Chronic kidney disease (CKD) and metabolic dysfunction–associated steatotic liver disease (MASLD) have been associated with an increased risk of cardiovascular disease. This study seeks to examine the prognostic value of the coexistence of CKD and MASLD in patients presenting with acute myocardial infarction (AMI). This cohort study describes the clinical characteristics and long-term outcomes of patients following AMI, stratified by the presence of CKD and MASLD. A Kaplan–Meier curve was constructed for 30-day mortality. Cox regression analysis was used to investigate independent predictors of long-term all-cause mortality, adjusted for age, sex, ethnicity, previous AMI, AMI type, and left ventricular ejection fraction (LVEF). A total of 6757 patients with AMI were examined. Those with coexisting CKD and MASLD (CKD(+)/MASLD(+)) had the highest rates of obesity (97.7
The optimal treatment strategy for elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. While endovascular coiling and surgical clipping are both established interventions, age-related physiological vulnerability and comorbidity burden may alter the risk–benefit profile. We performed a systematic review and meta-analysis to compare outcomes between these two modalities in elderly patients with aSAH. Searches of PubMed, Embase, Scopus, and Cochrane CENTRAL were conducted from inception to 20th July 2025. The definition of elderly patients aged ≥ 60 years was adopted as per the World Health Organization. Primary outcomes were favorable functional outcome (modified Rankin Scale [mRS] 0–2) and mortality. Secondary outcomes were delayed cerebral ischemia (DCI), delayed hydrocephalus and rebleed. Twenty studies (2 randomized controlled trials, 18 observational) were included. A total of 44,526 patients were included with 24,724 aneurysms clipped and 19,802 coiled. The mean age was 72.1 years in the coiling cohort and 72.8 years in the clipping cohort. Aneurysm location was anterior in 94
Medication adherence is essential for effective management of allergic rhinitis (AR), yet real-world adherence to guideline-recommended pharmacotherapies remains poorly characterized. This systematic review and meta-analysis aims to estimate pooled adherence proportions to prescribed intranasal corticosteroids and oral antihistamines in adults with AR, further stratified by adherence measurement method and geographic region. Twelve studies encompassing 191,103 AR patients were included. Overall pooled adherence to both intranasal corticosteroids and oral antihistamines was 43
In complex ventral hernias, tension-free midline fascial re-approximation may remain unattainable despite posterior component separation (PCS) with transversus abdominis release (TAR). We describe a technique and our initial experience using the entire peritoneal sac as a free flap to augment repair in this setting. This retrospective single-center study included all consecutive patients who underwent PERitoneal Free Flap (PERFF) reconstruction between January 2024 and January 2025. Demographics, hernia characteristics, operative details, and post-operative outcomes—including complications (Clavien–Dindo classification), surgical site infection, seroma, hematoma, and hernia recurrence—were analyzed. Eight patients underwent ventral hernia repair using PERFF. The mean age was 68.1 years (range, 57–82), and the mean body mass index was 32.5 kg/m² (range, 27–43). The mean defect width was 6.6 cm (range, 5–15 cm), defect sizes ranged from 5 × 5 cm to 12 × 15 cm, and the Tanaka index ranged from 0.25 to 0.45. Six patients required bilateral TAR and two unilateral TAR. Two patients underwent concomitant small bowel resection. All patients were discharged by post-operative day 3. No post-operative complications or hernia recurrences were observed during a mean follow-up of 17.6 months. PERFF is a feasible and safe adjunct to augment PCS with TAR in complex ventral hernia repair when midline closure is not achievable. Harvesting the entire peritoneal sac as a free flap provides flexible and durable fascial coverage while maintaining separation of the mesh from visceral and subcutaneous tissues.
The objective was to evaluate the overall economic burden of spinal muscular atrophy (SMA) in Singapore. A retrospective cohort study of electronic medical records and billing data was used to obtain medical costs from public healthcare consumption. Private medical costs, nonmedical costs from transportation and hired domestic helpers, and indirect costs due to caregiver productivity loss were estimated with a cross-sectional caregiver survey. The survey also examined intangible negative and positive effects on these caregivers. All costs were adjusted to 2024 Singapore dollar (SGD). A total of 61 patients were identified in the electronic medical records, and 15 caregivers were interviewed. One caregiver who took care of two patients with SMA was excluded from the analysis. The gross cost of inpatient admission is SGD 1663.81 (standard deviation [SD] = 986.03) per day with mean length of stay of 6.22 days (SD = 10.89) per year, while annual mean outpatient cost is SGD 940.31 (SD = 1071.28). In addition to public healthcare services, private services incur an additional SGD 5992.35 (SD = 7557.33) per year, with fixed costs for respiratory devices and mobility aids at SGD 5677.06 (SD = 4519.57) and SGD 12,412.70 (SD = 8307.35), respectively. Nonmedical costs from hiring a domestic helper, medical-related transport, and nonmedical transport amount to SGD 7002.22 (SD = 6516.36), SGD 387.86 (SD = 196.36), and SGD 840.95 (SD = 1067.81) per annum, respectively. Paid work productivity loss is estimated at SGD 42,932.88 per family per year. Average overall economic burden is estimated at SGD 62,004.03, SGD 10,840.13, and SGD 59,629.64 per patient per year from the societal perspective, healthcare system perspective, and patient perspective, respectively. SMA poses a significant economic burden on patients, families, and the healthcare system. This study informs policy discussions for SMA management, advocating for a comprehensive, compassionate approach and societal perspective in economic evaluations to capture all costs and benefits.
