Singapore medical journal最新文献

{"title":"Associations of the gut microbiota with diet and mild cognitive impairment in elderly individuals: a cross-sectional study.","authors":"Hongyu Zhao, Lixiang Li, Liming Zhang, Xinpeng Li, Shichen Fu, Feixue Chen, Yanqing Li, Xiuli Zuo","doi":"10.4103/singaporemedj.SMJ-2026-039","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-039","url":null,"abstract":"<p><strong>Introduction: </strong>The role of gut microbiota in linking diet to cognitive function in the elderly remains unclear. This study investigated whether the gut microbiota is associated with dietary modulation of mild cognitive impairment (MCI).</p><p><strong>Methods: </strong>A total of 48 patients with MCI and 43 healthy controls were included in the study. Participant demographics, along with the results of a food frequency questionnaire and the Montreal Cognitive Assessment, were recorded. Faecal samples underwent 16S rRNA sequencing. Spearman's correlation examined relationships among gut microbiota composition, dietary intake and cognitive function.</p><p><strong>Results: </strong>Compared with healthy controls, patients with MCI had lower educational levels, higher serum total cholesterol and low-density lipoprotein cholesterol levels, and lower consumption of bean curd/tofu pudding, yoghurt, freshwater fish, shrimp/crab, pine nuts and pumpkin (all P < 0.05). In the MCI group, the abundances of Desulfovibrio, Sutterella, UCG-003 and other taxa were enriched, whereas those of Actinomyces, Streptococcus and other taxa were decreased (P < 0.05). Spearman's correlation analysis revealed positive associations between cognitive scores and intake of yoghurt, freshwater fish, shrimp/crab or pine nut (P < 0.05). Furthermore, Actinomyces and Streptococcus abundances correlated positively with both freshwater fish and yoghurt intake and cognitive performance, whereas UCG-003 and Desulfovibrio abundances correlated negatively with both shrimp/crab and yoghurt intake and cognitive scores.</p><p><strong>Conclusion: </strong>The consumption of yoghurt, freshwater fish, crustaceans, pine nuts or pumpkin was positively associated with cognitive function. Actinomyces and Streptococcus may contribute to the positive associations between freshwater fish and yoghurt consumption and cognitive function, whereas UCG-003 and Desulfovibrio may weaken the cognitive benefits associated with crustacean and yoghurt consumption.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of oral paracetamol versus intravenous paracetamol in preterm infants with patent ductus arteriosus: a randomised controlled trial.","authors":"Nurshafinaz Salmah Mohd Fezal, Noraida Ramli, Nor Rosidah Ibrahim, Hans Van Rostenberghe, Mohd Rizal Mohd Zain, Anis Munirah Mohd Kori","doi":"10.4103/singaporemedj.SMJ-2026-034","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-034","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the widespread use of paracetamol for ductus arteriosus closure in preterm infants, direct comparisons between oral and intravenous paracetamol remain limited. This study aimed to evaluate the efficacy and safety of oral versus intravenous paracetamol for the pharmacological closure of haemodynamically significant patent ductus arteriosus in preterm infants.</p><p><strong>Methods: </strong>A randomised controlled trial was conducted at the neonatal intensive care unit of Hospital Pakar Universiti Sains Malaysia from January 2023 to July 2024. Fifty preterm infants (26 weeks to 33 + 6 weeks gestational age) diagnosed with haemodynamically significant patent ductus arteriosus were randomised to receive either oral or intravenous paracetamol (15 mg/kg every 6 h for 3 days). A second course was administered if the initial treatment failed. The primary outcome was complete ductal closure; secondary outcomes included renal and hepatic function, early complications and late neonatal morbidities over a 30-day follow-up period.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. Ductal closure was significantly higher with intravenous paracetamol than with oral paracetamol (92.6% vs. 69.6%; P = 0.035). The intravenous group also demonstrated greater reduction in ductal size (1.81 mm vs. 1.34 mm; P = 0.018). No significant differences were observed in early or late complications between groups. Both administration routes showed favourable safety profiles without serious adverse effects.</p><p><strong>Conclusion: </strong>This study found that intravenous paracetamol had superior efficacy compared with oral administration in achieving ductal closure in preterm infants while maintaining a similar safety profile.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalisation experience and frailty prevention in older patients: a qualitative study.","authors":"Yingqi Xu, Sze Ling Chan, Manjit Kaur, Candelyn Yu Pong, Vivian Cantiller Barrera, Wrenzie Del Valle Espeleta, Rachelle Tumbokon Tan-Patanao, Theik di Oo, Rebecca Hui Shan Ong, Barbara Helen Rosario","doi":"10.4103/singaporemedj.SMJ-2025-186","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-186","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is associated with an increased risk of falls, delirium, disability, hospitalisation, readmission and nursing home admission. This study aimed to explore the perception of frailty, frailty prevention strategies and hospitalisation experience among frail inpatients and their caregivers.</p><p><strong>Methods: </strong>This qualitative study included frail hospitalised patients in a tertiary hospital and their primary family caregivers who provided physical and social support daily. Face-to-face interviews were conducted from May 2023 to November 2023.</p><p><strong>Results: </strong>Ten patients (median age 74.3 years) and 11 caregivers (median age 56.0 years) were interviewed. Five themes emerged. We found a lack of understanding and awareness of frailty as well as barriers to preventing it. Due to the decreasing ability to perform daily activities, patients were not actively engaging in preventive activities and seldom used community services owing to inconvenience, financial concerns and a lack of trust in the external party. The majority of patients faced self-care difficulties during hospital stay.</p><p><strong>Conclusion: </strong>We identified gaps in frailty awareness and specific barriers to and facilitators of frailty prevention. The findings from this study could guide the development and implementation of frailty interventions.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated grading of short-answer image-based assessments using a hybrid natural language processing-AI framework: validation in radiology education.","authors":"Xu Hao Isaac Tan, Zhen Li Samantha Lee, Thida Win, Phua Hwee Tang","doi":"10.4103/singaporemedj.SMJ-2025-302","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-302","url":null,"abstract":"<p><strong>Introduction: </strong>Efficient and reliable assessment is essential in medical education. Manual grading of short-answer radiology quizzes is resource-intensive and variable. Automated marking systems can alleviate these challenges. This study introduces a novel automated grading system leveraging techniques in natural language processing (NLP) and generative artificial intelligence. Our objective was to assess the system's agreement against human grading and to analyse how response length influences grading concordance.</p><p><strong>Methods: </strong>We obtained 840 responses from 28 radiology residents to 30 X-ray quiz questions. The system employed string-matching algorithms and rule-based logic for anatomical and laterality mismatches. A ChatGPT-created synonym dictionary was used to recognise acceptable alternative answers. Cohen's κ was used to assess inter-rater agreement across answer lengths, and logistic regression was used to examine the response length's relationship with grading disagreement.</p><p><strong>Results: </strong>To establish a reference standard, two independent human raters graded the responses, achieving near-perfect inter-rater reliability (κ = 0.985). Evaluated against human consensus, the system achieved 97.5% raw agreement (816/837). Perfect agreement (κ = 1.00) was observed for one-word responses (n = 429), with near-perfect agreement for two-word responses (κ = 0.927, n = 75). Agreement decreased as response length increased, with each additional word increasing the odds of disagreement by 51.9% (odds ratio 1.519; 95% confidence interval 1.227-1.879).</p><p><strong>Conclusion: </strong>The automated grading system, enhanced by NLP techniques and ChatGPT-assisted synonym expansion, demonstrated strong concordance with human grading, particularly for one- and two-word answers. This hybrid approach offers a scalable solution for short-answer assessment, with strong potential in radiology and other medical education contexts.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Constructing personalised nutrition plans for adolescents using knowledge graphs and dietary profiles.","authors":"Fei Zhao, Weiwei Ma, Rong Xiao","doi":"10.4103/singaporemedj.SMJ-2026-038","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-038","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescence is a crucial period for youth development. However, many teenagers consume diets high in sugar and fat but low in essential nutrients, which can impair growth and increase the risk of obesity and metabolic diseases. This study developed a knowledge graph-based system that generates personalised menus for adolescents by combining structured nutrition data with individual dietary profiles, and evaluated its effects in a school setting.</p><p><strong>Methods: </strong>An adolescent dietary knowledge graph was built to integrate 339 dishes, 246 ingredients, 30 nutrients and 26 adolescent nutrient problems. This framework was enriched with 300 individual dietary profiles capturing physiological traits, health risks and taste preferences. Furthermore, a rule-based engine generated daily menus, aiming to meet nutrient targets. This was assessed using diet-quality indicators and a three-month randomised controlled trial involving 400 adolescents (intervention: n = 200; control: n = 200).</p><p><strong>Results: </strong>Recommended menus consistently showed higher scores on the Chinese Healthy Diet Index, Dietary Diversity Score and Food Variety Score than the non-intervention meals (P < 0.0001). Following the intervention, the personalised menu group demonstrated significantly lower increases in body weight, body mass index and body fat index compared to the control group (P < 0.05). Height gain did not differ significantly between groups (P = 0.088).</p><p><strong>Conclusion: </strong>These results suggest that knowledge graph-based personalised recommendation systems can translate established nutritional guidelines into structured, individualised dietary guidance for adolescents. This integrated approach provides a feasible digital framework for implementing guideline-concordant meal planning in school settings and may help bridge the gap between general recommendations and the diverse needs of growing teenagers.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the gap in Singapore: Gynaecologic Cancer Awareness Month.","authors":"Grace Ming Fen Chan, Keng Ho Pwee, Ga Won Yim, Mahesh Choolani, Jeffrey Jen Hui Low","doi":"10.4103/singaporemedj.SMJ-2026-520","DOIUrl":"10.4103/singaporemedj.SMJ-2026-520","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 9","pages":"568-570"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of migrant workers admitted from the emergency department.","authors":"Jie Er Janice Soo, Joanna Shi-En Chan, Hanis Abdul Kadir, Dennis Wen Jie Chia, Shieh Mei Lai, Sujata Sheth, Marcus Eng Hock Ong, Mui Teng Chua","doi":"10.4103/singaporemedj.SMJ-2023-070","DOIUrl":"10.4103/singaporemedj.SMJ-2023-070","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department (ED) admissions for non-work-related injuries and illnesses in the migrant worker (MW) population in Singapore are not well studied. We aimed to examine ED triage acuity and bills associated with admissions among MW for non-trauma, workplace injury (WI) trauma, and non-workplace injury (NWI) trauma.</p><p><strong>Methods: </strong>In this retrospective observational study, we included all work permit holders admitted to hospital via the ED of three public hospitals from 1 May 2016 to 31 October 2016. Data obtained from medical records included demographics, triage acuity and bill information.</p><p><strong>Results: </strong>There were 1,750 unique patients accounting for 1,788 admissions. The median age was 33 (interquartile range 27-40) years, with a male predominance of 67%. Trauma accounted for 33% ( n = 595) of admissions, and of these, 73% ( n = 433) were due to WI. Admissions for NWI, as compared to WI, were more likely to present as high acuity P1 cases (43% vs 24%, P < 0.001), be conveyed by ambulance (49% vs 24%, P < 0.001) and result in trauma team activations (29% vs 7%, P < 0.001). More NWI admissions (22%, 36/162) exceeded the insurance claim limit under prevailing healthcare policies, as compared to WI admissions (3%, 13/433).</p><p><strong>Conclusion: </strong>Migrant workers are admitted to hospital for non-trauma conditions more frequently than for trauma. Non-workplace injury trauma may be severe. Non-trauma and NWI admissions can result in large bills that exceed mandatory insurance coverage. Recent changes to healthcare policy governing MW to allow copayment of large bills and better access to primary care are timely.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"559-567"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on allergic rhinitis - diagnosis and management.","authors":"Samuel Li Earn Goh, Jing Xi Yang, Shu Jun Kan, Valentina Ricci, Phyllis Al Kim","doi":"10.4103/singaporemedj.SMJ-2026-182","DOIUrl":"10.4103/singaporemedj.SMJ-2026-182","url":null,"abstract":"<p><strong>Abstract: </strong>This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for the diagnosis and management of allergic rhinitis (AR), providing justifications for its recommendations. Allergic rhinitis is highly prevalent in Singapore, with most cases being moderate to severe. While AR is not associated with severe outcomes, poorly controlled or untreated AR can lead to complications, such as asthma, sinusitis or otitis media with effusion. The ACG covers the diagnosis and management of perennial AR, which is the predominant local form of AR and is largely attributed to house dust mites. The Grading of Recommendations Assessment, Development and Evaluation framework was followed to develop four evidence-based recommendations that cover diagnosis, role of allergy testing, and management through pharmacological interventions and allergen avoidance. This EtR framework summarises factors that have informed the direction and strength of the ACG recommendations, including balance of benefits and risks, certainty of evidence, patient preferences and values, resources and feasibility considerations, and acceptability. The ACG can be found at https://go.gov.sg/acg-ar .</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"537-543"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alzheimer's disease: from breakthroughs to real-world impact.","authors":"Li Feng Tan, Yao Feng Chong, Adeline Sl Ng, Tau Ming Liew, Philip Lk Yap","doi":"10.4103/singaporemedj.SMJ-2026-466","DOIUrl":"10.4103/singaporemedj.SMJ-2026-466","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 9","pages":"535-536"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to symptomatic pleural effusion in acute and critical care.","authors":"Arturo Yong Yao Neo, Isaac Kah Siang Ng, Hiang Ping Chan, Kay Choong See","doi":"10.4103/singaporemedj.SMJ-2025-005","DOIUrl":"10.4103/singaporemedj.SMJ-2025-005","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 9","pages":"581-587"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}