Annals of the Academy of Medicine, Singapore最新文献

Introduction: Cardiovascular disease remains a leading cause of morbidity and mortality in Singapore, with rising demand for longitudinal cardiovascular care driven by ageing and metabolic risk factors. Cardiology pharmacists support medication optimisation, transitions of care and patient education across hospital, ambulatory and community settings. However, limited specialist accreditation pathways, uneven service distribution and emerging digital requirements constrain scalable delivery to match national needs.

Methods: This position paper was developed by the Pharmaceutical Society of Singapore Cardiology Pharmacy Working Group. A multidisciplinary consensus approach was adopted, guided by RIGHT and AGREE II principles to ensure transparency, applicability and editorial independence. Evidence synthesis drew from published literature, national epidemiology and institutional experience, contextualised within governance under the Healthcare Services Act and Collaborative Prescribing Agreement.

Results: Cardiology pharmacists are essential to medication safety, adherence support and protocol-guided dose optimisation under physician oversight. Key gaps include delayed post-discharge follow-up, fragmented hospital-primary care alignment, telehealth implementation challenges and a limited pipeline of accredited specialists, restricting capacity to achieve guideline-directed therapy targets and sustained continuity of care.

Conclusion: Five priorities were endorsed: strengthening specialist workforce capability; enhancing early postdischarge reviews; integrating pharmacists across care settings; leveraging digital-enabled care; and expanding medication-focused roles in prevention, atrial fibrillation, palliative heart failure and precision medicine. Cardiology pharmacists are critical contributors to a safe, coordinated and future-ready cardiovascular care ecosystem. A physician-led, pharmacist-enabled model supports national goals under Healthier SG.

Introduction: Knowledge of late effects after oncological treatment in Southeast Asia remains limited. This study is among the first comprehensive audits of late effects experienced by paediatric cancer survivors from the long-term follow-up (LTFU) clinic at KK Women's and Children's Hospital in Singapore, between September 2017 and December 2023.

Method: A total of 485 survivors were examined, all of whom had at least 2 years of treatment and 5 years of remission. Data on cancer diagnoses, treatments and late effects were analysed, with severity classified by the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Results: The analysis showed 394 survivors (81%) experienced at least 1 late effect. Body mass index ≥23 kg/m2 or ≥90th percentile, low bone mineral density (e.g. Z-score ≤-2.0 standard deviation score) and hearing difficulties were observed in 149 (30.7%), 87 (17.9%) and 73 (15.1%) survivors, respectively. Leukaemia survivors' detection of their first late effect was 10-14 years postdiagnosis, while central nervous system (CNS) and solid tumour survivors detected their first late effect within ≤5 years. Majority of late effects were of mild CTCAE severity. The odd ratio of developing late effects in the first 5 years post-diagnosis was 4.88 (95% confidence interval 2.98-7.71, P<0.001) in survivors treated with both chemotherapy and radiotherapy (with and without surgery) compared to chemotherapy (with and without surgery).

Conclusion: Despite risk-adapted protocols, timely screening is recommended to improve early detection of metabolic health, bone health and hearing impairment. Radiotherapy-treated survivors and survivors of CNS tumours and solid tumours would benefit from earlier and frequent screening. Adopting an exposure-based approach to proactively screen for late effects, coupled with survivor education, can help mitigate the biopsychosocial impacts.

Introduction: Mycobacterium abscessus complex (MABC) is an emerging global threat due to its intrinsic and acquired resistance to many antibiotics, making treatment particularly challenging. This systematic review aimed to evaluate current treatment regimens and clinical outcomes in patients with MABC pulmonary disease.

Method: A comprehensive electronic search of PubMed, Embase and Cochrane databases was conducted for studies published between 1 January 2010 and 31 December 2024. A total of 28 studies met the inclusion criteria, comprising 24 retrospective chart reviews and 4 multicentre prospective studies.

Results: Sputum culture conversion (SCC) was reported in 25 studies, with rates ranging from 29% to 77%. Radiographic improvement was observed in 33% to 54% of patients, while clinical improvement varied widely, ranging from 14% to 91%. Notably, infections caused by M. massiliense were consistently associated with superior clinical, radiologic, and microbiologic outcomes compared to M. abscessus. Although surgical intervention was reported in selected cases, it was associated with higher SCC rates and remains a definitive treatment option in refractory disease. The overall risk of bias across studies was moderate to high, largely due to the predominance of retrospective study designs and heterogeneity in treatment protocols and outcome measures.

Conclusion: These findings underscore the suboptimal outcomes associated with current treatment strategies for MABC pulmonary disease. There is an urgent need for large-scale, multicentre prospective studies utilising standardised treatment outcome definitions and unified therapeutic regimens to improve patient care and clinical outcomes.

Introduction: Ischaemic stroke is a severe complication of dermal filler injections that remains poorly described and understood. This study aims to characterise the clinical features and outcomes of patients who experience strokes following facial dermal filler injections.

Method: A systematic review and retrospective analysis of ischaemic strokes caused by dermal filler injections and reported over the past 3 decades, were conducted. Cases involving autologous fat were also compared against those that did not.

Results: Fifty-five cases from 45 studies were analysed. Their median age was 32 years (18-61), and most were women (49/55, 89%). Injections frequently occurred at the glabella (17/53, 32%) and temples (12/53, 23%), and autologous fat was most often used (33/55, 60%). Half (29/55, 53%) had ocular symptoms at presentation. Hemiparesis/hemiplegia (30/55, 55%) and confusion/ reduced consciousness/alertness (26/55, 47%) were the predominant stroke symptoms. Most infarcts were unilateral (45/54, 83%) and large (32/48, 67%). Treatment primarily involved corticosteroids (12/41, 29%) and antiplatelet agents (11/41, 27%), while hyaluronidase injections (3/41, 7%) and hyperbaric oxygen therapy (2/41, 5%) were rarely used. Less than half (22/55, 40%) experienced good functional recovery. Those injected with autologous fat were likelier to be symptomatic from their strokes (100% versus [vs] 68%, P=0.0012), develop larger strokes (93% vs 24%, P<0.0001) and experience non-ambulatory outcomes (44% vs 73%, =0.0381).

Conclusion: Strokes are rare complications of dermal fillers. Injections using autologous fat risk larger strokes and worse ambulatory outcomes. An hour of post-procedural observation appears reasonable, and those with ocular complications should undergo brain imaging even in the absence of stroke symptoms.