Annals Academy of Medicine Singapore最新文献

{"title":"Outcomes of selexipag for treatment of pulmonary arterial hypertension in an Asian population.","authors":"Germaine Loo, Jonathan Yap, Jin Shing Hon, Aidila Ismail, Wen Ruan, Andrea Low, Soo Teik Lim, Ju Le Tan","doi":"10.47102/annals-acadmedsg.2022474","DOIUrl":"10.47102/annals-acadmedsg.2022474","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47077544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An approach to genetic testing in patients with metastatic castration-resistant prostate cancer in Singapore.","authors":"Ravindran Kanesvaran, Puey Ling Chia, Edmund Chiong, Melvin Lee Kiang Chua, Nye Thane Ngo, Samuel Ow, Hong Gee Sim, Min-Han Tan, Kiang Hiong Tay, Alvin Seng Cheong Wong, Siew Wei Wong, Puay Hoon Tan","doi":"10.47102/annals-acadmedsg.2022372","DOIUrl":"10.47102/annals-acadmedsg.2022372","url":null,"abstract":"<p><strong>Introduction: </strong>There has been a rapid evolution in the treatment strategies for metastatic castration-resistant prostate cancer (mCRPC) following the identification of targetable mutations, making genetic testing essential for patient selection. Although several international guidelines recommend genetic testing for patients with mCRPC, there is a lack of locally endorsed clinical practice guidelines in Singapore.</p><p><strong>Method: </strong>A multidisciplinary specialist panel with representation from medical and radiation oncology, urology, pathology, interventional radiology, and medical genetics discussed the challenges associated with patient selection, genetic counselling and sample processing in mCRPC.</p><p><strong>Results: </strong>A clinical model for incorporating genetic testing into routine clinical practice in Singapore was formulated. Tumour testing with an assay that is able to detect both somatic and germline mutations should be utilised. The panel also recommended the \"mainstreaming\" approach for genetic counselling in which pre-test counselling is conducted by the managing clinician and post-test discussion with a genetic counsellor, to alleviate the bottlenecks at genetic counselling stage in Singapore. The need for training of clinicians to provide pre-test genetic counselling and educating the laboratory personnel for appropriate sample processing that facilitates downstream genetic testing was recognised. Molecular tumour boards and multidisciplinary discussions are recommended to guide therapeutic decisions in mCRPC. The panel also highlighted the issue of reimbursement for genetic testing to reduce patient-borne costs and increase the reach of genetic testing among this patient population.</p><p><strong>Conclusion: </strong>This article aims to provide strategic and implementable recommendations to overcome the challenges in genetic testing for patients with mCRPC in Singapore.</p>","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42407436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic surgery in morbidly obese women with endometrial cancer in Singapore.","authors":"Sabrina Lasini Gruhl, Muhammad Ashraf Yusoff, Hui Men Selina Chin, Ravichandran Nadarajah","doi":"10.47102/annals-acadmedsg.20234","DOIUrl":"10.47102/annals-acadmedsg.20234","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47678827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-examining the roles of generalists and specialists in healthcare.","authors":"Priyanka Khatri, Ashna Nastar, Gim Gee Teng, Jason Phua","doi":"10.47102/annals-acadmedsg.2022434","DOIUrl":"10.47102/annals-acadmedsg.2022434","url":null,"abstract":"<p><p>Increasing workload and case complexity of a multimorbid ageing population have catalysed primary care transformation for general practitioners to meet these challenges. There is also a need to re-examine the role of hospital specialists as overly disease-centric, hospital-based specialist care is no longer sustainable. A new specialist-generalist model can maximise the potential of generalists and specialists to provide person-centred care, increase cost-effectiveness, improve appropriateness of referrals, decrease length of hospital stay and lower mortality.</p>","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41795722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges with mainstreaming genetic testing for metastatic prostate cancer treatment in Singapore.","authors":"Jianbang Chiang, Joanne Yuen Yie Ngeow","doi":"10.47102/annals-acadmedsg.202384","DOIUrl":"10.47102/annals-acadmedsg.202384","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47618550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients.","authors":"Serena Low, Sharon Li Ting Pek, Angela Mei Chung Moh, Jonathon Khoo, Keven Ang, Wern Ee Tang, Ziliang Lim, Tavintharan Subramaniam, Chee Fang Sum, Su Chi Lim","doi":"10.47102/annals-acadmedsg.2022350","DOIUrl":"10.47102/annals-acadmedsg.2022350","url":null,"abstract":"<p><strong>Introduction: </strong>Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is the angle of vector determined by the body's resistance and reactance. It indicates cellular integrity and hydration status. Though extracellular volume excess was associated with chronic kidney disease (CKD) progression, the association between PhA and CKD progression is unknown. Matrix metalloproteinase-2 (MMP-2) is a member of zinc-dependent endopeptidase family and promotes renal interstitial fibrosis. We investigated association between PhA and CKD progression, and whether the association was through MMP-2 in patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Method: </strong>We conducted a prospective study on 1,078 patients with T2DM (mean age 58.9±9.1 years). PhA was measured using BIA. CKD progression was defined as ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline with deterioration across eGFR categories. Multiplex immunoassay was used to quantitate MMP-2. We examined association between PhA and CKD progression using Cox proportional hazards model, adjusting for demographics, clinical parameters and medications.</p><p><strong>Results: </strong>Over 8.6 years of follow-up, 43.7% of participants had CKD progression. Compared to tertile 3 PhA (higher level), tertiles 1 and 2 PhA were associated with higher hazards of CKD progression, with corresponding unadjusted hazard ratios (HRs) of 2.27 (95% confidence interval [CI] 1.80-2.87, P<0.001) and 1.57 (95% CI 1.24-2.01, P<0.001). The positive association between tertiles 1 and 2 PhA with CKD progression persisted in the fully adjusted model with corresponding HRs of 1.71 (95% CI 1.30-2.26, P<0.001) and 1.46 (95% CI 1.13-1.88, P=0.004). MMP-2 accounted for 14.7% of association between tertile 1 PhA and CKD progression.</p><p><strong>Conclusion: </strong>Our findings revealed a previously unobserved association between BIA-derived lower PhA and CKD progression through MMP-2 in patients with T2DM.</p>","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47871954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes and management of contrast hypersensitivity in patients requiring repeated computed tomography imaging.","authors":"Pearlyn Mei Ping Wong, Si Min Chiow, Chau Hung Lee, Sze-Chin Tan, Martin Weng Chin H'ng","doi":"10.47102/annals-acadmedsg.2022223","DOIUrl":"10.47102/annals-acadmedsg.2022223","url":null,"abstract":"<p><strong>Introduction: </strong>In collaboration with the Department of Rheumatology, Allergy and Immunology, our study aims to review the outcomes of and propose an improved workflow for the management of patients with prior hypersensitivity reactions to iodinated contrast media (ICM).</p><p><strong>Method: </strong>Outpatients coming for contrast-enhanced computed tomography (CECT) were stratified into 3 categories (definite, unconfirmed and inaccurate) based on likelihood of their contrast hypersensitivity label. Patients could be offered a different ICM, receive the same ICM, or be referred to an allergist for further evaluation. There were 4 outcomes: (1) alternative ICM tolerated; (2) same ICM tolerated again; (3) patient developed a hypersensitivity reaction to either alternative or original ICM; and (4) CECT was deferred until assessment by an allergist. Comparison was made pre- and post-intervention to see if patient outcomes were improved.</p><p><strong>Results: </strong>There were 132 patients who made a total of 154 visits (90.3% had documented contrast hypersensitivity). Post-intervention, the number of visits postponed for premedication decreased (81.0% to 34.7%). There was a reduction in hypersensitivity reactions (from 42.9% to 14.3%). Of the 12 patients assessed by the allergist, 6 could continue using the same or alternative ICM, 4 were advised to abstain from further contrast administration and 2 were pending testing with a third agent.</p><p><strong>Conclusion: </strong>Active intervention by the radiologist can decrease the number of postponed, converted or cancelled CECT studies as well as reduce the number of adverse allergic-like events. Direct collaboration between radiologist and allergist for specific cases may be helpful in patients who will likely need future/repeated CECTs.</p>","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43470130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle-aged woman with painless neck swelling.","authors":"Cherie Seah Xinyi, Yong Quan Alvin Soon, Hai Yi Clarence Teo, Ming Yann Lim","doi":"10.47102/annals-acadmedsg.2022137","DOIUrl":"10.47102/annals-acadmedsg.2022137","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48633849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing recurrent hypersensitivity reactions to iodinated contrast media.","authors":"Wey Chyi Teoh","doi":"10.47102/annals-acadmedsg.202346","DOIUrl":"10.47102/annals-acadmedsg.202346","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42569897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed treatment with nirmatrelvir/ritonavir could remain effective in patients with Omicron BA2.2 variant of COVID-19.","authors":"Wenjie Wang, Jing Wan, Wei Du, Jing Song, Ye Lu, Shuiming Gu, Yunhai Feng, Gang Wang, Minfang Tao, Jun Yin","doi":"10.47102/annals-acadmedsg.2022453","DOIUrl":"10.47102/annals-acadmedsg.2022453","url":null,"abstract":"","PeriodicalId":50774,"journal":{"name":"Annals Academy of Medicine Singapore","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49034242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}