was tested using Spearman’s rank correlation coefficient and Intra-class correlation coefficients (ICC). Forty-four community-dwelling older adults (12 men and 32 women; mean age ± SD= 66.95 ± 5.34) participated in this study. However, only 33 participants (8 men and 25 women; mean age ± SD= 66.64 ± 5.51) were able to achieve the minimum accelerometer wearing time and filled up the PASE-M questionnaire for two times with one weeks interval. The results showed the PASE-M score was significantly correlated with vector magnitude (VM) counts (r=0.54, p<0.01), time in moderate-to-vigorous physical activity (MVPA) (r =0.55, p<0.01), energy expenditure (r =0.53, p<0.01) and walking steps (r=0.39, p<0.05). A high reliability (ICC = 0.96) was demonstrated between first and the subsequent administration of PASE-M (p<0.01, 95% CI: 0.92-0.98). The PASE-M is a valid and reliable questionnaire to assess physical activity level for Malaysian community-dwelling older adults.
older adults, physical activity, questionnaire, accelerometer, validity, reliability

INTRODUCTIONNecrotising fasciitis is a disease associated with high morbidity and mortality, and multi-focal necrotising fasciitis is uncommon. We present 2 cases of concurrent necrotising fasciitis of contralateral upper and lower limbs.

CLINICAL PICTUREBoth presented with pain, swelling, bruising or necrosis of the affected extremities. Traditional medical therapy was sought prior to their presentation.

TREATMENTAfter initial debridement, one patient subsequently underwent amputation of the contralateral forearm and leg. The other underwent a forearm amputation, but refused a below-knee amputation.

OUTCOMEThe first patient survived, while the second died.

CONCLUSIONTraditional medical therapy can cause bacterial inoculation, leading to necrotising fasciitis, and also leads to delay in appropriate treatment. Radical surgery is needed to optimise patient survival.

Aged ; Amputation ; Debridement ; Fasciitis, Necrotizing ; diagnosis ; drug therapy ; surgery ; Fatal Outcome ; Female ; Hand ; microbiology ; surgery ; Humans ; Leg ; microbiology ; surgery ; Male ; Medicine, East Asian Traditional ; Middle Aged ; Risk Factors

INTRODUCTIONThere is paucity of local data on the prevalence of blood transmitted infections (BTIs), such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) infections, among illicit drug users. This study aimed to examine the prevalence of BTIs among substance dependent inpatients and identify the factors associated with BTIs.

METHODSWe conducted a retrospective analysis of clinical notes of 170 inpatients with a diagnosis of substance dependence who were admitted at the National Addictions Management Service, Singapore, between 1 June 2009 and 31 May 2010.

RESULTSMajority of the 170 inpatients were male (88.2%) and Chinese (58.2%). The mean age of the patients was 43.1 years, and the main drug of abuse was opioids (86.5%). BTIs were found in 70 (41.2%) inpatients; the prevalence of hepatitis B, hepatitis C and HIV infections was 3.7%, 39.6% and 0%, respectively. Lifetime intravenous drug use, but not needle-sharing, was more common among inpatients who were positive for BTIs (p < 0.01). Logistic regression analysis showed that lifetime intravenous drug use (OR 4.3, 95% CI 1.7- 10.8, p < 0.01) was the only significant predictor of BTIs.

CONCLUSIONA large proportion (41.2%) of the substance users seeking help was positive for at least one BTI. Lifetime intravenous drug users were found to be more than four times more likely to have a BTI. Early detection and prevention is essential to improve prognosis.

Adult ; Analgesics, Opioid ; therapeutic use ; Female ; HIV Infections ; blood ; complications ; Hepatitis B ; blood ; complications ; Hepatitis C ; blood ; complications ; Humans ; Inpatients ; Male ; Middle Aged ; Needle Sharing ; Odds Ratio ; Prevalence ; Prognosis ; Retrospective Studies ; Singapore ; Substance Abuse, Intravenous ; blood ; complications ; epidemiology

Wrist pain is a common presentation to the general practitioner and emergency department. Most cases are simple to treat, and pain frequently resolves with conservative treatment. However, there are certain conditions, such as scaphoid nonunion and Kienböck's disease, where delayed diagnosis and treatment can result in long-term deformity or disability. This article covers the various causes of wrist pain, recommendations on how wrist pain should be assessed, as well as details some of the common conditions that warrant specialist referral.
Acute Pain ; diagnosis ; etiology ; rehabilitation ; Arthralgia ; diagnosis ; etiology ; rehabilitation ; Chronic Pain ; diagnosis ; etiology ; rehabilitation ; Disability Evaluation ; Fractures, Ununited ; complications ; diagnosis ; Humans ; Orthopedic Procedures ; methods ; Osteonecrosis ; complications ; diagnosis ; Pain Measurement ; Scaphoid Bone ; injuries ; Wrist Injuries ; complications ; diagnosis ; rehabilitation ; Wrist Joint

INTRODUCTIONFew studies in Asia have assessed the burden of hypercholesterolaemia based on the global cardiovascular risk assessment. This study determines the burden of hypercholesterolaemia in an Asian population based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) guidelines, and examines predictors of low-density lipoprotein cholesterol (LDL-C) goal attainment.

MATERIALS AND METHODSFive thousand and eighty-three Chinese, Malays and Asian-Indians living in Singapore were assigned to coronary heart disease (CHD)-risk category based on the NCEP-ATPIII guidelines. Awareness, treatment and control of hypercholesterolaemia based on risk- specific LDL-C goal were determined, including the use of lipid-lowering therapy (LLT). Cox-regression models were used to identify predictors of LDL-C above goal among those who were aware and unaware of hypercholesterolaemia.

RESULTSOne thousand five hundred and sixty-eight (30.8%) participants were aware of hypercholesterolaemia and 877 (17.3%) were newly diagnosed (unaware). For those who were aware, 39.3% participants received LLT. Among those with 2 risk factors, only 59.7% attained LDL-C goal. The majority of them were taking statin monotherapy, and the median dose of statins was similar across all CHD risk categories. Among participants with 2 risk factors and not receiving LLT, 34.1% would require LLT. Malays or Asian-Indians, higher CHD risk category, increasing body mass index (BMI), current smoking and lower education status were associated with higher risk of LDL-C above goal. Being on LLT reduced the risk of having LDL-C above goal.

CONCLUSIONThe burden of hypercholesterolaemia is high in this multi-ethnic population especially those in the higher CHD risk categories, and might be partly contributed by inadequate titration of statins therapy. Raising awareness of hypercholesterolaemia, appropriate LLT initiation and titration, weight management and smoking cessation may improve LDL-C goal attainment in this population.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cholesterol, LDL ; blood ; Cross-Sectional Studies ; Female ; Humans ; Hypercholesterolemia ; blood ; epidemiology ; prevention & control ; Male ; Middle Aged ; Practice Guidelines as Topic ; Prevalence ; Singapore ; epidemiology ; Young Adult

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. Methods: Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. Results: Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. Conclusions Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.

INTRODUCTIONTrauma is the fifth principal cause of death in Singapore, with traumatic brain injury (TBI) being the leading specific subordinate cause.

METHODSThis study was an eight-year retrospective review of the demographic profiles of patients with severe TBI who were admitted to the neurointensive care unit (NICU) of the National Neuroscience Institute at Tan Tock Seng Hospital, Singapore, between 2004 and 2011.

RESULTSA total of 780 TBI patients were admitted during the study period; 365 (46.8%) patients sustained severe TBI (i.e. Glasgow Coma Scale score ≤ 8), with the majority (75.3%) being male. The ages of patients with severe TBI ranged from 14-93 years, with a bimodal preponderance in young adults (i.e. 21-40 years) and elderly persons (i.e. > 60 years). Motor vehicle accidents (48.8%) and falls (42.5%) were the main mechanisms of injury. Invasive line monitoring was frequently employed; invasive arterial blood pressure monitoring and central venous pressure monitoring were used in 81.6% and 60.0% of the patients, respectively, while intracranial pressure (ICP) measurement was required in 47.4% of the patients. The use of tiered therapy to control ICP (e.g. sedation, osmotherapy, cerebrospinal fluid drainage, moderate hyperventilation and barbiturate-induced coma) converged with international practices.

CONCLUSIONThe high-risk groups for severe TBI were young adults and elderly persons involved in motor vehicle accidents and falls, respectively. In the NICU, the care of patients with severe TBI requires heavy utilisation of resources. The healthcare burden of these patients extends beyond the acute critical care phase.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries, Traumatic ; economics ; epidemiology ; therapy ; Critical Care ; economics ; statistics & numerical data ; Female ; Glasgow Coma Scale ; Hospitalization ; Humans ; Intensive Care Units ; economics ; statistics & numerical data ; Intracranial Pressure ; Male ; Middle Aged ; Monitoring, Physiologic ; Public Health ; Resource Allocation ; Retrospective Studies ; Singapore ; Young Adult

INTRODUCTION: Family history of psychopathology is a risk factor for mood and anxiety disorders in children, but little is known about rates of parental psychopathology among treatment-seeking youth with affective disorders in the Asia Pacific region. This study examined patterns of emotional and behavioural problems in parents of clinically-referred youth in Singapore. We hypothesised that parents would have higher rates of affective disorders compared to the Singapore national prevalence rate of 12%. MATERIALS AND METHODS: In this cross-sectional study, 47 families were recruited from affective disorders and community-based psychiatry programmes run by a tertiary child psychiatry clinic. All children had a confirmed primary clinical diagnosis of depression or an anxiety disorder. Parents completed the Mini International Neuropsychiatric Interview (MINI) to assess for lifetime mood and anxiety disorders. They also completed the Adult Self Report (ASR) and Adult Behavior Checklist (ABCL) to assess current internalising and externalising symptoms. RESULTS: Consistent with our hypothesis, 38.5% of mothers and 10.5% of fathers reported a lifetime mood and anxiety disorder. Nearly 1/3 of mothers had clinical/subclinical scores on current internalising and externalising problems. A similar pattern was found for internalising problems among fathers, with a slightly lower rate of clinical/subclinical externalising problems. CONCLUSION Our findings are consistent with previous overseas studies showing elevated rates of affective disorders among parents - particularly mothers - of children seeking outpatient psychiatric care. Routine screening in this population may help to close the current treatment gap for adults with mood and anxiety disorders.
Adult ; Anxiety Disorders ; diagnosis ; epidemiology ; psychology ; Child ; Cross-Sectional Studies ; Family Health ; statistics & numerical data ; Female ; Humans ; Male ; Mood Disorders ; diagnosis ; epidemiology ; psychology ; Parent-Child Relations ; Parenting ; psychology ; Parents ; psychology ; Psychiatric Status Rating Scales ; Psychopathology ; Singapore ; epidemiology

INTRODUCTION: Three doses of SARS-CoV-2 mRNA vaccines have been recommended for cancer patients to reduce the risk of severe disease. Anti-neoplastic treatment, such as chemotherapy, may affect long-term vaccine immunogenicity. METHOD: Patients with solid or haematological cancer were recruited from 2 hospitals between July 2021 and March 2022. Humoral response was evaluated using GenScript cPASS surrogate virus neutralisation assays. Clinical outcomes were obtained from medical records and national mandatory-reporting databases. RESULTS: A total of 273 patients were recruited, with 40 having haematological malignancies and the rest solid tumours. Among the participants, 204 (74.7%) were receiving active cancer therapy, including 98 (35.9%) undergoing systemic chemotherapy and the rest targeted therapy or immunotherapy. All patients were seronegative at baseline. Seroconversion rates after receiving 1, 2 and 3 doses of SARS-CoV-2 mRNA vaccination were 35.2%, 79.4% and 92.4%, respectively. After 3 doses, patients on active treatment for haematological malignancies had lower antibodies (57.3%±46.2) when compared to patients on immunotherapy (94.1%±9.56, P<0.05) and chemotherapy (92.8%±18.1, P<0.05). SARS-CoV-2 infection was reported in 77 (28.2%) patients, of which 18 were severe. No patient receiving a third dose within 90 days of the second dose experienced severe infection. CONCLUSION This study demonstrates the benefit of early administration of the third dose among cancer patients.
Humans ; SARS-CoV-2 ; COVID-19/prevention & control* ; Treatment Outcome ; Neoplasms/drug therapy* ; Hematologic Neoplasms ; Vaccination ; RNA, Messenger ; Antibodies, Viral ; Immunogenicity, Vaccine