Singapore medical journal最新文献

{"title":"Effect of flushing technique on residual anaesthetic drug content in syringes.","authors":"Wei Keat Lau, Kelvin Kau-Kiat Goh, Choon Looi Bong, Li-Jiao Sin, Tze-Peng Lim, Evangeline Hua-Ling Lim","doi":"10.4103/singaporemedj.SMJ-2025-155","DOIUrl":"10.4103/singaporemedj.SMJ-2025-155","url":null,"abstract":"<p><strong>Introduction: </strong>The practice of reusing the same syringe to administer different medications during anaesthesia for the same patient is common. One concern with this practice is the potential for drug incompatibility. Although flushing the syringe between drugs may address this concern, its effect on drug removal is unknown. The primary aim of this study was to examine the effect of flushing technique on the residual drug content in syringes of different sizes that were initially used for administering propofol and subsequently reused for administering cefazolin and morphine.</p><p><strong>Methods: </strong>Syringes (3, 5, 10 and 20 mL) were filled with propofol (1%) and emptied. They were then flushed once, twice or three times using varying volumes of water for injection or normal saline (0.9% sodium chloride), before being reused for cefazolin. The procedure was repeated before the syringes were reused for morphine. Finally, morphine was flushed out. The expelled fluid after each flush was collected and analysed using liquid chromatography-tandem mass spectrometry.</p><p><strong>Results: </strong>For the 10- and 20-mL syringes, no residual drug was detected after a single flush, regardless of the flushing fluid, using 50% or 100% syringe volume flushes. For the 3- and 5-mL syringes, no residual drug was detected after flushing once with normal saline or twice with water for injection using 50% or 100% syringe volume flushes.</p><p><strong>Conclusion: </strong>A minimum of two 50% syringe volume flushes with normal saline or water for injection ensured complete removal of propofol, cefazolin and morphine, regardless of syringe size. This may enable safer single-patient syringe reuse during anaesthesia, reducing syringe use, lowering costs and promoting environmental sustainability.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864904","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":"Peri-procedural antibiotics for infection prevention in transjugular intrahepatic portosystemic shunt and plug-assisted retrograde transvenous obliteration: a randomised trial.","authors":"Aashika Bhashyakarla, Sathwika Pasam, Vivek Sreekanth, Mithun Sharma, Jagdeesh Rampal Singh, Shantan Venishetty, Manasa Alla, Jignesh Reddy, D Nageshwar Reddy, Manu Tandon, Anand V Kulkarni","doi":"10.4103/singaporemedj.SMJ-2025-229","DOIUrl":"10.4103/singaporemedj.SMJ-2025-229","url":null,"abstract":"<p><strong>Introduction: </strong>Transjugular intrahepatic portosystemic shunt (TIPS) and plug-assisted retrograde transvenous obliteration (PARTO) are the standard of care for managing portal hypertension-related complications. However, the role of peri-procedural antibiotics in preventing infections during these interventions remains unclear because of limited evidence, and this study aimed to address this gap.</p><p><strong>Methods: </strong>In this single-centre, double-blind, placebo-controlled, randomised trial, adult patients with portal hypertension were randomised to receive ceftriaxone (1 g twice daily until discharge) or placebo. The primary outcome was the incidence of clinically significant infection defined as fever and a quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2, and secondary outcomes were hospital stay duration, in-hospital mortality and adverse events.</p><p><strong>Results: </strong>Of the 70 patients, 35 received placebo and 35 received ceftriaxone (antibiotic). Twenty-one patients in the placebo arm and 22 in the antibiotic arm underwent PARTO, and the rest underwent TIPS or direct intrahepatic portocaval shunt. On Kaplan-Meier analysis, the risk of clinically significant infection (fever and qSOFA ≥ 2) was 17.1% in the placebo arm and 8.6% in the antibiotic arm ( P = 0.31). Fever rates were similar (20% in the placebo arm compared with 22.9% in the antibiotic arm, P = 0.77). Hospital stay duration (4.4 ± 1.7 days in the placebo arm compared with 4.1 ± 2.2 days in the antibiotic arm, P = 0.47) and in-hospital mortality (one death per arm) were comparable. One patient in the placebo arm experienced an injection-site rash. No significant predictors of infection were identified due to the small sample size.</p><p><strong>Conclusion: </strong>Peri-procedural ceftriaxone did not significantly reduce infection rates in patients undergoing elective TIPS or PARTO.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864878","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":"Paediatric Epstein-Barr virus-associated intracranial smooth muscle tumours.","authors":"Daniel Loh, Felicia Hui Zhuang Chua, Bingcheng Wu, Miriam Kimpo, Vincent Diong Weng Nga","doi":"10.4103/singaporemedj.SMJ-2025-226","DOIUrl":"10.4103/singaporemedj.SMJ-2025-226","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864898","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":"Congratulations to the 2025 SMJ Best Research Paper Award Winners.","authors":"","doi":"10.4103/singaporemedj.SMJ-2026-320","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-320","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 5","pages":"335"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059332","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":"The human microbiome at translational crossroads: an ecological and causal perspective.","authors":"Sunny H Wong","doi":"10.4103/singaporemedj.SMJ-2026-102","DOIUrl":"10.4103/singaporemedj.SMJ-2026-102","url":null,"abstract":"<p><strong>Abstract: </strong>The human microbiome has emerged as a central focus of biomedical research, driven by interest in its translational potential for chronic diseases. Although compelling associations link microbial alterations to gastrointestinal, metabolic, neuropsychiatric and systemic conditions, successful clinical translation remains limited. This perspective contends that the principal barrier is not biological relevance but the application of reductionist thinking to an inherently complex ecological system, compounded by an incomplete understanding of causality. This review examines the gradient of causal confidence across gut-organ axes, from established roles in digestive disorders to less established distal associations, as well as highlights the epistemological challenges underlying microbiome research. A critical appraisal of current strategies, including probiotics, live biotherapeutics and faecal microbiota transplantation, suggests that progress requires ecological reasoning, causal rigour and systems-level integration. Moving from association to intervention demands approaches that account for host-microbiome complexity rather than oversimplified microbial targeting.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 5","pages":"279-287"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019865","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 2025 SMJ Best Research Paper Award Winners.","authors":"","doi":"10.4103/singaporemedj.SMJ-2026-320","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2026-320","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 5","pages":"335"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440451","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":"World Pre-eclampsia Day: are we moving in the right direction?","authors":"Arundhati Gosavi, Sarah Li, Arijit Biswas, Mahesh Choolani","doi":"10.4103/singaporemedj.SMJ-2026-276","DOIUrl":"10.4103/singaporemedj.SMJ-2026-276","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 5","pages":"320-322"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019829","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":"World Ovarian Cancer Day: unravelling the molecular anatomy of a silent killer.","authors":"Abhiram Kanneganti, Jeffrey Jen Hui Low, Ruby Yun-Ju Huang, Mahesh Choolani","doi":"10.4103/singaporemedj.SMJ-2026-255","DOIUrl":"10.4103/singaporemedj.SMJ-2026-255","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 5","pages":"316-319"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019831","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":"Safety and efficacy of dupilumab in adult atopic dermatitis in Singapore.","authors":"Yik Weng Yew, Xiahong Zhao, Adeline Mei Yan Yong","doi":"10.4103/singaporemedj.SMJ-2023-031","DOIUrl":"10.4103/singaporemedj.SMJ-2023-031","url":null,"abstract":"<p><strong>Introduction: </strong>Dupilumab, a biologic approved for treatment of moderate-to-severe atopic dermatitis (AD), has been reported to be largely effective with minimal adverse effects. However, being a targeted therapy, its effectiveness and side effects are expected to be varied in a heterogeneous ethnic population. Currently, the majority of studies on dupilumab are based on Western populations.</p><p><strong>Methods: </strong>A retrospective cohort of 51 patients with moderate-to-severe AD treated with dupilumab at a tertiary skin institute from January 2018 to February 2020 was included. Outcome measures such as Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI) and Dermatology Quality of Life Index (DLQI) were analysed at baseline and after 16 weeks of treatment. Laboratory tests at the respective time points were also measured.</p><p><strong>Results: </strong>Patients treated with dupilumab showed consistent reduction in body surface area (BSA) involved, SCORAD, EASI and DLQI scores. Concurrently, serum immunoglobulin E (IgE) and absolute eosinophil count showed a downward trend at 4 months of treatment. There was a transient increase in mean serum IgE at 1 month of dupilumab treatment. Also, 42.0% and 35.3% of patients developed eye symptoms, and head and neck dermatitis, respectively, but there were no major adverse events reported. Childhood-onset AD was more likely to have improved BSA scores compared to adult-onset AD.</p><p><strong>Conclusions: </strong>Our study confirms the efficacy of dupilumab with real-world data in an adult Asian population. Higher proportions of eye symptoms, and head and neck dermatitis were observed in our cohort compared to other Asian clinical cohort studies. Further studies are needed to evaluate these differences.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":"302-308"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139379094","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":"Is it time to move away from legacy inflammatory bowel disease drugs?","authors":"Wai Keung Leung","doi":"10.4103/singaporemedj.SMJ-2026-138","DOIUrl":"10.4103/singaporemedj.SMJ-2026-138","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"67 5","pages":"314-315"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019874","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}