Migraine is a debilitating neurological condition that affects millions of people worldwide, causing intense headaches, sensory disturbances, and a significant decline in quality of life. Approximately one-third of patients encounter aura, which encompasses transient focal neurological disturbances that precede the attack. [Lancet 2017;390:1211-1259; Headache 2021;61:1021-1039]
The WHO defines long COVID as a condition that occurs 3 months from COVID-19 onset, whose symptoms last ≥2 months and cannot be attributed to an alternative diagnosis. In an interview with MIMS Doctor, Professor Ghassan Dbaibo of the Center for Infectious Diseases, American University of Beirut, Beirut, Lebanon, describes the evolving attitudes towards long COVID among healthcare professionals (HCPs), some unexpected predisposing factors, potential biological mechanisms behind prolonged symptom duration and shares data on vaccination’s protective effects against long COVID.
Executive function (EF) skills in childhood predict academic success better than a child’s intelligence quotient (IQ), and are associated with better physical health, more stable careers, and higher socioeconomic status in adulthood. [Psychol Sci 2005;16:939-944; J Clin Psychiatry 2012;73:941-950; Pediatrics 2013;131:637-644] Despite this, EF is an important topic that is often overlooked. To learn more about EF, MIMS Doctor interviewed Dr Evelyn Law, a clinician scientist specialising in developmental and behavioural paediatrics. Dr Law is Assistant Professor at the National University of Singapore Yong Loo Lin School of Medicine, Singapore.
Geriatric patients with atrial fibrillation (AF) are at increased risk of blood clots that can lodge in the brain and cause fatal strokes. At a recent webinar, Professor Olivier Hanon, Head of Geriatrics Department in Broca Hospital, Paris, France, shared insights on how to optimally protect geriatric patients with AF, with a special focus on direct oral anticoagulants (DOACs), particularly rivaroxaban, for stroke prevention in AF.
Dr. Tan Vern Hsen, Dr. Barbara Helen Rosario, 20220401100000
A key focus in the management of atrial fibrillation (AF) in older patients is stroke prevention through oral anticoagulation. However, a significant proportion of older AF patients remain undercoagulated due to the perceived bleeding risk of oral anticoagulants (OACs). Dr Tan Vern Hsen, Senior Consultant, Department of Cardiology, Changi General Hospital, Singapore, and Dr Barbara Helen Rosario, Senior Consultant, Department of Geriatric Medicine, Changi General Hospital, Singapore, shared their respective insights into managing older AF patients for an integrated approach.
Venous thromboembolism (VTE) is a serious medical condition. It comprises deep vein thrombosis and pulmonary embolism. Left untreated, it could result in significant morbidity and mortality. Most patients with VTE receive anticoagulation therapy for 3 months or longer. For more than 50 years since the 1940s, vitamin K antagonists (VKAs) such as warfarin were the mainstay of oral anticoagulation therapy for VTE. As it has a narrow therapeutic index, VKAs require frequent coagulation monitoring with International Normalised Ratio (INR) to adjust and optimize the dose for each individual. As the peak effect for warfarin takes at least 4-5 days, in the initial stage of VTE, concurrent administration of daily subcutaneous injections of low molecular weight heparin (LMWH) is needed until INR reaches therapeutic levels. Due to numerous drug and dietary interactions with warfarin, regular INR monitoring is required to ensure therapeutic levels are maintained and to avoid under or overdosing.
Nonvalvular atrial fibrillation (NVAF) raises the risk of stroke by three to five times, particularly in older patients. Treating older patients with NVAF presents special challenges because of their elevated risks for both stroke and bleeding. This necessitates optimization of anticoagulant therapy by balancing efficacy and bleeding risk. Non-vitamin K antagonist oral anticoagulants (NOACs), such as apixaban, have shown advantages in safety and efficacy over warfarin, which has a very narrow therapeutic index. In an interview with Dr Soon Chao Yang, Cardiologist at The Heart Doctors Clinic, Mount Alvernia Hospital, Singapore, he shared insights on managing NVAF in older patients, as well as his experience with using apixaban in this special population.
Prof. Peter Taylor, Prof. Christopher Edwards, Dr. Lian Tsui Yee, 20211103000000
Nearly half of all rheumatoid arthritis (RA) patients suffer comorbidity, which has a negative impact on quality of life and mortality. At a recent scientific symposium, Professor Peter Taylor from the University of Oxford in Oxford, UK emphasized the importance of monitoring, preventing, and treating comorbidities in RA while Professor Christopher Edwards from the University Hospital Southampton in Southampton, UK focused on the impact of mental health in RA. The symposium was organized by Fresenius Kabi and held under the auspices of the Singapore Society of Rheumatology. Dr Lian Tsui Yee from Tan Tock Seng Hospital, Singapore chaired the event.
Galcanezumab (Emgality®, DKSH Singapore) was developed to target calcitonin gene-related peptide (CGRP) to prevent migraine.1-3 At the symposium to mark the launch of Emgality® in Singapore on 23 January 2021 chaired by Dr Jonathan Ong, Dr Patricia Pozo-Rosich provided an overview of the current clinical and real-world evidence supporting the use of galcanezumab; a panel discussion led by Dr Ho King Hee and Dr Zhao Yi Jing also highlighted local headache specialists’ experience in the use of CGRP monoclonal antibodies (mAbs) in the treatment of patients with migraine.
Intracranial atherosclerotic disease (ICAD) is an important cause of ischaemic stroke and transient ischaemic attacks. Clinical trial data indicate that medical treatment and lifestyle modifications are superior to endovascular treatment for stroke prevention in ICAD patients. [N Engl J Med2011;365:993–1003; JAMA 2015;313:1240–1248] However, the risk of recurrent stroke in patients with symptomatic ICAD remains high despite aggressive, highly monitored medical management.