3D MRI with CT-like bone contrast (3D-BONE): a pictorial review of clinical applications.

Background: Computed tomography (CT) is the gold standard imaging modality for the assessment of 3D bony morphology but incurs the cost of ionizing radiation exposure. High-resolution 3D magnetic resonance imaging (MRI) with CT-like bone contrast (CLBC) may provide an alternative to CT in allowing complete evaluation of both bony and soft tissue structures with a single MRI examination.

Purpose: To review the technical aspects of an optimized stack-of-stars 3D gradient recalled echo pulse sequence method (3D-Bone) in generating 3D MR images with CLBC, and to present a pictorial review of the utility of 3D-Bone in the clinical assessment of common musculoskeletal conditions.

Cultural and urban city living expectations of knee motion in a Southeast Asian city: implications on total knee arthroplasty outcomes.

Background: The prevalence of knee osteoarthritis in Southeast Asia has increased steadily over the years. When conservative management options fail, total knee arthroplasty (TKA) is a reliable surgical option. Despite over 90% post-operative satisfaction, the high volume of TKAs performed means that even a small percentage of dissatisfied patients holds significance.

Image-guided biopsy of clinically occult nipple lesions: techniques and learning points.

Percutaneous biopsy is the standard of care for breast lesions, except nipple lesions which are primarily biopsied by excision due to perceived risks of pain and bleeding. However, excisional biopsy of nipple lesion inevitably leads to disfigurement and possible loss of the nipple-areolar complex (NAC), highlighting the need for minimally invasive biopsy techniques. We present our experience of seven patients who underwent ultrasound-guided core biopsy or vacuum-assisted biopsy (VAB) for sampling of clinically occult nipple lesions.

Acute upper limb ischaemia secondary to metastatic tumour thromboembolism: a rare clinical phenomenon.

Acute upper limb ischaemia is a vascular emergency which requires prompt diagnosis and treatment to optimise outcomes. Tumour embolism is a rare but known cause of this. We hereby report a rare case of acute upper limb ischaemia from a malignant lung embolism, which was subsequently treated successfully with surgical embolectomy.

Cost-effectiveness of robotic mastectomy vs. conventional mastectomy: A long-term economic evaluation from a Singapore healthcare perspective.

Importance: Breast cancer is the most prevalent cancer among women globally, and Singapore is no exception. Surgical intervention, especially mastectomy, is a cornerstone of breast cancer treatment. While conventional mastectomy (CM) has been the gold standard, robotic mastectomy (RM) has emerged as a promising alternative due to its minimally invasive nature.

Outcomes after medical treatment for primary aldosteronism: an international consensus and analysis of treatment response in an international cohort.

Background: Primary aldosteronism can be treated medically but there is no standardised method to evaluate treatment outcomes. We aimed to develop criteria for assessing the outcomes of targeted medical treatment of primary aldosteronism, analyse outcomes across an international cohort, and identify factors associated with a complete treatment response.

Methods: An international panel of 31 primary aldosteronism experts used the Delphi method to reach consensus on the definition of complete, partial, or absent biochemical and clinical outcomes of medical treatment of primary aldosteronism.

Characterizing Cardiac Adipose Tissue in Post-AMI Patients via CT Imaging: A Comparative Cross-sectional Study.

Aims: To identify differences in CT-derived perivascular (PVAT) and epicardial adipose tissue (EAT) characteristics that may indicate inflammatory status differences between post-treatment acute myocardial infarction (AMI) and stable coronary artery disease (CAD) patients.

Methods And Results: A cohort of 205 post-AMI patients (age 59.8±9.

Perceptions of community healthcare workers on the use of teledentistry for seniors in Singapore: A qualitative study.

Objective: This study aimed to identify barriers and facilitators surrounding the implementation of TDOCS from Community Health Workers (CHW)'s perspective before TDOCS implementation.

Methods: A descriptive qualitative study was conducted through semistructured interviews with a purposive sampling of CHWs from partner nursing homes and home care teams. A French framework outlining barriers to asynchronous oral teleconsultation adoption was used to develop the topic guide for this study.

Robot-assisted minimally invasive transforaminal interbody fusion: a complete workflow pilot feasibility study.

Background: Robotic-assisted spinal surgery has reportedly improved the accuracy of instrumentation with smaller incisions, improving surgical outcomes and reducing hospital stay. However, robot-assisted spine surgery has thus far been confined to placement of pedicle screw instrumentation only. This pilot study aims to explore the feasibility of utilizing the Mazor™ X Stealth Edition (Medtronic, Sofamor Danek USA), robotic-arm platform in the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) procedure inclusive of interbody cage placement, in our institution.

Remission of persistent hypertension and hypokalaemia following redo adrenalectomy for primary aldosteronism - case report.

We report on a case of a 67-year-old male who was referred to our care with persistent aldosteronism post adrenalectomy. Biochemical failure after surgery is rare after surgery for primary aldosteronism (PA). Persistent hypokalaemia and raised aldosteronism is an indication of treatment failure after surgery.

Global, regional, and national burden of primary liver cancer attributable to metabolic risks: an analysis of the Global Burden of Disease Study 1990-2021.

Background: The global burden of metabolic diseases is increasing, but estimates of their impact on primary liver cancer are uncertain. We aimed to assess the global burden of primary liver cancer attributable to metabolic risk factors, including high body mass index (BMI) and high fasting plasma glucose (FPG) levels, between 1990 and 2021.

Methods: The total number and age-standardized rates of deaths and disability-adjusted life years (DALYs) from primary liver cancer attributable to each metabolic risk factor were extracted from the Global Burden of Disease Study 1990-2021.

Dropping the baton: Cognitive biases in emergency physicians.

Introduction: Clinical medicine is becoming more complex and increasingly requires a team-based approach to deliver healthcare needs. This dispersion of cognitive reasoning across individuals, teams and systems (termed "distributed cognition") means that our understanding of cognitive biases and errors must expand beyond traditional "in-the-head" individual mental models and focus on a broader "out-in-the-world" context instead. To our knowledge, no qualitative studies thus far have examined cognitive biases in clinical settings from a team-based sociocultural perspective.

Piecing together the narrative of #longcovid: an unsupervised deep learning of 1,354,889 X (formerly Twitter) posts from 2020 to 2023.

Objective: To characterize the public conversations around long COVID, as expressed through X (formerly Twitter) posts from May 2020 to April 2023.

Methods: Using X as the data source, we extracted tweets containing #long-covid, #long_covid, or "long covid," posted from May 2020 to April 2023. We then conducted an unsupervised deep learning analysis using Bidirectional Encoder Representations from Transformers (BERT).

Performance of Risk-Stratification Scores for Patients With Pulmonary Arterial Hypertension in a Multi-Ethnic Asian Population.

Guidelines recommend risk stratification of pulmonary arterial hypertension (PAH) patients to guide management. There are currently several risk stratification scores available, which have largely been validated in various pulmonary hypertension registries in the West but not in Asia. We aim to study the performance of these different risk scores in PAH patients from a multi-ethnic Asian population.

Endoscopic mucosal resection and open-lid submucosal biopsy for the diagnosis of diffuse infiltrative gastric cancer: a retrospective observational study.

Background And Study Aims: Diffuse infiltrative gastric cancer can be difficult to diagnose owing to a lack of endoscopic features in the superficial mucosa. Moreover, a forceps biopsy may not reveal a pathological diagnosis. We aimed to evaluate the diagnostic yield and safety of endoscopic mucosal resection (EMR) and 'open-lid submucosal biopsy', a technique wherein EMR followed by biopsy of the ulcer floor is performed for a pathological diagnosis.

Management of perioperative thyrotoxicosis - what to do when standard therapy is contraindicated or fails?

Background: Current guidelines recommend that hyperthyroid patients should be rendered euthyroid prior to surgical procedures. These guidelines rely heavily on the use of ATDs as the primary medication, and do not give recommendations for patients who have contraindications to ATDs, or for whom standalone ATD treatment is inadequate.

Objectives: To evaluate the efficacy and safety of adjunctive pharmacological therapy and/or therapeutic plasma exchange (TPE) in the perioperative management of patients with thyrotoxicosis who were intolerant to ATD or for whom standalone ATD therapy was inadequate to achieve euthyroidism prior to surgery.

Adverse Local Tissue Reaction and Osteolysis After Ceramic-on-Ceramic Total Hip Arthroplasty.

Adverse local tissue reaction (ALTR) and osteolysis formation are more frequently described complications after total hip arthroplasty (THA) with metal-on-metal bearings. In this report, we present a unique case of ALTR and osteolysis formation with ceramic-on-ceramic bearing THA, which has been less commonly described in the existing literature. This rare case occurred in a 54-year-old patient who had a primary THA done 17 years prior to representing to our institution.

Navigating COVID-19 Surges: A Case Study of a Hospital-at-Home Implementation.

This study documents the experience of implementing an adaptation of the Hospital-at-Home (HaH) model to alleviate the constraints in available hospital beds and manpower amid a surge in infection rates in Singapore during the Omicron and XBB COVID waves, addressing challenges and proposing insights for scalable implementation. HaH substitutes inpatient hospitalizations by leveraging existing community healthcare services and remote healthcare technologies. This HaH adaptation was designed to be activated in during surges and deactivated when bed and manpower demands stabilize, making it less intensive on hospital resources.

Multifaceted approach to reduce duplicate therapy errors in the emergency department.

Medication errors continue to pose a significant risk to patient safety, accounting for half of the avoidable harm in healthcare systems around the world. In emergency departments (EDs), factors such as high patient loads and emergent nature of care increase the likelihood of such errors. An audit conducted at the ED of Changi General Hospital Singapore from January 2019 to July 2022 revealed that the duplicate therapy error comprised 31% of all reported medication errors.

Artificial Intelligence and Machine Learning Predicting Transarterial Chemoembolization Outcomes: A Systematic Review.

Background: Major society guidelines recommend transarterial chemoembolization (TACE) as the standard of care for intermediate-stage hepatocellular carcinoma (HCC) patients. However, predicting treatment response remains challenging.

Aims: As artificial intelligence (AI) may predict therapeutic responses, this systematic review aims to assess the performance and effectiveness of radiomics and AI-based models in predicting TACE outcomes in patients with HCC.