Andrew Arjun Sayampanathan

Prevalence of Mental Health Disorders Among Caregivers of Patients With Alzheimer Disease

OBJECTIVE The overall prevalence of mental health disorders among caregivers of patients with Alzheimer disease (AD) remains unclear. This meta-analysis aims to evaluate the prevalence of various mental health disorders among caregivers of patients with AD globally and to determine factors that predispose to development of the aforementioned, namely gender of caregiver, gender of patient, and caregiver-patient relationship. METHODS A total of 17 studies were eligible for systematic review and meta-analysis. A meta-analysis of published work was performed using the random effect model. Data analysis was done with RevMan 5.3. A total of 10,825 caregivers were assessed. RESULTS The aggregate prevalence of depression among caregivers was 34.0%, anxiety at 43.6%, and use of psychotropic drugs at 27.2%. Meta-analysis revealed the odds of having of depression was 1.53 times higher in female caregivers (95% confidence interval [CI] 1.29-1.83; I(2) = 7%; Z = 4.78; P < .001), 1.86 times higher in caregivers to male care-recipients (95% CI 1.66-2.08; I(2) = 40%; Z = 10.86; P < .001), and 2.51 times higher in spousal caregivers (95% CI 1.68-3.76; I(2) = 55%; Z = 4.49; P < .001). CONCLUSION Caregivers of patients with AD have a higher prevalence of mental health disorders, particularly depression and anxiety, as compared with the general population and with their counterparts caring for patients with other illnesses. The higher prevalence is mainly observed in female caregivers, caregivers with male care-recipients, and caregivers who have a spousal relationship with care-recipients. Prevalence of anxiety was also notably higher in this cohort but more research needs to be done in this area.

Epidemiology of surgically managed anterior cruciate ligament ruptures in a sports surgery practice

Introduction: Anterior cruciate ligament (ACL) tears are common knee injuries, especially among sportsmen and sportswomen. The aim of this study is to better understand the epidemiology of surgically managed ACL tears sustained in our institution. Methods: All patients who underwent arthroscopic ACL reconstruction by the senior author of this article in Singapore from 2008 to 2013 were studied. Patients who were diagnosed clinically and/or radiologically to have a complete tear of the ACL and subsequently underwent arthroscopic ACL reconstruction were included. Patients who suffered from traumatic knee dislocation were excluded. Two hundred and ninety-two patients were available for analysis. All patients were operated on by the senior author. Results: 83.9% of patients were male. 60.5, 23.0, 8.46, and 8.11% were of Chinese, Malay, Indian and other origins, respectively. 69.6 and 28.7% were in white-collared and blue-collared jobs, respectively, while 1.69% were unemployed. Mean age at operation was 29.4 years. Mean body mass index was 25.3 kg/m2. 82.4 and 17.6% of ACL tears were sports (contact—27.5%; non-contact—72.5%) and non-sports injuries (activities of daily living—94.2%, road traffic accidents—5.77%), respectively. The top four sporting activities causing ACL tears were soccer, basketball, racquet games and volleyball. 56.2% of ACL tears presented with concomitant knee injuries (medial meniscus—63.4%; lateral meniscus—31.1%; posterior cruciate ligament—5.49%). 84.5% were primary tears. Conclusions: In this epidemiological review of ACL injuries, we found that ACL injuries tend to cluster within certain population subgroups. Patterns of mechanisms of injuries have been observed. These findings may lead to better preventive and treatment strategies in the management of ACL tears.

Diagnosis of ligamentous and meniscal pathologies in patients with anterior cruciate ligament injury: comparison of magnetic resonance imaging and arthroscopic findings.

BACKGROUND Magnetic resonance imaging (MRI) is routinely used to diagnose or support clinical diagnoses for meniscal or ligamentous injuries prior to offering patients arthroscopic treatment. However, the sensitivity of MRI for the detection of meniscal injury is not yet 100%. Sportsmen have occasionally returned to play with undiagnosed meniscal lesions on the basis of a normal MRI examination. This study was designed to assess the diagnostic parameters of MRI in patients with acute anterior cruciate ligament (ACL) injury. METHODS MRI and arthroscopic findings of 320 patients with acute ACL injury were included in this retrospective review. Patients belonged to a single surgeon from a high volume tertiary healthcare institution. All patients had either a MRI or an arthroscopic diagnosis of an acute ACL injury of one knee or both. All patients underwent therapeutic arthroscopy by the senior author routinely as part of arthroscopy-aided ACL reconstruction. Arthroscopic findings were the diagnostic reference based on which the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and concordance strength of association of MRI were calculated for ACL, posterior cruciate ligament (PCL), medial meniscus (MM) and lateral meniscus (LM) injuries. RESULTS MRI was most accurate in diagnosing cruciate ligament injuries with a PPV approaching 100%. The PPV of MRI in diagnosing meniscal injuries was approximately 60%. MRI was almost 100% sensitive and specific in diagnosing ACL injuries and 82% sensitive and 100% specific in diagnosing PCL injuries. Conversely, MRI was 77% sensitive and 90% specific in diagnosing MM injuries; and 57% sensitive and 95% specific in diagnosing LM injuries. CONCLUSIONS MRI remains the gold standard for diagnosing soft tissue injuries of the knee. However, there is a false positive rate ranging from 6% to 11% for meniscal tears.

Mental health issues amongst medical students in Asia: a systematic review [2000-2015].

BACKGROUND Studies have shown that the stress experienced by medical students is far greater than that experienced by other university students. In this study, we aim to understand the consequent mental health issues that are experienced by medical students, particularly in Asia, via a systematic review of the current literature. METHODS Initial searches on MEDLINE, Embase and SpringerLink came up with a total of 1,033 unique articles. Studies not focusing on medical students alone, not mentioning mental health issues or not containing prevalence values were excluded. RESULTS We included 14 articles in our analysis. ADs had a prevalence of 7.04% (100/1,420). Depression was prevalent in 11.0% (1,115/10,147) of students. A total of 12.9% (54/420) and 12.9% (41/319) of male and female medical students respectively were screened for depression. Preclinical students were also 1.63 times more likely to be depressed compared to clinical students, with 98.0% (48/49) pre-clinical students having screened for depression, compared to 60% (27/45) clinical students. Home staying medical students are 1.33 times more likely to be depressed compared to hostel-stayers, with 12.1% (29/239) of home stayers being depressed compared to 9.2% (37/402) of hostel stayers. CONCLUSIONS We found that mental health issues affect a significant proportion of medical students and they are more prevalent in certain subpopulations of medical students. Our data revealed that preclinical and home staying students can be more susceptible to depression. More research should be done regarding this issue. With such information, it is hoped that appropriate interventions can be designed to improve the mental health of medical students.

Systematic review on risk factors of rotator cuff tears

Purpose: Rotator cuff tears (RCTs) occur commonly, especially among certain groups of individuals. In this meta-analysis, we aim to identify risk factors for RCTs. Methods: We searched MEDLINE for 210 articles. Seventeen articles were selected for systematic review, of which 10 were eligible for meta-analysis. Data was analysed with Review Manager 5.3, using Mantel–Haenszel statistics and random effect models. Results: A total of 6653 individuals were analysed. The odds of sustaining a RCT on the dominant hand was 2.30 times more than the non-dominant hand (95% confidence interval (CI): 1.01–5.25, Z = 1.99, p = 0.05; Heterogenity: τ 2 = 0.38, χ 2 = 8.84, df = 2 (p = 0.01), I 2 = 77%). The odds of an individual aged 60 years and above sustaining a RCT was 5.07 times higher than an individual less than 60 years old (95% CI: 2.45–10.51, Z = 4.37, p < 0.001; Heterogenity: τ 2 = 0.47, χ 2 = 25.24, df = 3 (p < 0.001), I 2 = 88%). Female gender was not a significant association, with an odds ratio of 0.98 when compared to the male gender (95% CI: 0.66–1.45, Z = 0.09, p = 0.93; Heterogenity: τ 2 = 0.20, χ 2 = 44.24, df = 5 (p < 0.001), I 2 = 89%). Conclusions: Hand dominance and older age are associated with RCTs. More studies are required for further assessment of associations and risk factors of RCTs.

Arthroscopic management of posterior instability of the shoulder: A systematic review of predictive factors associated with poorer surgical outcomes

Introduction: We aimed to perform a systematic review to identify factors that may lead to poorer outcomes in arthroscopic surgery for posterior shoulder instability. Methods: We searched MEDLINE, Embase and the Cochrane Database of Systematic Reviews for 757 unique articles. We eventually included 22 articles. Data were analysed using Review Manager 5.3. Results: The presence of chondral damage was associated with poorer outcomes as reflected in a higher post-operative Quick Disabilities of theArm, Shoulder and Hand score (mean difference (MD) = 17.1; 95% confidence interval (CI) = 2.82–31.4; p = 0.02), higher WesternOntario Shoulder Instability (WOSI) index (MD = 468.0; 95% CI = 136.5–799.5; p = 0.006), lower Simple Shoulder Test score (MD = −2.40; 95% CI = −4.34 to −0.46; p = 0.02) and a lower Single Assessment Numeric Evaluation score (MD = −15.4; 95% CI = −30.6 to −0.23; p = 0.05). The presence of previous shoulder surgery was associated with poorer outcomes as depicted by a lower American Shoulder and Elbow Society (ASES) score (MD = −93.1; 95% CI = −96.9 to −89.3; p < 0.0001). The availability of workers’ compensation was associated with poorer outcomes as revealed by a lower rate of return to work (odds ratio (OR) = 0.02; 95% CI = 0.00–0.20; p = 0.0008). The presence of additional procedures while performing surgery for posterior shoulder instability was associated with poorer outcomes as reflected by lower ASES scores (MD = −6.70; 95% CI = −8.64 to −4.76; p < 0.0001), higher WOSI index (MD = 63.4; 95% CI = 33.0–93.8; p < 0.0001), lower University of California at Los Angeles (UCLA) scores (MD = −2.30; 95% CI = −2.81 to −1.79; p < 0.0001), higher pain scores (MD = 0.72; 95% CI = 0.39–1.05; p < 0.0001) and higher post-operative instability (MD = 0.80; 95% CI = 0.57–1.03; p < 0.0001). Conclusion: The presence of chondral damage, previous shoulder surgery, concomitant surgery and workman’s compensation was associated with poorer outcomes for arthroscopic repair of posterior shoulder instability. Further studies should be done to further validate these factors.

Use of single-question screening for erectile dysfunction: a study of at-risk Asian men in primary health care

This study assesses the validity of a single-question screener for erectile dysfunction (ED) in men at risk in comparison to a standard validated tool - the five-item version of the International Index of Erectile Function (IIEF-5). A total of 174 men with at least one risk factor for ED were studied, with 58.0% and 10.9% of the study respondents meeting the criteria for their erectile impairment by IIEF-5 and single-question screener respectively. Our results suggest that in spite of high feasibility, a simplified, single-question screener has low sensitivity in capturing ED prevalence, even in an at-risk population, within the Asian context.

Patellar tendon re-rupture on the opposite end of the previous site of surgical repair

We describe a rare case of a patellar tendon “re-rupture” at the opposite end of a previous proximal tendon repair. A 32-year-old male with a history of surgically repaired right proximal patellar tendon rupture presented with an acute non-traumatic right knee pain and instability during sports. Magnetic resonance imaging confirmed a complete rupture of his distal patellar tendon at the tibial tuberosity. The patellar tendon was repaired using two 5.5 mm BioCorkscrews (Arthrex) inserted into the tibial tuberosity; the tendon was stitched with the No. 2 fiberwires using Krackow technique. As the patellar tendon was degenerative, the repair was augmented with a semitendinosus tendon harvested using an open tendon stripper, leaving the distal attachment intact. At 2.6 years followup he had mild anterior knee pain, range of motion 0-130° and was able to squat. MRI scan done at followup revealed good healing of repaired patellar tendon.

Leadership development in undergraduate education

o manage the progressive complexities of our health care system, our health care community needs to ensure a constant pipeline of strong leaders. After all, a key trait of successful organisa-tions is their ability to embrace change and deal with complexities. 3 After studying 160 companies from 40 varied industries, Joyce et al . observed that businesses with performance- oriented cultures and fast, fl exible structures outperformed competi-tors over a 10- year period. 1 Consequently, a potential way forward for health care is to focus on designing fl exible systems. For fl exible systems to function, leadership must exist at all levels of the system. It is an equal and shared responsibility of every health care worker, regardless of duty, rank or seniority. Morison and McMullan put forward the idea that leadership development is essentially an educational matter; thus, having educational programmes on leadership is imperative for grooming effective future leaders.

Factors Affecting Foot Self-Care Practices in Individuals with Diabetes Mellitus Living in an Asian Population - A Quantitative Study:

Category: Diabetes Introduction/Purpose: Diabetic foot complications and subsequent lower limb amputations commonly occur in diabetic patients due to poor foot care. We aimed to understand the extent of proper footcare practices and to identify the factors which influence these among diabetic patients in a multi-ethnic Asian population. Methods: A cross-sectional multi-centre quantitative study was performed. Inclusion criteria was all patients attending hospital outpatients clinics for diabetes. Patients were only excluded if they were unable to understand basic English. Demographic information, medical history (including formal assessment for peripheral neuropathy) and Nottingham Assessment of Functional Footcare (NAFF) scoreswere collected. All data was analysed using SPSS Version 21. Results: 350 valid responses were obtained. The mean NAFF score was 49.6±7.19. Univariate analysis revealed that ethnically non-Chinese patients had significantly better scores than did Chinese patients. After linear regression analysis, a statistically significant correlation with better foot care practices was found for patients with higher education levels, active employment and the presence of previous diabetic foot complications. Conclusion: The mean NAFF scores in our study were lower than those published in other populations which may in part account for the huge burden of diabetic foot disease in Singapore. Patients appear to start to look after their feet better only after suffering a complication.Cultural and financial factors probably account for the differences in our risk factor findings and those published in other populations. Future studies should i evaluate the effectiveness of targeted interventions for the specific groups that we have identified who have poorer NAFF scores.