Skeletal muscle is the largest organ in the human body. Any of these muscles may develop pain and dysfunction. In modern society, myofascial pain is a major cause of morbidity. It may present as regional musculoskeletal pain, as neck or back pain mimicking radiculopathy. It may also present as shoulder pain with concomitant capsulitis, and hip or knee pain with concomitant osteoarthritis. The condition is treatable. However, it is often under-diagnosed and hence undertreated. Traditional medical training and management of musculoskeletal pain have focused much attention on bones, joints and nerves. This review will focus on muscles, myofascial pain and dysfunction. During history taking and physical examination, precipitating and perpetuating factors, taut bands, trigger points, tender spots and sensitised spinal segments have to be accurately located and correctly identified for effective needling treatment. There is also a high recurrence rate unless appropriate exercises are prescribed, with active participation from the patient, to restore flexibility and balance to the muscles. With rehabilitation, many patients do not have to continue to suffer unnecessary pain that affects their daily activities and quality of life. Early diagnosis and management may also help reduce psychosocial complications and financial burden of chronic pain syndrome.
Humans ; Muscle, Skeletal ; physiopathology ; Myofascial Pain Syndromes ; epidemiology ; physiopathology ; rehabilitation ; therapy ; Physical Examination ; Relaxation Therapy ; Stress, Mechanical

INTRODUCTIONDengue is a major public health problem in Singapore. Age-specific dengue morbidity rates are highest in the young adult population, unlike in many other Southeast Asian countries where dengue is mainly a paediatric disease. Hence, the World Health Organization (WHO) guidelines on dengue diagnosis and management which were developed using the paediatric experiences, may not be suitable for the management of adult dengue infections.

MATERIALS AND METHODSThe Early DENgue (EDEN) infection and outcome study is a collaborative longitudinal study to investigate epidemiological, clinical, viral and host-specific features of early dengue-infected adults, in an effort to identify new early markers for prognostication. Patients presenting with early undifferentiated fever were included in the study. We carried out an interim analysis to look for early indicators of severe disease.

RESULTSDuring the period of this interim study analysis, 455 febrile patients were recruited. Of these, 133 were confirmed as acute dengue cases based on dengue-specific polymerase chain reaction (PCR) results. There were significant clinical and epidemiological differences between dengue and febrile non-dengue cases. Nine per cent of the dengue cases experienced persistent tiredness, drowsiness and loss of appetite beyond 3 weeks of illness. Quantitation of viral loads using the crossover (Ct) value of real-time RT-PCR correlated with the duration of symptoms. More than half of both primary and secondary dengue cases were hospitalised. There was no dengue-related mortality in this study.

CONCLUSIONThe duration of illness and prolonged symptom duration in 9% of the subjects indicate that the burden of dengue illness is substantially different from other non-dengue febrile illness in our study cohort. Our study also highlights the paucity of early prognostic markers for dengue fever in adults.

Adult ; Antibodies, Viral ; analysis ; Dengue ; diagnosis ; epidemiology ; virology ; Dengue Virus ; genetics ; immunology ; isolation & purification ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Humans ; Male ; Morbidity ; trends ; Prognosis ; RNA, Viral ; analysis ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Singapore ; epidemiology

INTRODUCTION: We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity. METHODS: We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January 2020 and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded. RESULTS: 169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum. CONCLUSION Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement; and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.
Humans ; Asian People ; COVID-19/complications* ; Inflammation/complications* ; SARS-CoV-2 ; Thrombosis

The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Falls Prevention among Older Adults Living in the Community to provide health professionals in Singapore with recommendations for evidence-based assessments and interventions for falls prevention. This article reproduces the introduction and executive summary of the key recommendations from the HPB-MOH CPG on Falls Prevention among Older Adults Living in the Community for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov. sg/cpg-falls-prevention. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Accidental Falls ; prevention & control ; Aged ; Environment ; Evidence-Based Medicine ; Geriatrics ; standards ; Health Promotion ; methods ; Housing ; Humans ; Incidence ; Middle Aged ; Practice Guidelines as Topic ; Risk Assessment ; methods ; Singapore ; Social Class