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The Omicron variant has been reported to present with milder disease compared with Delta, although this may be due to immunity from vaccination and prior exposure. Predictors of severity with recent strains have not been well characterized. We retrospectively examined consecutive cases of moderate‐to‐severe COVID‐19 (defined as requiring supplemental oxygenation, intensive care or mortality) admitted to seven tertiary hospitals across Singapore in April 2023. Whole genome sequencing was performed on each isolate to determine the sublineage, while baseline clinical, laboratory data and outcomes were tabulated. We reviewed 182 patients with moderate‐to‐severe illness and 466 controls hospitalized at the same time. Advanced age and presence of chronic kidney disease predicted adverse outcome. Previously reported markers such as radiographic evidence of pneumonia, elevated C‐reactive protein and serum creatinine levels at presentation also correlated with adverse outcomes. There were no observable differences in outcomes with any specific Omicron XBB sublineage. We did not find any specific Omicron XBB sublineage that was associated with worse outcomes. Larger multinational studies would be important to track the clinical evolution of the virus in its current endemic state. [ABSTRACT FROM AUTHOR]

Early treatment of high‐risk COVID‐19 patients may prevent disease progression. However, there are limited data to support treatment of hospitalized or fully vaccinated patients with mild‐to‐moderate disease. In this retrospective cohort study, we studied the effect of early use of sotrovimab and remdesivir in high‐risk hospitalized COVID‐19 patients. We included PCR‐confirmed COVID‐19 patients admitted to the National Centre for Infectious Diseases who presented within the first 5 days of illness, and who were not requiring oxygen or ICU care at presentation. Sotrovimab‐ and remdesivir‐treated groups were compared with control (no early treatment). A multiple propensity‐score adjusted multivariable regression analysis was conducted with a composite primary endpoint of in‐hospital deterioration (oxygen requirement, ICU admission, or mortality). Of 1118 patients, 841 were in the control group, 106 in the sotrovimab group and 169 in the remdesivir group. The median age was 63 years (IQR 46–74 years) and 505 (45.2%) were female. In unvaccinated patients, both remdesivir and sotrovimab treatment were protective (adjusted odds ratio [aOR] 0.19, 95% CI 0.064–0.60 and 0.18 [95% CI 0.066–0.47]), respectively. Contrarily, among the vaccinated patients there was no significant treatment effect with early remdesivir treatment (aOR 2.51, 95% CI 0.83–7.57, p = 0.10). Remdesivir and sotrovimab treatment, given early in the disease course to unvaccinated high‐risk patients, was effective in reducing the risk of in‐hospital deterioration and severe disease. This effect was not seen in fully vaccinated patients, which may be due to a small sample size or residual confounding. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics of healthcare workers (HCWs) infected with COVID‐19 and to examine their sources of exposure. Methods: A descriptive cross‐sectional study using data extracted from the centralized disease notification system comprising individuals confirmed with COVID‐19 in Singapore between 23 January and 17 April 2020. Occupation of HCWs was categorized into six categories. Their job nature was classified into "frontline" or "back‐end" based on the frequency of direct patient contact, and source of exposure was classified as family/household, social interaction or workplace. Chi‐square and median tests were used to identify differences between categorical groups and sample medians, respectively. Results: A total of 88 (1.7%) HCWs were identified from 5,050 cases. Their median age was 35 years. Chinese and Indians constituted 42.0% and 31.8%, respectively, and 43.2% were foreigners. The majority (63.6%) was serving at frontlines handling patient‐facing duties, 15.9% were doctors, 11.4% were nurses and 44.3% were ancillary staff. About 81.8% acquired the infection locally, of which 40.3% did not have a clearly identifiable source of exposure. Exposure from the family/household was most common (27.8%), followed by workplace (16.7%) and social interaction (15.3%). All HCWs were discharged well with no mortality; three (3.4%) were ever admitted to intensive care unit and required increased care. Conclusion: Healthcare workers accounted for a small proportion of COVID‐19 cases in Singapore with favourable outcomes. The possibility of transmission resulting from family/household exposure and social interactions highlights the need to maintain strict vigilance and precautionary measures at all times beyond the workplace. [ABSTRACT FROM AUTHOR]

Purpose This retrospective cohort study aims to examine adherence to secondary stroke preventive medications and their association with risk of stroke recurrence and mortality in patients after first‐ever ischemic stroke. Methods: Using data from the National Healthcare Group and Singapore Stroke Registry, patients with first‐ever ischemic stroke between 2010 and 2014 were included, and categorized based on antithrombotic or statin adherence using the proportion of days covered: high (≥75%), intermediate (50%‐74%), low (25%‐49%), and very low (<25%). The primary outcome was first recurrent ischemic stroke within a year after hospital discharge, while the secondary composite outcomes were (a) stroke recurrence and all‐cause mortality and (b) stroke recurrence and cardiovascular mortality. The Cox proportional hazard model was used to examine the association between medication adherence and outcomes. Adjusted hazard ratios (aHRs) and the corresponding 95% confidence intervals (CIs) were reported. Results: Among ischemic stroke patients prescribed with antithrombotics (n = 1139) or statins (n = 1160) at hospital discharge, about one‐third were highly adherent to their medications. Patients with lower medication adherence tended to be younger, were admitted to private ward classes, and were without hypertension. Compared with the patients with high medication adherence, the risk of stroke recurrence was higher in patients with very low antithrombotic (aHR = 4.65; 95% CI: 1.45‐14.89) or statin (aHR = 3.44; 95% CI: 0.93‐12.74) adherence. Similar findings were observed for the secondary outcomes. Conclusions: Poor adherence to antithrombotic and statin treatment increases the risk of recurrent stroke and mortality in patients after first‐ever ischemic stroke. Further measures are needed to improve medication adherence among stroke survivors. [ABSTRACT FROM AUTHOR]

Aims Diabetic kidney disease ( DKD) incidence is rising in Singapore. While measures to prevent onset and early detection of diabetes as well as optimal diabetes and blood pressure control are important, early detection and treatment of DKD at primary care are crucial to ameliorate its course. This study aimed to evaluate the prevalence of DKD in a primary care cluster in Singapore and identify its risk factors in a multi-ethnic Asian population. Methods A total of 57 594 patients with type 2 diabetes mellitus ( T2 DM) followed-up at the National Healthcare Group Polyclinics with estimated glomerular filtration rate and at least two urine albumin/creatinine ratio ( UACR) were stratified into DKD stages: normoalbuminuria ( UACR <30 mg/g), microalbuminuria ( MI, UACR 30-299 mg/g), macroalbuminuria ( MA, ≥300 mg/g) and renal impairment ( RI, estimated glomerular filtration rate eGFR <60 mL/min per 1.73 m2). Factors associated with DKD stages were evaluated. Results Overall DKD prevalence ( T2 DM with MI, MA or RI) was high at 52.5%; 32.1% had MI, 5.3% had MA and 15.1% had RI. DKD prevalence within ethnic subpopulations was different: 52.2% of Chinese, 60.4% of Malays and 45.3% of Indians had DKD, respectively. Malays had a 1.42-fold higher DKD prevalence, while Indians had a 0.86-fold lower. Other independent risk factors were age, female gender, duration of diabetes and hypertension, Hb A1c and body mass index. Conclusion The high prevalence of DKD and its interethnic differences suggest need for additional measures to optimize the care of T2 DM at primary care to mitigate its progression. [ABSTRACT FROM AUTHOR]

Background: The aims of the present study were to estimate the rate of progression from newly diagnosed impaired fasting glycemia (IFG) to type 2 diabetes mellitus (T2DM) in Singapore and to identify factors associated with the progression to T2DM in individuals with newly diagnosed IFG. Methods: The present study was a retrospective cohort study of newly diagnosed IFG from the National Healthcare Group Diabetes Registry between 1 January 2006 and 31 December 2007 to estimated the rate of progression to T2DM. Univariate survival analysis, followed by multivariate survival analysis, was performed and interactions were tested in the final model. Results: Over a mean follow-up period of 1.65 ± 0.13 years, 85 of 490 participants with newly diagnosed IFG developed T2DM, giving an annual progression rate of 6.8%. The factors associated with the development of T2DM were higher fasting plasma glucose level in the year of IFG diagnosis (hazard ratio [HR] = 14.6; 95% confidence interval [CI] 5.66-37.5), Chinese race (HR = 2.70; 95% CI 1.44-5.06), and body mass index (HR = 1.11; 95% CI, 1.06-1.15). Conclusions: The progression rate to T2DM is high in subjects with newly diagnosed IFG. Intensive lifestyle modification can be incorporated into their current yearly follow-up to prevent progression to T2DM, which is a growing problem in Singapore. [ABSTRACT FROM AUTHOR]

Background The aim of the present study was to forecast the prevalence and number of adult Singapore residents with prediabetes and diabetes in 2035. Methods A dynamic Markov model with nine mutually exclusive states was developed based on the clinical course of diabetes using time-dependent rates and probabilities. A 1-year cycle over a 25-year time horizon from 2010 to 2035 was used in the model. With publicly available data and a chronic disease register, the model forecast annual disease burden by simulating transition of cohorts across different health states using prevalence rates, incidence rates, mortality rates, disease transition, disease detection, and complication rates. An aging index was used in the model in anticipation of population aging to minimize risks of underestimating disease burden. Results From 2010 to 2035, the number of Singapore residents with prediabetes and diabetes is projected to more than double, from 434 685 to 903 596 and from 373 104 to 823 802, respectively. The prevalence of prediabetes and diabetes will rise steadily from 15.5 % to 24.9 % and from 13.3 % to 22.7 %, respectively. By 2035, a further estimate of 733 174 and 100 250 patients with prediabetes and uncomplicated diabetes, respectively, will remain undiagnosed. The prevalence of detected and undetected complications is forecast to rise from 60.0 % in 2010 to 70.2 % by 2035. Conclusion By 2035, the prevalence of prediabetes and diabetes among Singapore residents aged 21+ years is expected to be one in four and one in five, respectively. There is an impetus to adopt more aggressive interventions to contain disease progression. [ABSTRACT FROM AUTHOR]