INTRODUCTION: Fertility-sparing management is an option for young patients with gynaecological cancers, conferring comparable oncological and favourable reproductive outcomes as standard treatment. With delayed childbear...INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Tay JY, Mucheli SS, Fan BE
… +23 more, Fong SZ, Boo CK, Ding Y, Chia W, Tan CW, Young B, Lim PL, Leo YS, Rao S, Ang AL, Tso A, Sampath VS, Chan SSW, Kuperan P, Dheepa C, Naw WWS, Ang AE, Chen CSP, Sandig L, Lye D, Wang LF, Ong KH, Vasoo S
INTRODUCTION: 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 tre...INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Singapore Med J
· 2025 Mar · PMID 40160102
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Since the development of Chat Generative Pre-trained Transformer (ChatGPT), its roles in health care and various medical specialties have been increasingly explored, showing significant potential in supplementing clinica...Since the development of Chat Generative Pre-trained Transformer (ChatGPT), its roles in health care and various medical specialties have been increasingly explored, showing significant potential in supplementing clinical approaches and management, as well as medical education and training for healthcare professionals. Furthermore, ChatGPT could have potential in the field of interventional cardiology, especially in aiding clinical decision-making, education and training. However, its role in interventional cardiology has yet to be comprehensively evaluated. This review aimed to evaluate existing literature on the potential of ChatGPT in interventional cardiology to better understand and utilise the platform for clinical decision-making, education and training in the future.
Mak YH, Chua F, Koh XH
… +7 more, Tan VH, Lee ZH, Lam A, Tong KL, Yeo C, Chow W, Loh WJ
Singapore Med J
· 2025 Mar · PMID 40116062
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INTRODUCTION: Achieving low-density lipoprotein cholesterol (LDL-C) levels is key to preventing atherosclerotic cardiovascular events. However, many high-risk cardiovascular patients still experience poor LDL-C goal atta...INTRODUCTION: Achieving low-density lipoprotein cholesterol (LDL-C) levels is key to preventing atherosclerotic cardiovascular events. However, many high-risk cardiovascular patients still experience poor LDL-C goal attainment and receive suboptimal lipid-lowering therapy (LLT) prescriptions. Herein, we evaluated LLT prescription patterns, LDL-C goal attainment and cardiovascular mortality among this population group in Singapore. METHODS: This prospective observational cohort study included 555 patients with ischaemic heart disease (IHD) admitted to the hospital in 2020. The LLT prescriptions, corresponding LDL-C levels and cardiovascular outcomes were assessed over a 24-month period. RESULTS: Most participants were male (82.3%), with 48.5% identified as Chinese. High-intensity statin prescriptions increased from 45.4% at hospital admission to 87.1% at discharge and remained stable at approximately 80% at 6, 12, and 24 months post-discharge. Combination LLT prescriptions increased from 12.3% at discharge to 33.8% by 24 months. Ezetimibe was the most commonly prescribed second-line LLT (40.8%), followed by inclisiran (1.09%) and anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapies (0.87%). Over 24 months, LDL-C goal attainment rates were 22.1% for LDL-C < 1.4 mmol/L and 47.2% for LDL-C < 1.8 mmol/L. Multivariable Cox proportional hazards regression indicated that achieving LDL-C < 1.8 mmol/L goal was associated with a reduction in all-cause mortality at 24 months (hazard ratio 0.53, 95% confidence interval 0.30-0.94, P = 0.030). CONCLUSION: Treatment gaps in lipid management persist in 80% of the study population, indicating that statin monotherapy alone is insufficient to achieve LDL-C goals. Greater efforts to improve LDL-C goal attainment rates in high-risk cardiovascular patients are imperative.
Xu C, Lai YW, Chou SH
… +4 more, Zhang X, Koh ET, Dalan R, Leong KP
Singapore Med J
· 2025 Mar · PMID 40116061
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INTRODUCTION: Rheumatoid arthritis (RA) is associated with heightened cardiovascular disease and increased susceptibility to osteoporosis, with shared underlying mechanisms. This study aimed to investigate the associatio...INTRODUCTION: Rheumatoid arthritis (RA) is associated with heightened cardiovascular disease and increased susceptibility to osteoporosis, with shared underlying mechanisms. This study aimed to investigate the association between vascular function and bone mineral density (BMD). METHODS: We conducted a cross-sectional study of 49 patients with RA at Tan Tock Seng Hospital, Singapore. Endothelial function was measured as reactive hyperaemia index (RHI)-endothelial peripheral arterial tonometry and aortic stiffness as carotid-femoral pulse wave velocity (cf-PWV) using SphygmoCor. Univariable and multivariable linear regression analyses were performed to evaluate the associations between BMD and vascular function. We used natural logarithm RHI (lnRHI) and cf-PWV as response variables, and each BMD as covariate, adjusting for body mass index, positive anti-cyclic citrullinated peptide, cumulative prednisolone dose, hydroxychloroquine use and Systematic COronary Risk Evaluation 2. RESULTS: We recruited 49 patients (mean age 61.08 ± 8.20 years), of whom 44 (89.80%) were women and 39 (81.25%) were Chinese. Significant associations were found between lnRHI and BMD at the lumbar spine (β = 0.4289, P = 0.037) and total hip (β = 0.7544, P = 0.014) in univariable analyses. Multivariable analyses confirmed these associations, showing that lower BMD at the lumbar spine (β = 0.7303, P = 0.001), femoral neck (β = 0.8694, P = 0.030) and total hip (β = 0.8909, P = 0.010) were significantly associated with worse lnRHI. No significant associations were found between BMD and cf-PWV. CONCLUSION: Lower BMD is associated with endothelial dysfunction, but not aortic stiffness in patients with RA. Further longitudinal studies are needed to confirm these associations and understand the underlying mechanisms.
Singapore Med J
· 2025 Mar · PMID 40116060
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Subclinical atherosclerosis underlies most cardiovascular diseases, manifesting before clinical symptoms and representing a key focus for early prevention strategies. Recent advancements highlight the importance of early...Subclinical atherosclerosis underlies most cardiovascular diseases, manifesting before clinical symptoms and representing a key focus for early prevention strategies. Recent advancements highlight the importance of early detection and management of subclinical atherosclerosis. This review underscores that traditional risk factor levels considered safe, such as low-density lipoprotein cholesterol (LDL-C) and glycated haemoglobin (HbA1c), may still permit the development of atherosclerosis, suggesting a need for stricter thresholds. Early-life interventions are crucial, leveraging the brain's neuroplasticity to establish lifelong healthy habits. Preventive strategies should include more aggressive management of LDL-C and HbA1c from youth and persist into old age, supported by public health policies that promote healthy environments. Emphasising early education on cardiovascular health can fundamentally shift the trajectory of cardiovascular disease prevention and optimise long-term health outcomes.
Ong JYS, Yap JJY, Choolani M
… +3 more, Poh KK, Dashraath P, Low TT
Singapore Med J
· 2025 Mar · PMID 40116059
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Pulmonary hypertension in pregnancy has been associated with negative maternal and fetal outcomes over the past decades. With the emergence of novel treatment modalities, morbidity and mortality of women who have pulmona...Pulmonary hypertension in pregnancy has been associated with negative maternal and fetal outcomes over the past decades. With the emergence of novel treatment modalities, morbidity and mortality of women who have pulmonary hypertension in pregnancy have improved. In this review, we aim to explore the contemporary updates in the management of pre-capillary and post-capillary pulmonary hypertension in pregnancy.
Singapore Med J
· 2026 Mar · PMID 40084701
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Ischaemic stroke in young adults is a major public health problem and accounts for 10%-15% of all cases. Moreover, young ischaemic stroke patients often suffer long-lasting disabilities that affect the most productive ye...Ischaemic stroke in young adults is a major public health problem and accounts for 10%-15% of all cases. Moreover, young ischaemic stroke patients often suffer long-lasting disabilities that affect the most productive years of their lives and have devastating consequences and significant socioeconomic impact. The defining age range for young adults with ischaemic stroke has varied across studies, with most studies using the younger upper age limit of 45-50 years. Identifying underlying risk factors and aetiologies of ischaemic stroke in young adults is important for guiding management, improving outcomes and reducing stroke recurrence. However, this can be challenging, as the causes of stroke in young adults are more heterogeneous, diagnosis may be confounded by stroke mimics and a substantial proportion of young adults are classified as having stroke of undermined aetiology or cryptogenic stroke. This review provides an overview of the classification, risk factors, aetiologies, treatment and outcomes of ischaemic stroke in the young adult population.
Singapore Med J
· 2025 Mar · PMID 40055922
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INTRODUCTION: Musculoskeletal disorders (MSDs) commonly affect workers across many industries. This includes healthcare workers, where the prevalence of MSDs ranges from 20% to 91.2% globally. As there is a lack of studi...INTRODUCTION: Musculoskeletal disorders (MSDs) commonly affect workers across many industries. This includes healthcare workers, where the prevalence of MSDs ranges from 20% to 91.2% globally. As there is a lack of studies looking at the burden of MSDs among primary care physicians (PCPs), our study aimed to understand the prevalence of MSDs and explore their associated risk factors among PCPs working in the public sector in Singapore. METHODS: This was a cross-sectional study, where PCPs in a primary healthcare cluster were invited to complete a self-administered web-based questionnaire, which consisted of demographic information and the Nordic Musculoskeletal Questionnaire (NMQ). Descriptive statistics were used to describe the demographic information and prevalence of MSDs. Multivariable logistic regression was used to explore the factors associated with the presence of MSDs. RESULTS: A total of 193 PCPs completed the study, of whom 174 (90.2%) reported the presence of MSDs in at least one body region in the last 12 months. The most common sites of trouble were the neck (72.5%), lower back (61.1%) and shoulder (50.3%). We also found that females had a higher risk of MSDs (odds ratio 5.66; 95% confidence interval 1.29-24.90) than males. CONCLUSION: Our study demonstrated a high prevalence of MSDs among our local PCPs. Female gender was associated with a higher risk of MSDs. As such, further research can be conducted to explore the risk factors for MSDs and their impact on productivity and quality of care. This would help in the development of preventive measures with the goal of reducing MSDs among PCPs.