Pub Date : 2024-01-30DOI: 10.47102/annals-acadmedsg.20244
M. Chandran, Tang Ching Lau
Osteoporosis and cancer share a complex relationship, with each condition influencing the progression and outcomes of the other.1 Multiple factors, such as chemo- and hormonal therapies, and the direct invasion of bone tissue by malignant cells contribute to the accelerated bone loss seen in cancer patients.1 Various anti-osteoporosis drugs, including anti-resorptives such as bisphosphonates, denosumab and selective estrogen receptor modulators (SERMs), and anabolic agents such as teriparatide and romosozumab have demonstrated efficacy in preventing bone loss and reducing fracture risk in non-cancer populations. These medications exert their effects through different mechanisms, such as inhibiting osteoclast activity, modulating hormonal pathways or promoting bone formation.2 However, their effectiveness in cancer patients remains an area of ongoing research and debate. The interplay between cancer-related bone loss and the actions and potential benefits of anti-osteoporosis drugs is complex. The plausible biological mechanisms underlying the observed benefits of anti-osteoporosis drugs in cancer patients with osteoporotic fractures warrant exploration. Beyond their direct effects on bone density, these medications may influence the tumour microenvironment, immune response, and the release of factors that affect cancer progression.1,3
{"title":"Anti-osteoporosis drugs and reduction of mortality in cancer patients","authors":"M. Chandran, Tang Ching Lau","doi":"10.47102/annals-acadmedsg.20244","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.20244","url":null,"abstract":"Osteoporosis and cancer share a complex relationship, with each condition influencing the progression and outcomes of the other.1 Multiple factors, such as chemo- and hormonal therapies, and the direct invasion of bone tissue by malignant cells contribute to the accelerated bone loss seen in cancer patients.1 Various anti-osteoporosis drugs, including anti-resorptives such as bisphosphonates, denosumab and selective estrogen receptor modulators (SERMs), and anabolic agents such as teriparatide and romosozumab have demonstrated efficacy in preventing bone loss and reducing fracture risk in non-cancer populations. These medications exert their effects through different mechanisms, such as inhibiting osteoclast activity, modulating hormonal pathways or promoting bone formation.2 However, their effectiveness in cancer patients remains an area of ongoing research and debate. The interplay between cancer-related bone loss and the actions and potential benefits of anti-osteoporosis drugs is complex. The plausible biological mechanisms underlying the observed benefits of anti-osteoporosis drugs in cancer patients with osteoporotic fractures warrant exploration. Beyond their direct effects on bone density, these medications may influence the tumour microenvironment, immune response, and the release of factors that affect cancer progression.1,3","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"117 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140481107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.47102/annals-acadmedsg.2023249
Ryan Xuan Wei Teo, B. P. Leung, B. Thong, J. Tan, Grace Yin Lai Chan, X. Lim
Coronavirus 2019 (COVID-19) vaccination remains one of the key public health measures against the SARS-CoV-2 infection, significantly reducing illness severity and mortality rates. Urticaria and/or angioedema are cutaneous reactions that have been reported in response to messenger RNA (mRNA) COVID-19 vaccination and potentially affect fitness for revaccination.1 The development of chronic spontaneous urticaria (CSU) post-COVID-19 vaccination2 may further discourage patients from revaccination or preclude revaccination to keep vaccinations updated. We describe a Singapore case series of 64 patients with urticaria post-COVID-19 vaccination, studying patient tolerance to revaccination, immunological profile and development of CSU.
{"title":"Development of immediate and chronic spontaneous urticaria following mRNA COVID-19 vaccination: Tolerability of revaccination and immunological study","authors":"Ryan Xuan Wei Teo, B. P. Leung, B. Thong, J. Tan, Grace Yin Lai Chan, X. Lim","doi":"10.47102/annals-acadmedsg.2023249","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023249","url":null,"abstract":"Coronavirus 2019 (COVID-19) vaccination remains one of the key public health measures against the SARS-CoV-2 infection, significantly reducing illness severity and mortality rates. Urticaria and/or angioedema are cutaneous reactions that have been reported in response to messenger RNA (mRNA) COVID-19 vaccination and potentially affect fitness for revaccination.1 The development of chronic spontaneous urticaria (CSU) post-COVID-19 vaccination2 may further discourage patients from revaccination or preclude revaccination to keep vaccinations updated. We describe a Singapore case series of 64 patients with urticaria post-COVID-19 vaccination, studying patient tolerance to revaccination, immunological profile and development of CSU.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"178 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140485209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.47102/annals-acadmedsg.2023428
Hui Men Selina Chin, H. Rajesh
The 2022 White Paper on Singapore Women’s Development, which aimed at a fair and inclusive society where both women and men can pursue their aspirations fully, announced the option for elective egg freezing (EEF) and that the age limit for EEF was planned to be set at 35 years. The limit has been set at 37 years following recent review of success rates of EEF up to this age.2 This was implemented on 1 July 2023, presenting a conundrum among health professionals and women alike. While this is an exciting long-overdue progress in women’s reproductive autonomy, elective egg freezing needs adequate counselling and critical appraisal before a woman embarks on this journey. In this issue of the Annals, Ong et al.3 have presented a comprehensive overview on the key clinical aspects of EEF that a clinician should consider, while empowering women in this complicated decision-making. This review is a foundation for the consideration of EEF for young Singaporean women who intend to navigate newly charted waters in EEF in the context of a still rather conservative society.
{"title":"Freezing hope: Balancing realism and optimism in elective egg freezing","authors":"Hui Men Selina Chin, H. Rajesh","doi":"10.47102/annals-acadmedsg.2023428","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023428","url":null,"abstract":"The 2022 White Paper on Singapore Women’s Development, which aimed at a fair and inclusive society where both women and men can pursue their aspirations fully, announced the option for elective egg freezing (EEF) and that the age limit for EEF was planned to be set at 35 years. The limit has been set at 37 years following recent review of success rates of EEF up to this age.2 This was implemented on 1 July 2023, presenting a conundrum among health professionals and women alike. While this is an exciting long-overdue progress in women’s reproductive autonomy, elective egg freezing needs adequate counselling and critical appraisal before a woman embarks on this journey. In this issue of the Annals, Ong et al.3 have presented a comprehensive overview on the key clinical aspects of EEF that a clinician should consider, while empowering women in this complicated decision-making. This review is a foundation for the consideration of EEF for young Singaporean women who intend to navigate newly charted waters in EEF in the context of a still rather conservative society.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"71 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140481607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.47102/annals-acadmedsg.2023112
Jiacai Cho, Anselm Mak, Sachin Agrawal, P. Dhanasekaran, Peter P Cheun, Manjari Lahiri
Rheumatoid arthritis (RA) is a chronic disabling disease where continued disease activity translates to irreversible articular damage. Seropositivity for rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA) are markers of poorer prognosis; with increased disease activity, radiographic progression and even mortality.1 However, other than ACPA, no other biomarker has emerged for clinical use in the last 10 years.
{"title":"Redefining seropositive rheumatoid arthritis: Clinical implications of anti-carbamylated protein on remission, radiographic damage and quality of life","authors":"Jiacai Cho, Anselm Mak, Sachin Agrawal, P. Dhanasekaran, Peter P Cheun, Manjari Lahiri","doi":"10.47102/annals-acadmedsg.2023112","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023112","url":null,"abstract":"Rheumatoid arthritis (RA) is a chronic disabling disease where continued disease activity translates to irreversible articular damage. Seropositivity for rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA) are markers of poorer prognosis; with increased disease activity, radiographic progression and even mortality.1 However, other than ACPA, no other biomarker has emerged for clinical use in the last 10 years.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"395 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140480112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.47102/annals-acadmedsg.2023141
J. Tan, Tee Joo Yeo, Doreen S. Y. Tan, Terrance Siang Jin Chua, K. Yeo, Natalie Si Ya Koh, T. Subramaniam, Yew Seng Kwan, Michael Chun Leng Lim, Lip Ping Low, Huay-Cheem Tan
Introduction: In 2022, the Minister for Health of Singapore launched Healthier SG, a national strategy in championing the shift towards a population health approach. Method: The Singapore Heart Foundation conducted a series of roundtable discussions, also attended by representatives of the Singapore Cardiac Society and the Chapter of Cardiologists of the Academy of Medicine Singapore. During the meetings, the authors formulated interventions supportive of Healthier SG that specifically aimed to uplift the state of cardiovascular (CV) preventive care in Singapore. Results: In line with Healthier SG, the authors propose a 3-pronged approach (“Healthier Heart SG”) to augment the success of Healthier SG in achieving good CV outcomes. This proposal includes the following components: (1) a call to update the standards of care in addressing the 5 main modifiable risk factors of cardiovascular disease (CVD); (2) patient education through cooperation between healthcare professionals and community partners for a whole-of-system approach; and (3) support for integrated care, including access to cardiac rehabilitation in the community, improved referral processes and access to nutrition/dietetics counselling and tobacco cessation, optimal use of information technology, and continued CV research. Conclusion: Healthier Heart SG would bring the standards of care and CV care delivery in Singapore closer to achieving the vision of proactive prevention of CVD and CV morbidity and mortality. This can only be achieved through the concerted efforts of healthcare professionals, policymakers and community partners, coupled with the cooperation of community members.
{"title":"Strategies to prevent cardiovascular disease in Singapore: A call to action from Singapore Heart Foundation, Singapore Cardiac Society and Chapter of Cardiologists of the Academy of Medicine, Singapore","authors":"J. Tan, Tee Joo Yeo, Doreen S. Y. Tan, Terrance Siang Jin Chua, K. Yeo, Natalie Si Ya Koh, T. Subramaniam, Yew Seng Kwan, Michael Chun Leng Lim, Lip Ping Low, Huay-Cheem Tan","doi":"10.47102/annals-acadmedsg.2023141","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023141","url":null,"abstract":"Introduction: In 2022, the Minister for Health of Singapore launched Healthier SG, a national strategy in championing the shift towards a population health approach.\u0000\u0000Method: The Singapore Heart Foundation conducted a series of roundtable discussions, also attended by representatives of the Singapore Cardiac Society and the Chapter of Cardiologists of the Academy of Medicine Singapore. During the meetings, the authors formulated interventions supportive of Healthier SG that specifically aimed to uplift the state of cardiovascular (CV) preventive care in Singapore.\u0000\u0000Results: In line with Healthier SG, the authors propose a 3-pronged approach (“Healthier Heart SG”) to augment the success of Healthier SG in achieving good CV outcomes. This proposal includes the following components: (1) a call to update the standards of care in addressing the 5 main modifiable risk factors of cardiovascular disease (CVD); (2) patient education through cooperation between healthcare professionals and community partners for a whole-of-system approach; and (3) support for integrated care, including access to cardiac rehabilitation in the community, improved referral processes and access to nutrition/dietetics counselling and tobacco cessation, optimal use of information technology, and continued CV research.\u0000\u0000Conclusion: Healthier Heart SG would bring the standards of care and CV care delivery in Singapore closer to achieving the vision of proactive prevention of CVD and CV morbidity and mortality. This can only be achieved through the concerted efforts of healthcare professionals, policymakers and community partners, coupled with the cooperation of community members.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"234 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140480827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.47102/annals-acadmedsg.2023226
Judith Ong, Joyce Matthew, Mahesh Choolani, Peng Cheang Wong
Introduction: Female fecundity decreases significantly after the age of 32, and rapidly so after age 37. There is no treatment to prevent this decline. Furthermore, globally, women are getting married later and the age at which they have their first child is increasing. As of July 2023, elective egg freezing (EEF) or oocyte cryopreservation (OC) for age-related fertility decline, commenced in Singapore. With medical advancements in OC, EEF is no longer considered experimental. The aim of this review is to examine the existing literature around EEF with regard to reproductive outcomes and its safety, to better guide clinicians in counselling young single women. Method: Published studies were examined to increase understanding on optimal age for EEF, ideal number of oocytes for a live birth, recommended OC protocols, cryopreservation techniques affecting thaw survival or fertilisation, oocyte storage and pregnancy risks. Results: Models predict that EEF should be performed at age <37 years and to achieve a 70% chance of live birth, women would need 14, 15 and 26 mature oocytes at ages 30–34, 35–37 and >38 years, respectively. An antagonist stimulation protocol with an agonist trigger would minimise ovarian hyperstimulation syndrome and duration of stimulation without affecting outcomes. Oocyte vitrification in comparison to slow freezing increases thaw survival, fertilisation and clinical pregnancy rates. No increased risks exist for the woman, future pregnancy or child when compared with conventional IVF. Conclusion: EEF is a viable option for single women desiring fertility preservation. Financial costs are significant, but returns are worthwhile if oocytes are utilised.
{"title":"Oocytes on ice: Exploring the advancements in elective egg freezing for women","authors":"Judith Ong, Joyce Matthew, Mahesh Choolani, Peng Cheang Wong","doi":"10.47102/annals-acadmedsg.2023226","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023226","url":null,"abstract":"Introduction: Female fecundity decreases significantly after the age of 32, and rapidly so after age 37. There is no treatment to prevent this decline. Furthermore, globally, women are getting married later and the age at which they have their first child is increasing. As of July 2023, elective egg freezing (EEF) or oocyte cryopreservation (OC) for age-related fertility decline, commenced in Singapore. With medical advancements in OC, EEF is no longer considered experimental. The aim of this review is to examine the existing literature around EEF with regard to reproductive outcomes and its safety, to better guide clinicians in counselling young single women.\u0000\u0000Method: Published studies were examined to increase understanding on optimal age for EEF, ideal number of oocytes for a live birth, recommended OC protocols, cryopreservation techniques affecting thaw survival or fertilisation, oocyte storage and pregnancy risks.\u0000\u0000Results: Models predict that EEF should be performed at age <37 years and to achieve a 70% chance of live birth, women would need 14, 15 and 26 mature oocytes at ages 30–34, 35–37 and >38 years, respectively. An antagonist stimulation protocol with an agonist trigger would minimise ovarian hyperstimulation syndrome and duration of stimulation without affecting outcomes. Oocyte vitrification in comparison to slow freezing increases thaw survival, fertilisation and clinical pregnancy rates. No increased risks exist for the woman, future pregnancy or child when compared with conventional IVF.\u0000\u0000Conclusion: EEF is a viable option for single women desiring fertility preservation. Financial costs are significant, but returns are worthwhile if oocytes are utilised.","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"90 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140484843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.47102/annals-acadmedsg.2023286
Ee Ling Goh, Kay Choong See, W. Chua
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of healthcare resources due to longer hospitalisation and the need for intensive care.3 The resultant economic impact is tremendous; for instance, the 1-year incremental costs of sepsis to the healthcare system in Ontario, Canada approximates CAD 1 billion.3 In addition to the complexity of care required for sepsis, the higher healthcare costs incurred may be explained by the post-sepsis syndrome. Sequelae of sepsis include physical, psychological and medical complications.4
{"title":"Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives","authors":"Ee Ling Goh, Kay Choong See, W. Chua","doi":"10.47102/annals-acadmedsg.2023286","DOIUrl":"https://doi.org/10.47102/annals-acadmedsg.2023286","url":null,"abstract":"Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of healthcare resources due to longer hospitalisation and the need for intensive care.3 The resultant economic impact is tremendous; for instance, the 1-year incremental costs of sepsis to the healthcare system in Ontario, Canada approximates CAD 1 billion.3 In addition to the complexity of care required for sepsis, the higher healthcare costs incurred may be explained by the post-sepsis syndrome. Sequelae of sepsis include physical, psychological and medical complications.4","PeriodicalId":513926,"journal":{"name":"Annals of the Academy of Medicine, Singapore","volume":"43 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140480992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：