Objectives: The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP). Methods: A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation. Results: This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate. Conclusions The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.

Humans ; COVID-19/epidemiology* ; Pandemics ; Orthopedics ; Orthopedic Procedures ; Telemedicine

COVID-19 ; Dermatology ; Humans ; Inpatients ; SARS-CoV-2 ; Singapore

Objectives: To explore the epidemiological and histopathological patterns of glomerular diseases in Sabah. Methods: A state-wide cross-sectional study was conducted. There were 336 native renal biopsies in 296 eligible patients from 1st January 2013 to 30th June 2016. All patients aged ≥12 years with sufficient sampling (≥8 glomeruli) for histopathological assessment were included. Graft kidney biopsies, protocol-based biopsies and patients with uncertain demographics were excluded. Demographics of patients, clinical data, laboratory parameters prior to biopsy, and histology findings of renal biopsies were collected from local unit database and recorded into a standardised data collection form. Descriptive statistical analyses were employed and factors associated with Lupus nephritis (LN) were explored using logistic regression. Results: The mean age during biopsy was 34.53 years (Standard Deviation 0.759). Primary glomerulonephritis (PGN) accounted for 42.6% (126) of all native renal biopsies. The commonest cause of PGN was minimal change disease (38.9%, 49) followed by focal segmental glomerulosclerosis (33.3%, 42) and IgA nephropathy (14.3%, 18). LN is the leading cause for secondary glomerulonephritis (SGN) (87.2%, 136). Younger age (Odds Ratio, OR 0.978; 95% Confidence Interval, 95%CI 0.960, 0.996); female gender (OR 17.53; p<0.001); significant proteinuria (OR 132.0; p<0.001); creatinine level at biopsy (OR 11.26; p=0.004); positive antinuclear antibody (ANA) (OR 46.7; p<0.001); and ANA patterns (OR 8.038; p=0.018) were significant in predicting the odds of having LN. Conclusion: This is the first epidemiology study of glomerular diseases in Sabah. The predominance of LN suggests lower threshold for renal biopsy in patients with suspected glomerular disorders. We have identified significant predictors for early detection and treatment of LN

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.

STUDY DESIGN: Clinical imaging study. PURPOSE: To study the surgical morphometry of C1 and C2 vertebrae in Chinese, Indian, and Malay patients. OVERVIEW OF LITERATURE: C1 lateral mass and C2 pedicle screw fixation is gaining popularity. However, there is a lack of C1–C2 morphometric data for the Asian population. METHODS: Computed tomography analysis of 180 subjects (60 subjects each belonging to Chinese, Indian, and Malay populations) using simulation software was performed. Length and angulations of C1 lateral mass (C1LM) and C2 pedicle (C2P) screws were assessed. RESULTS: The predicted C1LM screw length was between 23.2 and 30.2 mm. The safe zone of trajectories was within 11.0°±7.7° laterally to 29.1°±6.2° medially in the axial plane and 37.0°±10.2° caudally to 20.9°±7.8° cephalically in the sagittal plane. The shortest and longest predicted C2P screw lengths were 22.1±2.8 mm and 28.5±3.2 mm, respectively. The safe trajectories were from 25.1° to 39.3° medially in the axial plane and 32.3° to 45.9° cephalically in the sagittal plane. CONCLUSIONS: C1LM screw length was 23–30 mm with the axial safe zone from 11° laterally to 29° medially and sagittal safe zone at 21° cephalically. C2P screw length was 22–28 mm with axial safe zone from 26° to 40° medially and sagittal safe zone from 32° to 46° cephalically. These data serve as an important reference for Chinese, Indian, and Malay populations during C1–C2 instrumentation.
Asian Continental Ancestry Group* ; Humans ; Pedicle Screws ; Spine*

There is a paucity of research available on the effect of mindfulness on cognitive function. However, the topic has recently gained more attention due to the ageing population in Singapore, catalysed by recent findings on brain function and cellular ageing. Recognising the potential benefits of practising mindfulness, we aimed to develop a localised, self-training mindfulness programme, guided by expert practitioners and usability testing, for older Singaporean adults. This was followed by a pilot study to examine the potential cognitive benefits and feasibility of this self-training programme for the cognitive function of older adults in Singapore. We found that the results from the pilot study were suggestive but inconclusive, and thus, merit further investigation.
Aged ; Aging ; Asian Continental Ancestry Group ; Attention ; Cognition ; Cognition Disorders ; therapy ; Executive Function ; Humans ; Middle Aged ; Mindfulness ; methods ; Pilot Projects ; Program Development ; Singapore ; User-Computer Interface

Aged, 80 and over ; Axilla ; Breast Neoplasms ; epidemiology ; surgery ; Comorbidity ; Diabetes Mellitus ; epidemiology ; Dyslipidemias ; epidemiology ; Female ; Humans ; Hypertension ; epidemiology ; Length of Stay ; Lymph Node Excision ; Mastectomy ; Myocardial Infarction ; epidemiology ; Myocardial Ischemia ; epidemiology ; Operative Time ; Postoperative Complications ; epidemiology ; Postoperative Hemorrhage ; epidemiology ; Seroma ; epidemiology ; Singapore ; epidemiology ; Surgical Wound Dehiscence ; epidemiology ; Surgical Wound Infection ; epidemiology ; Venous Thrombosis ; epidemiology

STUDY DESIGN: Prospective cohort study. PURPOSE: To report the outcome of 50 patients with spinal metastases treated with minimally invasive stabilization (MISt) using fluoroscopic guided percutaneous pedicle screws with/without minimally invasive decompression. OVERVIEW OF LITERATURE: The advent of minimally invasive percutaneous pedicle screw stabilization system has revolutionized the treatment of spinal metastasis. METHODS: Between 2008 and 2013, 50 cases of spinal metastasis with pathological fracture(s) with/without neurology deficit were treated by MISt at our institution. The patients were assessed by Tomita score, pain score, operation time, blood loss, neurological recovery, time to ambulation and survival. RESULTS: The mean Tomita score was 6.3+/-2.4. Thirty seven patients (74.0%) required minimally invasive decompression in addition to MISt. The mean operating time was 2.3+/-0.5 hours for MISt alone and 3.4+/-1.2 hours for MISt with decompression. Mean blood loss for MISt alone and MISt with decompression was 0.4+/-0.2 L and 1.7+/-0.9 L, respectively. MISt provided a statistically significant reduction in visual analog scale pain score with mean preoperative score of 7.9+/-1.4 that was significantly decreased to 2.5+/-1.2 postoperatively (p=0.000). For patients with neurological deficit, 70% displayed improvement of one Frankel grade and 5% had an improvement of 2 Frankel grades. No patient was bed-ridden postoperatively, with the average time to ambulation of 3.4+/-1.8 days. The mean overall survival time was 11.3 months (range, 2-51 months). Those with a Tomita score <8 survived significantly longer than those a Tomita score > or =8 with a mean survival of 14.1+/-12.5 months and 6.8+/-4.9 months, respectively (p=0.019). There were no surgical complications, except one case of implant failure. CONCLUSIONS: MISt is an acceptable treatment option for spinal metastatic patients, providing good relief of instability back pain with no major complications.
Back Pain ; Cohort Studies ; Decompression ; Fractures, Spontaneous ; Humans ; Neoplasm Metastasis* ; Neurology ; Palliative Care* ; Prospective Studies ; Visual Analog Scale ; Walking

INTRODUCTIONSingapore experienced its second riot in 40 years on 8 December 2013, in the area known as Little India. A retrospective review of 36 casualties treated at the emergency department was conducted to evaluate injury patterns.

METHODSCharacteristics including the rate of arrival, injury severity, type and location, and disposition of the casualties were analysed.

RESULTSThe injuries were predominantly mild (97.2%), with the most common injuries involving the head (50.0%) and limbs (38.9%). 97.2% of the casualties were managed as outpatient cases.

CONCLUSIONThe majority of the injuries in this incident were mild and could be managed as outpatient cases. Important lessons were learnt from the incident about the utilisation of manpower and safety of staff in the emergency department.

Adult ; Emergency Medical Services ; Emergency Medicine ; methods ; Emergency Service, Hospital ; Female ; Humans ; Injury Severity Score ; Male ; Patient Safety ; Retrospective Studies ; Riots ; Singapore ; Triage