Radiological Sublingual Space Invasion in Tongue Squamous Cell Carcinoma: Clinicopathological Associations and Impact on Survival.

Objectives: We investigate if sublingual space invasion (SLI) determined on magnetic resonance imaging confers differences in clinicopathological manifestations and treatment outcomes of oral tongue squamous cell carcinoma (OTSCC).

Study Design: Retrospective cohort study.

Setting: Tertiary Academic Medical Center.

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.

Individualized Antimicrobial Therapy using Antibiotic Combination Testing and Therapeutic Drug Monitoring to Treat Carbapenem-Resistant Acinetobacter baumannii Infection.

Treatment of multidrug resistant infections is challenging due to limited therapeutic options. To maximise treatment success of such infections, our infectious disease-trained pharmacists employ a two-pronged approach, using both in vitro antibiotic combination testing and therapeutic drug monitoring, to individualise antibiotic combination regimens for our patients, akin to precision medicine. This approach ensures that the most optimal antibiotic combination and dosing regimens are prescribed for our patients with multidrug resistant infection, to ensure adequate antibiotic exposure and maximal clinical efficacy.

A Rare Case of Functional Metastatic Follicular Thyroid Carcinoma With Concomitant Thyrotoxicosis.

We report a case of a 60-year-old lady with metastatic follicular thyroid carcinoma (FTC) who was presented with thyrotoxicosis and heart failure symptoms after total thyroidectomy. Clinical features and investigations led to the diagnosis of functional metastatic FTC with concomitant thyrotoxicosis. Levothyroxine therapy was stopped, and she was treated with propylthiouracil (PTU) followed by serial radioiodine treatments (RAITs) with good control of thyrotoxicosis and metastases.

Complications of total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis with trial sequential analysis.

Background: Ankle osteoarthritis affects 1-3 % of all adults. Contemporary evidence is equivocal when comparing the outcomes and complications of TAA and AA. This review aims to compare the complications between TAA and AA to provide surgeons with an additional perspective when managing ESAO.

Discriminatory Accuracy of Fracture Risk Assessment Tool in Asian Populations: A Systematic Review and Meta-Analysis.

Background: This review explores the discriminative ability of fracture risk assessment tool (FRAX) in major osteoporotic fracture (MOF) and hip fracture (HF) risk prediction and the densitometric diagnosis of osteoporosis in Asian populations.

Methods: We systematically searched the EMBASE, Cochrane, and PubMed databases from the earliest indexing date to January 2024. Studies were included if FRAX was used to identify future osteoporotic fractures or a densitometric diagnosis of osteoporosis in an Asian population and reported the area under the curve (AUC) values.

Establishing Core elements for a Prehospital Emergency Care Systems Evaluation Tool (PECSET) for systems in early stages of development: A Delphi consensus.

Objectives: International Prehospital Emergency Care (PEC) standards have been primarily developed by and for high resource settings. Most PEC systems in Asia, which are still in the early stages of development, struggle to achieve these standards. There is a need for an evaluation tool which can define achievable basic building blocks for PEC systems in low resource settings to improve quality of PEC.

Unravelling the natural history of localised prostate cancer in the post-prostate specific antigen era: implications for clinical management.

Background: Management of localised prostate cancer (PCa) remains controversial in the era of prostate-specific antigen (PSA) testing. This study aims to describe the natural history of men with PCa being followed up expectantly to evaluate disease mortality.

Methods: After exclusion, clinical data of 204 patients retrieved from a prospective large PCa registry were reviewed.

Healthcare utilisation patterns and contributory factors among middle-aged adults: a scoping review.

Background: Middle-aged adults, defined as individuals between the ages of 45 and 64, represent a significant yet under researched group of healthcare service users. This scoping review aimed to provide a comprehensive overview of the patterns of healthcare utilisation and the factors contributing to them within this demographic.

Methods: Following PRISMA-ScR guidelines and the framework proposed by Arksey and O'Malley, a systematic literature search was conducted across PubMed, EMBASE, and the Cochrane Library databases from their inception until July 2023.

Development and Usability of an Advance Care Planning Website (My Voice) to Empower Patients With Heart Failure and Their Caregivers: Mixed Methods Study.

Background: Web-based advance care planning (ACP) interventions offer a promising solution to improve ACP engagement, but none are specifically designed to meet the needs of patients with heart failure and their caregivers.

Objective: We aimed to develop and assess the usability and acceptability of a web-based ACP decision aid called "My Voice," which is tailored for patients with heart failure and their caregivers.

Methods: This study's team and advisory board codeveloped the content for both patient and caregiver modules in "My Voice.

Community Health Worker Optimization of Antihypertensive Care in HIV (COACH): Study protocol for a pilot trial of an intervention to improve hypertension care among Tanzanians with HIV.

Objective: This study will evaluate the feasibility and preliminary effectiveness of the COACH (Community Health Worker Optimization of Antihypertensive Care in HIV) intervention, which integrates hypertension management into existing HIV care for people living with HIV (PLWH) in Tanzania.

Methods: The study will be conducted at two HIV Care and Treatment Centers (CTCs) in Tanzania. In a single-arm pre-post feasibility trial, 100 PLWH with hypertension will be enrolled and will receive the six-month intervention.

Examining the Association Between Overweight, Obesity, and Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis.

Background: Irritable bowel syndrome (IBS) is a common yet debilitating disorder of gut-brain interaction, characterized by gut-brain axis dysregulation, visceral hypersensitivity, and other comorbidities. Obesity has been hypothesized to be a risk factor linked to IBS, albeit evidence remains conflicting. Given the growing global prevalence of obesity and IBS, we performed a meta-analysis examining their purported association.

Fusion Genes in Myeloid Malignancies.

Fusion genes arise from gross chromosomal rearrangements and have been closely linked to oncogenesis. In myeloid malignancies, fusion genes play an integral role in the establishment of diagnosis and prognostication. In the clinical management of patients with acute myeloid leukemia, fusion genes are deeply incorporated in risk stratification criteria to guide the choice of therapy.

The Tumour Microenvironment and Epigenetic Regulation in Pathogenic Variant-Associated Breast Cancers.

: pathogenic variant (PV)-associated breast cancers are most commonly seen in hereditary genetic conditions such as the autosomal-dominant Hereditary Breast and Ovarian Cancer (HBOC) syndrome, and rarely in sporadic breast cancer. Such breast cancers tend to exhibit greater aggressiveness and poorer prognoses due to the influence of pathogenic variants (PVs) on the tumour microenvironment. Additionally, while the genetic basis of PV breast cancer is well-studied, the role of epigenetic mediators in the tumourigenesis of these hereditary breast cancers is also worth exploring.

Postcholecystectomy Gut Microbiome Changes and the Clinical Impact: A Systematic Review With Narrative Synthesis.

Background: Cholecystectomy (CCE) can affect the enterohepatic circulation of bile acids and result in gut microbiome changes. This systematic review aimed to clarify the effect of CCE on gut microbiome composition and its clinical impact.

Method: A systematic search was conducted in PubMed, Web of Science, and Scopus, combining keywords such as "cholecystectomy" or "post-cholecystectomy" with "gut microbiome," "stool microbiome," or "gut dysbiosis.

Non-alcohol-related cirrhosis leads to higher 6-week mortality after acute variceal bleeding than alcohol-related cirrhosis.

Introduction: Acute variceal bleeding (AVB) portends significant 6-week mortality in patients with cirrhosis. It remains unclear if the correlation between liver prognostic scores and 6-week mortality are similar across different etiologies of liver cirrhosis, particularly alcohol-related liver disease (ALD) vs. non-alcohol-related liver disease (non-ALD).

Bivalent boosters and risk of post-acute sequelae following vaccine-breakthrough SARS-CoV-2 Omicron infection: a cohort study.

Background: Vaccination has been shown to attenuate the risk of post-acute sequelae following SARS-CoV-2 infection. However, no prior population-based studies have evaluated if updated bivalent boosters reduce risk of post-acute sequelae following Omicron-variant infection, versus ancestral vaccines.

Methods: National databases were utilised to construct a population-based cohort of adult individuals infected during Omicron-predominant transmission.

Association of Lupus Low Disease Activity State And Remission With Reduced Organ Damage And Flare in Systemic lupus erythematosus Patients With High Disease Activity.

Objective: High disease activity status (HDAS) in patients with systemic lupus erythematosus (SLE) is associated with adverse long-term outcomes. We examined the frequency of lupus low disease activity state (LLDAS) and remission (REM) attainment in HDAS patients and whether their attainment was associated with improved patient outcomes.

Methods: Demographic, clinical and outcomes data, collected prospectively from a multinational cohort between 2013 and 2020, were analysed.

Exploring student acceptance of learning technologies in anatomy education: A mixed-method approach.

Anatomical education is transitioning from the time-honored cadaveric dissection to a blend of learner-centered and technology-enhanced learning approaches. In view of the increased use of various technologies for teaching and learning human anatomy, the aim of this study is to explore students' acceptance of four learning technologies using the technology acceptance model (TAM). This work was conducted at a graduate medical school in Singapore with first-year MD Program students.

Nuances in endoscopic carpal tunnel release a guide to improving outcomes.

Endoscopic technique of carpal tunnel release is widely accepted as successful and safe as long as the surgeon is well-trained. Compared to the traditional open technique, there exists a steep learning curve for familiarisation of equipment, training of hand-eye coordination and appreciating tactile feedback. The available literature and manuals do not illustrate the practical challenges encountered during the procedure.

Biomechanical evaluation of spiral fracture in human metacarpal using chicken humerus model.

Introduction: Animal bones have been used as a model to mimic human bones for investigation of fracture patterns and fixation techniques. This study aims to investigate the effects of torsional forces of varying speeds on the spiral fracture in human metacarpal using a chicken humerus model.

Materials And Methods: Thirty fresh-frozen chicken humerus bones were dissected and equally divided into three groups.

ArtiSential laparoscopic cholecystectomy: a comparative analysis with robotic single-port cholecystectomy.

Purpose: Laparoscopic cholecystectomy is the gold standard procedure for benign gallbladder disease. However, reducing ports still causes frustration when using various instruments. We investigated early perioperative outcomes of laparoscopic single site + 1 cholecystectomy using ArtiSential instruments (ArtiSential laparoscopic cholecystectomy [ALC], LIVSMED).

Lessons learned from a case of phlegmasia cerulea dolens treated with thrombolysis and iliac vein stenting.

Phlegmasia cerulea dolens is a rare manifestation of massive deep vein thrombosis with threat to limb and life. A patient with a background of ovarian malignancy in remission and pelvic radiotherapy presented with left lower limb phlegmasia cerulea dolens as a result of extensive acute left lower limb deep vein thrombosis, extending from the popliteal vein to the inferior vena cava. While initial rapid thrombolysis and left iliac vein stenting were successful, she developed significant hemorrhagic complications from her right radial intra-arterial line with compartment syndrome requiring fasciotomy.