Long-term Cardiovascular, Cerebrovascular, and Other Thrombotic Complications in COVID-19 Survivors: A Retrospective Cohort Study.

BACKGROUND: Growing evidence suggests that some coronavirus disease 2019 (COVID-19) survivors experience a wide range of long-term postacute sequelae. We examined the postacute risk and burden of new-incident cardiovascular, cerebrovascular, and other thrombotic complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a highly vaccinated multiethnic Southeast Asian population, during Delta predominance. METHODS: This cohort study used national testing and healthcare claims databases in Singapore to build a cohort of individuals who had a positive SARS-CoV-2 test between 1 September and 30 November 2021 when Delta predominated community transmission. Concurrently, we constructed a test-negative control group by enrolling individuals between 13 April 2020 and 31 December 2022 with no evidence of SARS-CoV-2 infection. Participants in both groups were followed up for a median of 300 days. We estimated risks of new-incident cardiovascular, cerebrovascular, and other thrombotic complications using doubly robust competing-risks survival analysis. Risks were reported using 2 measures: hazard ratio (HR) and excess burden (EB) with 95% confidence intervals. RESULTS: We included 106 012 infected cases and 1 684 085 test-negative controls. Compared with the control group, individuals with COVID-19 exhibited increased risk (HR, 1.157 [1.069-1.252]) and excess burden (EB, 0.70 [.53-.88]) of new-incident cardiovascular and cerebrovascular complications. Risks decreased in a graded fashion for fully vaccinated (HR, 1.11 [1.02-1.22]) and boosted (HR, 1.10 [.92-1.32]) individuals. Conversely, risks and burdens of subsequent cardiovascular/cerebrovascular complications increased for hospitalized and severe COVID-19 cases (compared to nonhospitalized cases). CONCLUSIONS: Increased risks and excess burdens of new-incident cardiovascular/cerebrovascular complications were reported among infected individuals; risks can be attenuated with vaccination and boosting.

Disseminated Mucormycosis Due to Saksenaea vasiformis Complex in an Immunocompetent Adult with Sustained Response to Posaconazole Treatment.

Saksenaea vasiformis complex is an emerging cause of mucormycosis. We report a case of an immunocompetent patient presenting with a non-resolving lung mass who developed multiple skin nodules. Skin biopsy yielded Saksenaea vasiformis complex. This showcases an uncommon occurrence of disseminated Saksenaea infection without cutaneous inoculation that improved with posaconazole.

Chronic Pain in a Low Socioeconomic Status Population in Singapore: A Cross-Sectional Study.

PURPOSE: . The authors sought to determine the prevalence of chronic pain in a low socioeconomic-status rental-flat community in Singapore and its associations. In Singapore, ≥85% own homes; public rental flats are reserved for the low-income. METHODS: . Chronic pain was defined as pain ≥3 months. From 2009-2014, residents aged ≥ 40 years in five public rental-flat enclaves were surveyed for chronic pain, as well as sociodemographic factors. Subsequently, the authors conducted an additional study among elderly (aged ≥60) in two public rental-flat enclaves in 2012. The authors compared against residents staying in adjacent owner-occupied public housing. RESULTS: . Prevalence of chronic pain in the rental-flat population was 14.2% (133/936) compared with 14.4% (158/1101) in the owner-occupied population (p = 0.949). On multivariate analysis, among those aged 40-59 years, staying in the rental flat community was independently associated with higher prevalence of leg/ankle/foot pain, compared to staying in the owner-occupied flat community (aOR = 2.35, CI = 1.24-7.35, p = 0.008). In the rental-flat population, unemployment was associated with chronic pain (aOR = 1.92, 95%, CI = 1.05-2.78, p = 0.030); among the elderly, dependency in instrumental-activities-of-daily-living (iADLs) was associated with chronic pain (aOR = 2.38, CI = 1.11-5.00, p = 0.025), as well as female gender, being single, and having higher education (all p > 0.05). CONCLUSIONS: . In this low socioeconomic-status population, chronic pain associated with unemployment and functional limitation. There was no difference in pain prevalence between the rental-flat population and adjacent owner-occupied precincts.

Caring for underserved patients through neighborhood health screening: outcomes of a longitudinal, interprofessional, student-run home visit program in Singapore.

PURPOSE: Service learning, an effective vehicle for teaching undergraduate public health while providing underserved communities with medical care, is not well established in Asia. The authors evaluated a service learning program, Neighborhood Health Screening (NHS), in Singapore. METHOD: Medical and nursing undergraduate students provided in-home medical services to patients in a low-income neighborhood (January-June 2010). The authors assessed student-reported pedagogical effectiveness in nine domains, asked students for qualitative feedback on their experiences, assessed patients' satisfaction with NHS, and tracked clinical outcomes. RESULTS: Of the 240 medical and 34 nursing students who participated, 222 (93%) and 34 (100%), respectively, completed the questionnaire; 136 of the medical students (57%) also provided qualitative feedback. Most students felt NHS was beneficial across all domains. Male medical students were less likely to report increased understanding of deficiencies in the health care system and long-term management of chronic disease; preclinical students were more likely to report improvements in comprehending ethical issues, critical thinking and action skills, and gaining and applying knowledge. Qualitative feedback supported quantitative findings. Patients were satisfied with NHS: 266 (75%) agreed that NHS improved their health, and 301 (85%) felt NHS provided sufficient time to address their issues. After a single year, amongst patients with known hypertension, treatment increased from 63% to 93% (P < .001), and blood pressure control amongst those who were on treatment improved from 42% to 79% (P < .001). CONCLUSIONS: Service learning can make an important contribution to medical teaching and patient care in Asia.