Singapore Med J
· 2026 May · PMID 42184296
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The treatment landscape for Crohn's disease (CD) has evolved substantially in the 21st century with the advent of advanced therapies. Since the introduction of tumour necrosis factor (TNF) antagonists, new classes of adv...The treatment landscape for Crohn's disease (CD) has evolved substantially in the 21st century with the advent of advanced therapies. Since the introduction of tumour necrosis factor (TNF) antagonists, new classes of advanced CD therapies have been approved for use in the Asia-Pacific region, including anti-integrins, interleukin (IL)-12/23p40 inhibitors, IL-23p19 inhibitors and Janus kinase inhibitors (JAKi). In the last 10 years, biosimilars to infliximab, adalimumab and ustekinumab and generic JAKi have also become available. In this review, we discuss the indications for advanced therapies and whether certain classes of drugs are preferred for specific patient subsets. We also discuss the choice of first- and second-line agents for CD.
Singapore Med J
· 2026 May · PMID 42184295
·
Full text
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 gastroint...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.
Teo I, Puri J, Chodavadia P
… +4 more, Ho JH, Poremski D, Fung DSS, Finkelstein E
Singapore Med J
· 2026 May · PMID 42165811
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INTRODUCTION: Access to formal mental health care remains limited in Asia. Peer support can be a viable alternative gateway or complement to formal mental health care. The current study examined interest in various types...INTRODUCTION: Access to formal mental health care remains limited in Asia. Peer support can be a viable alternative gateway or complement to formal mental health care. The current study examined interest in various types of peer support, including individual versus group and virtual versus in-person, among Singaporean adults with symptoms of anxiety or depression. METHODS: A cross-sectional online survey was administered to members of a web panel. Participants with symptoms of depression or anxiety based on the Patient Health Questionnaire-4 screening tool were surveyed. Logistic regression analysis was conducted to examine factors associated with greater interest in peer support. RESULTS: A total of 350 panel members met our inclusion criteria. Of them, 77% had not received formal mental healthcare services, while 62% indicated interest in receiving peer support. The strongest preference was for one-on-one support delivered virtually. Younger age (odds ratio [OR] 1.05, P < 0.01), working in white-collar managerial as opposed to white-collar non-managerial positions (OR 1.96, P < 0.05), utilising formal health care in the last 3 months (OR 2.45, P < 0.05) and previously providing peer support (OR 7.33, P < 0.01) were associated with greater interest in receiving peer support. Most of those not interested in peer support cited concerns around confidentiality. CONCLUSION: Despite low uptake of formal mental health care, the majority of adult Singaporeans surveyed with anxiety or depression symptoms indicated interest in receiving peer support. Greater efforts to promote peer support programmes can be part of a comprehensive strategy to address rising rates of poor mental health in Singapore.
Bhashyakarla A, Pasam S, Sreekanth V
… +8 more, Sharma M, Singh JR, Venishetty S, Alla M, Reddy J, Reddy DN, Tandon M, Kulkarni AV
Singapore Med J
· 2026 May · PMID 42106961
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INTRODUCTION: Transjugular intrahepatic portosystemic shunt (TIPS) and plug-assisted retrograde transvenous obliteration (PARTO) are the standard of care for managing portal hypertension-related complications. However, t...INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Peri-procedural ceftriaxone did not significantly reduce infection rates in patients undergoing elective TIPS or PARTO.
Lau WK, Goh KK, Bong CL
… +3 more, Sin LJ, Lim TP, Lim EH
Singapore Med J
· 2026 May · PMID 42106960
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INTRODUCTION: 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. Alth...INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.