Singapore medical journal最新文献

{"title":"Anaemia in pregnancy: can we improve care?","authors":"Yang Xuan Cassandra Ang, Stella Rizalina Sasha Sugianto, Desiree Yu Ting Yen, Monica Shi Qi Chua, Kai Zhi Ong, Shu Qi Tan","doi":"10.4103/singaporemedj.SMJ-2024-013","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-013","url":null,"abstract":"<p><strong>Introduction: </strong>Maternal anaemia is the most common condition in pregnancy. It has profound consequences for both the mother and child, despite being easily treatable with iron supplementation. Our study aimed to investigate its prevalence, risk factors, and the current compliance to screening and treatment.</p><p><strong>Methods: </strong>Women who delivered a baby between 1 October 2019 and 31 December 2019 at KK Women's and Children's Hospital, Singapore, were included. Haemoglobin levels at booking, 24-28 weeks and delivery were analysed. The frequency of treatment with iron supplementation or blood transfusion was also evaluated. Patient demographics were analysed using descriptive statistical methods, while Pearson's chi-square test was used for analyses of proportions.</p><p><strong>Results: </strong>The prevalence of maternal anaemia at the time of delivery was 17.2%. Significant risk factors included receiving subsidised healthcare (associated with lower socioeconomic status), teenage pregnancy, multiparity, Indian ethnicity, thalassaemia and antepartum haemorrhage (P < 0.05). Compliance to screening was 62.8% at 24-28 weeks. Only 38.4% of women with anaemia at booking and 74.9% with anaemia at 24-28 weeks were prescribed oral iron. A total of 11.2% of women with maternal anaemia received intravenous iron. The mean haemoglobin level of women who received blood transfusion was 8.3 g/dL, which may not have been appropriate.</p><p><strong>Conclusion: </strong>Institutions should create guidelines to standardise the screening and treatment of maternal anaemia and conduct regular audits to monitor their implementation. We recommend a multi-pronged strategy targeting prevention, routine screening, and appropriate treatment of maternal anaemia.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049479","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":"Convalescent plasma for the treatment of patients with COVID-19: the Singapore experience and lessons learnt.","authors":"Jun Yang Tay, Sharavan Sadasiv Mucheli, Bingwen Eugene Fan, Sing-Zern Fong, Chek Kia Boo, Ying Ding, Wanni Chia, Chee Wah Tan, Barnaby Young, Poh Lian Lim, Yee Sin Leo, Suma Rao, Ai Leen Ang, Allison Tso, Venkata Sreekanth Sampath, Stephrene Seok Wei Chan, Ponnudurai Kuperan, Christopher Dheepa, Wah Wah Say Naw, Ah Eng Ang, Connie Siew Ping Chen, Laurence Sandig, David Lye, Lin-Fa Wang, Kiat Hoe Ong, Shawn Vasoo","doi":"10.4103/singaporemedj.SMJ-2024-089","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-089","url":null,"abstract":"<p><strong>Introduction: </strong>We report Singapore's convalescent plasma (CP) programme during the first year of the COVID-19 pandemic. Based on historical data and its potential therapeutic promise, CP was offered as an experimental treatment option for severe or high-risk COVID-19 patients when established therapeutics were lacking.</p><p><strong>Methods: </strong>The CP programme was implemented under monitored expanded access approved by Singapore's Ministry of Health. CP donors were primarily selected based on specific antibody titres, while suitable recipients were chosen based on risk factors and disease severity. Operational protocols and logistical considerations are discussed in-depth.</p><p><strong>Results: </strong>Between April 2020 and September 2020, the CP donor programme successfully collected 33 plasma units from 27 qualified donors. Seven patients received CP treatment under this programme. Six of the seven recipients of CP survived for more than 28 days post-transfusion and were discharged alive. Given the availability of other validated therapeutic options, the CP programme was officially suspended in September 2021.</p><p><strong>Conclusion: </strong>This study provides a comprehensive overview of the intricacies of Singapore's CP programme, from its operational challenges to the observed clinical outcomes, while highlighting the potential benefits and complexities of CP as a therapeutic option. Successful implementation of the CP programme requires robust collaboration across multidisciplinary teams. Access to serological tests was crucial for donor selection. Both the selection of CP with high neutralising antibodies and careful selection of appropriate recipients are key aspects to optimise the therapeutic success of CP. A meticulous approach is warranted if CP were to be used in future pandemics.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015477","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":"Oncofertility care and fertility preservation in gynaecological cancer: experience from Singapore's largest tertiary centre.","authors":"Qiu Ju Ng, Tat Xin Ee, Charissa Shu Ying Goh, Shi Hui Lee, Jasmine Earn Huay Low, Jinlin Lin, Jessie Wai Leng Phoon, Jack Junjie Chan, Felicia Hui Xian Chin","doi":"10.4103/singaporemedj.SMJ-2024-094","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-094","url":null,"abstract":"<p><strong>Introduction: </strong>Fertility-sparing management is an option for young patients with gynaecological cancers, conferring comparable oncological and favourable reproductive outcomes as standard treatment. With delayed childbearing, the need for fertility-sparing treatment and demand for fertility preservation have increased. We describe the development of an oncofertility model of care at a tertiary hospital, along with our experiences.</p><p><strong>Methods: </strong>This was a retrospective audit of patients who attended the OncoFertility Clinic, KK Women's and Children's Hospital, Singapore, from 9 September 2020 to 9 March 2023, focusing on the epidemiology and short-term outcomes.</p><p><strong>Results: </strong>A total of 144 women (median age 31 years) attended the OncoFertility Clinic, of whom 69 (47.9%) had uterine conditions, 65 (45.1%) had ovarian conditions, six (4.2%) had cervical conditions and four (2.8%) had synchronous uterine and ovarian conditions. Among the 45 women on fertility-sparing management for endometrial cancer, 66.7% had complete regression, 11.1% had persistent carcinoma and 22.2% regressed to endometrial hyperplasia. Fourteen women underwent in vitro fertilisation (IVF), resulting in three live births and one miscarriage. Thirty-two women had ovarian cancer, 23 had borderline ovarian tumours, one had Krukenberg tumour and nine had benign ovarian tumours. Fertility-sparing surgery was performed in 90.6% of the ovarian cancer cases. Fertility preservation was offered to twenty women, four of whom proceeded with fertility-preserving procedures. Three patients underwent assisted reproductive therapy. Four patients had surgery for suspected recurrences, but histologies were benign.</p><p><strong>Conclusion: </strong>A multidisciplinary OncoFertility Clinic provides comprehensive counselling for young women with gynaecological cancers or precancers, addresses their reproductive health concerns, supports their decision-making and ensures timely access to fertility services.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061615","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":"Convalescent plasma: is there still a role in the treatment of COVID-19?","authors":"Sophie Seine Xuan Tan, Thuan Tong Tan","doi":"10.4103/singaporemedj.SMJ-2024-197","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-197","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013752","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":"Deploying artificial intelligence in the detection of adult appendicular and pelvic fractures in the Singapore emergency department after hours: efficacy, cost savings and non-monetary benefits.","authors":"John Jian Xian Quek, Oliver James Nickalls, Bak Siew Steven Wong, Min On Tan","doi":"10.4103/singaporemedj.SMJ-2023-170","DOIUrl":"10.4103/singaporemedj.SMJ-2023-170","url":null,"abstract":"<p><strong>Introduction: </strong>Radiology plays an integral role in fracture detection in the emergency department (ED). After hours, when there are fewer reporting radiologists, most radiographs are interpreted by ED physicians. A minority of these interpretations may miss diagnoses, which later require the callback of patients for further management. Artificial intelligence (AI) has been viewed as a potential solution to augment the shortage of radiologists after hours. We explored the efficacy of an AI solution in the detection of appendicular and pelvic fractures for adult radiographs performed after hours at a general hospital ED in Singapore, and estimated the potential monetary and non-monetary benefits.</p><p><strong>Methods: </strong>One hundred and fifty anonymised abnormal radiographs were retrospectively collected and fed through an AI fracture detection solution. The radiographs were re-read by two radiologist reviewers and their consensus was established as the reference standard. Cases were stratified based on the concordance between the AI solution and the reviewers' findings. Discordant cases were further analysed based on the nature of the discrepancy into overcall and undercall subgroups. Statistical analysis was performed to evaluate the accuracy, sensitivity and inter-rater reliability of the AI solution.</p><p><strong>Results: </strong>Ninety-two examinations were included in the final study radiograph set. The AI solution had a sensitivity of 98.9%, an accuracy of 85.9% and an almost perfect agreement with the reference standard.</p><p><strong>Conclusion: </strong>An AI fracture detection solution has similar sensitivity to human radiologists in the detection of fractures on ED appendicular and pelvic radiographs. Its implementation offers significant potential measurable cost, manpower and time savings.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"202-207"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728464","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":"Clinics in diagnostic imaging (222).","authors":"Vanessa Meihui Khoo, Clement Hsiang Rong Yong, Betsy Kar Hoon Soon, Kejia Teo","doi":"10.4103/singaporemedj.SMJ-2023-082","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-082","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 4","pages":"221-226"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056652","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":"Care of the bedridden patient.","authors":"Xuan Yong Lee, Jeffrey Jiang, Li Feng Tan","doi":"10.4103/singaporemedj.SMJ-2022-123","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2022-123","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 4","pages":"215-220"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045726","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":"Obstructive sleep apnoea and nocturnal atrial fibrillation in patients with ischaemic heart disease.","authors":"Silin Kuang, Yiong Huak Chan, Serene Wong, See Meng Khoo","doi":"10.4103/singaporemedj.SMJ-2021-293","DOIUrl":"10.4103/singaporemedj.SMJ-2021-293","url":null,"abstract":"<p><strong>Introduction: </strong>Arrhythmias, especially atrial fibrillation (AF) and ventricular arrhythmias, are independent risk factors of mortality in patients with ischaemic heart disease (IHD). While there is a growing body of evidence that suggests an association between obstructive sleep apnoea (OSA) and cardiac arrhythmias, evidence on this relationship in patients with IHD has been scant and inconsistent. We hypothesised that in patients with IHD, severe OSA is associated with an increased risk of nocturnal arrhythmias.</p><p><strong>Methods: </strong>We studied 103 consecutive patients with IHD who underwent an overnight polysomnography. Exposed subjects were defined as patients who had an apnoea-hypopnoea index (AHI) ≥30/h (severe OSA), and nonexposed subjects were defined as patients who had an AHI <30/h (nonsevere OSA). All electrocardiograms (ECGs) were interpreted by the Somte ECG analysis software and confirmed by a physician blinded to the presence or absence of exposure. Arrhythmias were categorised as supraventricular and ventricular. Arrhythmia subtypes (ventricular, atrial and conduction delay) were analysed as dichotomous outcomes using multiple logistic regression models.</p><p><strong>Results: </strong>Atrial fibrillation and AF/flutter (odds ratio 13.5, 95% confidence interval 1.66-109.83; P = 0.003) were found to be more common in the severe OSA group than in the nonsevere OSA group. This association remained significant after adjustment for potential confounders. There was no significant difference in the prevalence of ventricular and conduction delay arrhythmias between the two groups.</p><p><strong>Conclusion: </strong>In patients with IHD, there was a significant association between severe OSA and nocturnal AF/flutter. This underscores the need to evaluate for OSA in patients with IHD, as it may have important implications on clinical outcomes.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"190-194"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139748037","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":"Congratulations to the 2024 SMJ Best Research Paper Award Winners.","authors":"","doi":"10.4103/singaporemedj.SMJ-2025-069","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-069","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 4","pages":"227"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996405","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":"Obstructive sleep apnoea.","authors":"Chew Lip Ng, Vijayaraj Thirunavukarasu","doi":"10.4103/singaporemedj.SMJ-2025-048","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-048","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 4","pages":"172"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039576","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}