Introduction: Glycolysis continues after blood collection and may reduce glucose concentrations in vitro, potentially compromising diagnostic accuracy. The effectiveness of glycolysisinhibiting additives differs among blood collection tubes. Citrate rapidly inhibits glycolysis through immediate acidification, whereas fluoride acts more slowly by inhibiting enolase at a later stage of the glycolytic pathway. This study aimed to compare short-term glucose stability in four commonly used blood collection tubes under routine laboratory conditions. Methodology: Venous blood samples were collected from 100 volunteers into Rapid Serum Tubes (RST), Barricor tubes, Fluoride tubes, and Citrate tubes. Glucose concentrations were measured at 30 and 60 minutes after collection using the hexokinase method. A repeated-measures ANOVA was performed to evaluate the effects of Time, Tube Type, and the Time × Tube interaction (α = 0.05), followed by Bonferroni-adjusted pairwise comparisons. Results: At 30 minutes, glucose concentrations were highest in the Fluoride tube (5.528 mmol/L), followed closely by the Citrate tube (5.505 mmol/L), while lower values were observed in RST (5.434 mmol/L) and Barricor tubes (5.430 mmol/L). By 60 minutes, glucose levels had declined in all tubes; however, the decrease was more pronounced in serum-based tubes. RST values fell to 5.277 mmol/L and Barricor to 5.300 mmol/L, whereas Fluoride and Citrate tubes remained relatively stable at 5.449 mmol/L and 5.489 mmol/L, respectively. Overall, glucose decreased significantly between 30 and 60 minutes (mean decrease = 0.096 mmol/L, p <0.001; partial η² = 0.705). Tube Type also had a significant effect on glucose concentrations (F(3,297) = 42.06, p <0.001; partial η² = 0.298). Conclusion Fluoride and Citrate tubes provided the most effective preservation of glucose concentrations over 60 minutes, showing minimal glycolytic decline. In contrast, RST and Barricor tubes demonstrated significantly greater glucose loss, highlighting the importance of rapid processing when serum-based tubes are used.
Glucose

INTRODUCTION: Conservative kidney management (CKM) is a recognised treatment option for selected patients with chronic kidney disease stage 5 (CKD G5), but prognostic indicators for mortality and optimal timing for palliative care transition remain uncertain. METHOD: This is a single-centre, prospective cohort study of CKD G5 patients who opted for CKM, conducted between April 2021 and September 2024, with longitudinal monitoring of Edmonton Symptom Assessment System Revised: Renal; Palliative Perfor-mance Scale (PPS); Resources Utilisation Group.Activities of Daily Living (RUG-ADL) scale; Clinical Frailty Score; Karnofsky Performance Score; and clinical and laboratory data. Primary outcomes included identifying baseline mortality predictors and validating the PPS for survival estimation. Cox proportional hazards models were used to identify independent predictors of mortality. RESULTS: Among 109 patients (mean age 79.8±7.3 years, 64.2% female), 62 (56.9%) died during follow-up. Multivariate analysis identified baseline estimated glomerular filtration rate (eGFR) (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.08.1.68, P<0.01) and serum albumin (HR 1.24, 95% CI 1.08.1.43, P<0.01) as predictors of 1-year mortality. Median survival varied by eGFR: 3.0 months (95% CI 0.6.2) for eGFR .5 mL/min/1.73 m², 13.0 months (95% CI 9.1.16.9) for eGFR 6.10 mL/ min/1.73 m², and 20.0 months (95% CI 16.5.23.5) for eGFR >10 mL/min/1.73 m² (P<0.01). Subsequent PPS correlated strongly with survival, with median survival of 1.8 months for PPS <50, 5.3 months for PPS 50.60, and 7.9 months for PPS 70.80 (P=0.03). CONCLUSION Baseline eGFR and serum albumin predict 1-year mortality in CKM patients. PPS offers a practical tool for identifying patients requiring palliative care transition, supporting personalised care pathways and timely integration of palliative care.
Humans ; Female ; Male ; Aged ; Prospective Studies ; Glomerular Filtration Rate ; Palliative Care/methods* ; Conservative Treatment/methods* ; Aged, 80 and over ; Prognosis ; Serum Albumin/analysis* ; Proportional Hazards Models ; Activities of Daily Living ; Singapore/epidemiology*

COMPARATIVE ANALYSIS OF PROSTATE VOLUME MEASUREMENT USING TRANSABDOMINAL ULTRASOUND, TRANSRECTAL ULTRASOUND, AND MRI: A RETROSPECTIVE OBSERVATIONAL STUDY Introduction: Prostate volume (PV) measurement is crucial for managing prostate conditions, including benign prostatic hyperplasia (BPH). Its range can be measured using different imaging modalities like transabdominal ultrasound (TAUS), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI) of the prostate, which were compared in this study. Methods: A single tertiary centre retrospective observational analysis was conducted on PV measurements obtained through TAUS, TRUS, and MRI prostate from the same patients prior to biopsy. The mean of PV from each imaging modality was analysed using the Analysis of Variance (ANOVA) and a Tukey post hoc test, with p < 0.05 was considered statistically significant. Results: Only 311 out of 718 patients who underwent TRUS biopsy from January 2018 until December 2022 were eligible for this study based on the inclusion criteria. The median age and PSA were 71 years old and 7.5 ng/mL, respectively. No significant difference was found across the means of the imaging modality and PV measurement among the imaging modalities (F = 0.713, p = 0.49). The Tukey post hoc test also revealed no significant difference between each modality, namely TAUS-TRUS (p = 0.45), MRI-TRUS (p = 0.79), and TAUS-MRI (p = 0.85). Conclusion: This study demonstrated no statistically significant relationship in prostate volume measurements from the three different imaging modalities, namely TAUS, TRUS, and MRI.

[CORRECTED] SLEEP QUALITY, SLEEP HYGIENE PRACTICES AND THEIR INFLUENCING FACTORS AMONG MALAYSIAN UNIVERSITY STUDENTS: A CROSS-SECTIONAL STUDY Introduction: Sleep quality refers to the subjective experience of sleep, encompassing aspects such as duration, depth and continuity. In contrast, sleep hygiene practices involve behaviours and habits conducive to healthy sleep patterns. This study aimed to explore the prevalence of good sleep quality and hygiene and the factors that affect good sleep hygiene and quality. Methods: A cross-sectional study was conducted among 384 Malaysian university students sampled from October to December 2023 using a validated self-administered questionnaire that included the Pittsburgh Sleep Quality Index (PSQI) and Sleep Hygiene Index (SHI). The PSQI and SHI were used to measure sleep quality and hygiene, respectively. Data was analysed using SPSS v26. Results: Approximately 94.0% (95% Confidence Interval (CI)=91.0–96.1) of the participants had good/normal sleep hygiene, while 60.2% (95% CI=55.1–65.1) had poor sleep quality. The multivariate binary logistic regression analysis showed that the participants who had good sleep hygiene had a 4.36-fold (95% CI=1.26–15.17, P=0.02) higher odds of having good sleep quality. Conversely, ethnicity (high odds ratio, P<0.001) and sleep hygiene were associated with a 4.22-fold (95% CI=1.19–14.95, P=0.03) higher odds of good sleep quality. Conclusion: Malaysian university students have a high prevalence of good sleep hygiene, but many have poor sleep quality. Although sleep hygiene may be directly affected by sleep quality, sleep quality can be affected by sleep hygiene and ethnicity.

Purpose: To investigate the effect of androgen deprivation therapy (ADT) on health-related quality of life (HRQOL) in Asian men with all stages of prostate cancer. Materials and Methods: READT (real-life evaluation of the effect of ADT in prostate cancer patients in Asia) was a multi-center, prospective observational study involving six sites across four Asian populations. We enrolled eligible prostate cancer patients, who opted for ADT alone or in combination without prior neoadjuvant or adjuvant ADT within 12 months. The EuroQoL-5 dimensions, 5 level scale (EQ-5D-5L) utility index scores and visual analog scale (VAS) were evaluated at baseline, month 6 and month 12. Results: A total of 504 patients were recruited into READT between September 2016 and May 2020 with 52.9% diagnosed with metastatic prostate cancer. The EQ-5D-5L was evaluable in 442/504 (87.7%) of patients. Overall baseline EQ-5D-5L utility index score was 0.924 (interquartile range [IQR] 0.876–1.000). We observed a statistically significant difference in baseline EQ-5D-5L utility index score among different populations with a median EQ-5D-5L utility index score of 1 for Taiwan & Hong Kong, 0.897 for China and 0.838 for Malaysia. Similar trend was observed throughout multiple treatment time-points. Stage IV prostate cancer were significantly associated with a lower baseline EQ-5D-5L utility index score compared to stage I–III prostate cancer, producing a median disutility value of -0.080. Participants had a high median VAS (80, IQR 70–90), indicating good overall health on average during ADT initiation. Conclusions The study highlights the differences in health state utility index scores among various Asian prostate cancer patients receiving ADT at real-world setting. Our findings will be informative and useful in cost-effectiveness evaluation and policy decision making.

The current standard treatment for muscularis propria-invasive (T2) colorectal cancer is surgical colectomy with lymph node dissection. With the advent of new endoscopic resection techniques, such as endoscopic full-thickness resection or endoscopic intermuscular dissection, T2 colorectal cancer, with metastasis to 20%-25% of the dissected lymph nodes, may be the next candidate for endoscopic resection following submucosal-invasive (T1) colorectal cancer. We present a novel endoscopic treatment strategy for T2 colorectal cancer and suggest further study to establish evidence on oncologic and endoscopic technical safety for its clinical implementation.

Submucosal invasive (T1) colorectal cancer is a significant clinical management challenge, with an estimated 10% of patients developing extraintestinal lymph node metastasis. This condition necessitates surgical resection along with lymph node dissection to achieve a curative outcome. Thus, the precise preoperative assessment of lymph node metastasis risk is crucial to guide treatment decisions after endoscopic resection. Contemporary clinical guidelines strive to identify a low-risk cohort for whom endoscopic resection will suffice, applying stringent criteria to maximize patient safety. Those failing to meet these criteria are often recommended for surgical resection, with its associated mortality risks although it may still include patients with a low risk of metastasis. In the quest to enhance the precision of preoperative lymph node metastasis risk prediction, innovative models leveraging artificial intelligence or nomograms are being developed. Nevertheless, the debate over the ideal sensitivity and specificity for such models persists, with no consensus on target metrics. This review puts forth postoperative mortality rates as a practical benchmark for the sensitivity of predictive models. We underscore the importance of this method and advocate for research to amass data on surgical mortality in T1 colorectal cancer. Establishing specific benchmarks for predictive accuracy in lymph node metastasis risk assessment will hopefully optimize the treatment of T1 colorectal cancer.

REPLY LETTER TO: IF SARS-COV-2 VACCINATION IS BLAMED FOR PARSONAGE–TURNER SYNDROME, NEUROSURGICAL NEUROLYSIS IS NOT INDICATED We would like to respond to the letter to the editor titled ‘If SARS-CoV-2 vaccination is blamed for Parsonage–Turner syndrome, neurosurgical neurolysis is not indicated’ addressed to our article titled ‘Parsonage–Turner syndrome: A case report of a rare side effect of COVID-19 booster vaccination’.1,2 We thank the author for raising several points worthy of discussion.

FEASIBILITY OF QUICK RESPONSE-BASED QUALITY IMPROVEMENT PROJECTS IN AN URBAN PRIMARY CARE SETTING: A CROSS-SECTIONAL SURVEY Introduction: Using quick response (QR) codes to disseminate information has become increasingly popular since the declaration of COVID-19 as a pandemic. We aimed to investigate the feasibility of implementing QR-based quality improvement projects in our clinic to improve patients’ medical knowledge, experience and access to care. Methods: We utilised systematic random sampling by recruiting every 25th patient registered in our clinic during data collection. Participants answered a self-administered printed questionnaire regarding their smartphone usage and familiarity with QR code scanning at the patients’ waiting area. Data were analysed using the Statistical Package for the Social Sciences version 26. Results: A total of 323 patients participated (response rate=100%). The participants’ median age was 57 years (interquartile range=41–67). Most participants were women (63.1%). Approximately 90.4% (n=282) used smartphones, with 83.7% (n=261) reporting average or good usage proficiency. More than half (58.0%) accessed medical information via their smartphones, and 67.0% were familiar with QR codes. Multiple logistic regression analyses revealed that familiarity with QR codes was linked to age of <65 years [adjusted odds ratio (AOR)=4.593, 95% confidence interval (CI)=2.351–8.976, P<0.001], tertiary education (AOR=2.385, 95% CI=1.170–4.863, P=0.017), smartphone proficiency (AOR=4.703, 95% CI=1.624–13.623, P=0.004) and prior smartphone usage to access medical information (AOR=5.472, 95% CI=2.790–10.732, P<0.001). Conclusion: Since smartphones were accessible to most primary care patients, and more than half of the patients were familiar with QR code scanning, QR code-based quality improvement projects can be used to improve services in our setting.