Singapore medical journal最新文献

{"title":"Primary care approach to alopecia in adult patients.","authors":"Ying Shan Cheung, Isaac Kah Siang Ng, Valencia Shihuan Long, Lay Hoon Goh, Nisha Suyien Chandran","doi":"10.4103/singaporemedj.SMJ-2026-042","DOIUrl":"10.4103/singaporemedj.SMJ-2026-042","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 8","pages":"523-528"},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835716","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":"The evolving landscape of stroke interventions.","authors":"Yu Tung Lo, Julian Han, Benjamin Yq Tan, Narayanaswamy Venketasubramanian","doi":"10.4103/singaporemedj.SMJ-2026-489","DOIUrl":"10.4103/singaporemedj.SMJ-2026-489","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 8","pages":"514-518"},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835710","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":"Feasibility of cooled radiofrequency ablation versus intra-articular hyaluronic acid for knee osteoarthritis in Singapore: a pilot study.","authors":"Jonathan Kiat Siong Tay, Aik Khien Victor Tan, Seok Hwee Koo, Mon Hnin Tun, Prit Anand Singh","doi":"10.4103/singaporemedj.SMJ-2025-210","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-210","url":null,"abstract":"<p><strong>Introduction: </strong>Knee osteoarthritis is a common and debilitating problem. Safe and effective nonoperative treatments with sustained outcomes are needed, especially for patients unsuitable for knee replacement. Cooled radiofrequency ablation (CRFA) and hyaluronic acid (HA) injection have demonstrated efficacy, but CRFA is less well studied in Asian populations.</p><p><strong>Methods: </strong>In this prospective, open-label, randomised controlled pilot study, patients with chronic knee osteoarthritis seen at a single tertiary centre in Singapore, who had at least 50% pain reduction after a genicular nerve block, were allocated to undergo CRFA or receive a single 6 mL injection of HA. Visual Analogue Scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee scores, Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQol-5 Dimensions-5 Level and Global Perceived Effect were compared at 2 weeks, 1 month, 3 months and 6 months after treatment.</p><p><strong>Results: </strong>Twelve participants underwent intervention (7 CRFA and 5 HA), and 11 completed follow-up to 6 months (7 CRFA and 4 HA). Responder rates at 6 months were 40.0% (95% confidence interval [CI] 11.8%-76.9%) for HA and 28.6% (95% CI 8.2%-64.1%) for CRFA. Over time, VAS, KOOS and WOMAC pain scores and GPE improved in both groups, with peak improvement at 1 month. Adverse events were generally minor and self-limiting. Intergroup differences were not statistically significant.</p><p><strong>Conclusion: </strong>Both interventions were safe and efficacious for knee osteoarthritis. Owing to the small sample size, the findings were preliminary and hypothesis-generating. Larger studies comparing CRFA with other interventions for knee osteoarthritis in the Singapore population are warranted.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581854","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":"Rapidly changing landscape of diabetic kidney disease management: recent advances and the road ahead.","authors":"Samuel Sherng Young Wang, Yan Zhi Chan, Xiao Ran Luo, Nichole Yue Ting Tan, Martin Klein, Muhammad M Javaid","doi":"10.4103/singaporemedj.SMJ-2025-240","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-240","url":null,"abstract":"<p><strong>Abstract: </strong>Diabetic kidney disease (DKD) management has advanced rapidly in recent years, with new therapies supplementing established treatments. The cardiorenal benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA) and nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) in patients with DKD have been proven in several large randomised controlled trials. Recent studies show that combining SGLT2i, ns-MRA and renin-angiotensin-aldosterone system (RAAS) blockade significantly slows DKD progression compared with using single agents. The concurrent use of four agents, including GLP-1RA, SGLT2i, ns-MRA and RAAS blockade, may confer additional benefits, and a four-pillar approach to managing DKD could become standard therapy in the future. Additional investigational agents, including endothelin receptor antagonists, aldosterone synthesis inhibitors, and Janus kinase 1 and Janus kinase 2 inhibitors, have demonstrated encouraging results in Phase 2 trials. These therapies may offer further treatment options for patients who are unable to use other agents.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581859","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":"Nanotheranostics for alcohol-related liver disease: advances in precision diagnosis and targeted therapy.","authors":"Arielle Xin Yi Tay, Shridhar Ganpathi Iyer, Tiing Leong Ang, Han Kiat Ho, Dinesh Kumar Srinivasan","doi":"10.4103/singaporemedj.SMJ-2025-271","DOIUrl":"10.4103/singaporemedj.SMJ-2025-271","url":null,"abstract":"<p><strong>Abstract: </strong>Alcohol-related liver disease remains a major and growing global health concern, with limited diagnostic and therapeutic options, particularly in advanced stages. Conventional diagnostic methods, including serum biomarkers, imaging and biopsy, often lack the sensitivity, specificity or practicality required for early detection and monitoring. Nanotheranostic platforms offer both targeted drug delivery and real-time assessment of disease activity. Organic, inorganic, polymeric and hybrid nanoparticles are being developed to improve the bioavailability and hepatic targeting of antioxidant, antifibrotic and RNA-based therapies. The use of novel nanodiagnostic probes and exosome-based assays enables the detection of early molecular alterations. However, delivery barriers and potential hepatotoxicity remain key translational challenges.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475063","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":"Divergent dietary thresholds for all-cause versus cardiovascular mortality in sarcopenia and advanced cardiovascular-kidney-metabolic syndrome: a national prospective cohort study.","authors":"Yuqi He, Jiantong Sun, Chao Liu, Xiaolong Yang, Weili Fu","doi":"10.4103/singaporemedj.SMJ-2025-292","DOIUrl":"10.4103/singaporemedj.SMJ-2025-292","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcopenia and cardiovascular-kidney-metabolic (CKM) syndrome are common comorbidities. We evaluated their cumulative impact on all-cause and cardiovascular mortality, and the modifying effect of a Composite Dietary Antioxidant Index (CDAI).</p><p><strong>Methods: </strong>This prospective study used data from the National Health and Nutrition Examination Survey linked to the National Death Index. Sarcopenia (Foundation for the National Institutes of Health criteria) and CKM syndrome (American Heart Association stages, dichotomised into advanced/non-advanced) defined the primary exposure. Outcomes were all-cause and cardiovascular mortality. Cox models estimated hazard ratios (HRs). Maximally selected rank statistics determined optimal outcome-specific CDAI thresholds.</p><p><strong>Results: </strong>Among 8782 participants (median follow-up 131 months), advanced CKM syndrome was associated with sarcopenia (odds ratio 2.29, 95% confidence interval [CI] 1.48-3.53). This study demonstrated a cumulative risk of comorbid advanced CKM syndrome and sarcopenia on mortality, with this group exhibiting the highest risk for all-cause (HR 3.11, 95% CI 1.72-5.61) and cardiovascular (HR 1.80, 95% CI 1.04-3.12) mortality. Furthermore, we identified an inverse relationship between disease burden and protective CDAI thresholds for all-cause mortality, whereas cardiovascular mortality exhibited a distinctly higher threshold. Specifically, the comorbidity group required lower antioxidant intake (CDAI >-3.80) than the non-comorbidity group (CDAI >-1.19) for all-cause mortality. Conversely, cardiovascular mortality required a substantially higher threshold (CDAI >3.04).</p><p><strong>Conclusion: </strong>Coexisting advanced CKM syndrome and sarcopenia present a significant cumulative mortality risk. Exploratory analyses suggest that this risk may be mitigated by dietary antioxidants, but the protective threshold is context-dependent. Modest dietary improvement was associated with improved all-cause survival in high-risk patients, whereas higher antioxidant intake correlated with better cardiovascular outcomes. These results suggest that precision nutrition strategies may vary depending on the specific health outcome.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475089","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":"Baseline and post-treatment fibrosis-4 scores to predict hepatocellular carcinoma after direct-acting antiviral therapy.","authors":"Mustafa Al-Karaghouli, Ashley Kai Le Tiong, Pooja Devan, Jean Ee Neo, Wei Xuan Tay, Carlos Moctezuma-Velazquez, Yi-Lyn Jessica Tan, Rahul Kumar, Yu Jun Wong","doi":"10.4103/singaporemedj.SMJ-2025-259","DOIUrl":"10.4103/singaporemedj.SMJ-2025-259","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic hepatitis C remain at risk of hepatocellular carcinoma (HCC) even after attaining sustained virological response at 12 weeks (SVR12). The optimal strategy to stratify HCC risk, particularly in non-cirrhotic patients, remains unclear. This study compared the predictive performance of baseline and post-SVR12 fibrosis-4 index (FIB-4 index) for incident HCC.</p><p><strong>Methods: </strong>We conducted a post hoc analysis of consecutive patients with chronic hepatitis C treated with direct-acting antivirals between 2018 and 2019, with follow-up for de novo HCC occurrence. Primary predictors were FIB-4 at baseline, post-SVR12 and their dynamic change. The primary outcome was the development of post-SVR12 HCC.</p><p><strong>Results: </strong>Among 762 patients, 2.4% developed HCC over a median follow-up of 53 months. Patients who developed HCC were older (58 years vs. 52 years; P = 0.003), exclusively male, and had a higher baseline FIB-4. The FIB-4 values declined after SVR12 (2.9 ± 3.6 vs. 2.1 ± 2.6, P = 0.043), resulting in a different optimal threshold for HCC prediction (baseline 2.9; post-SVR 2.4). Both baseline and post-SVR12 FIB-4 showed strong and comparable predictive performance (area under the receiver operating characteristic curves 0.91 vs. 0.88, P = 0.279). By contrast, changes in FIB-4 were not predictive of HCC risk.</p><p><strong>Conclusion: </strong>Both baseline and post-SVR12 FIB-4 reliably predict HCC after direct-acting antiviral-induced SVR, although the optimal threshold differs due to post-SVR improvements. A post-SVR12 FIB-4 of less than 1.3 identifies a very low-risk group who may be safely discharged from long-term HCC surveillance.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475097","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":"Post-inflammatory nevus comedonicus following neonatal Bacillus Calmette-Guérin vaccination: a case report.","authors":"Terri Chiong, Yiping Emily Gan, Pui Yoong Valerie Ho","doi":"10.4103/singaporemedj.SMJ-2025-140","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-140","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475197","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":"Suboptimal response to ursodeoxycholic acid among patients with primary biliary cholangitis and fenofibrate as add-on therapy: a single-centre retrospective study.","authors":"Farahani Khamis, E-Shing Teoh, Wah-Kheong Chan","doi":"10.4103/singaporemedj.SMJ-2025-184","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2025-184","url":null,"abstract":"<p><strong>Introduction: </strong>Ursodeoxycholic acid (UDCA) is the first-line treatment for primary biliary cholangitis. We aimed to determine the prevalence of suboptimal response to UDCA and to examine the use of fenofibrate as an add-on therapy.</p><p><strong>Methods: </strong>This was a retrospective study on all patients with primary biliary cholangitis seen at Gastroenterology and Hepatology Clinic between January 2019 and December 2024.</p><p><strong>Results: </strong>Data for 59 patients were analysed (median age 62.5 [range 51.0-72.3] years, 78.0% female). More than half (54.2%) of the patients had suboptimal response (i.e. failure to achieve alkaline phosphatase [ALP] ≤1.67 times the upper limit of normal [ULN], total bilirubin less than ULN and ALP decreased by ≥15%) after 1 year of UDCA. Among them, 73.1% continued UDCA monotherapy, whereas the remaining 26.9% received fenofibrate add-on therapy. A significantly greater proportion of patients who received fenofibrate add-on therapy achieved biochemical response (83.3% vs. 14.3%, P = 0.003), ALP normalisation (66.7% vs. 14.3%, P = 0.019) and deep response (i.e. ALP normalisation and total bilirubin ≤0.6 ULN) (33.3% vs. 0%, P = 0.023) compared with patients who continued UDCA monotherapy. After a median follow-up of 56 (19-122) months, seven patients developed cirrhosis, eight patients developed decompensated cirrhosis and three patients had liver-related mortality. There were no liver-related events among patients who achieved a biochemical response after 1 year of UDCA therapy and among patients who were on fenofibrate add-on therapy.</p><p><strong>Conclusion: </strong>Suboptimal response to UDCA is common among patients with primary biliary cholangitis, and fenofibrate add-on therapy can improve biochemical response in these patients.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475252","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":"Approach to occupational disease in Singapore.","authors":"Joshua Tze Yin Kuek, David Soo Quee Koh, Kian Wei Alvin Tan","doi":"10.4103/singaporemedj.SMJ-2026-053","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-053","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427815","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}