INTRODUCTION: Obstructive sleep apnoea (OSA) is common in Singapore, with moderate to severe OSA affecting around 30% of residents. These consensus statements aim to provide scientifically grounded recommendations for the management of OSA, standar-dise the management of OSA in Singapore and promote multidisciplinary collaboration. METHOD: An expert panel, which was convened in 2024, identified several areas of OSA management that require guidance. The expert panel reviewed the current literature and developed consensus statements, which were later independently voted on using a 3-point Likert scale (agree, neutral or disagree). Consensus (total ratings of agree and neutral) was set a priori at ≥80% agreement. Any statement not reaching consensus was excluded. RESULTS: The final consensus included 49 statements that provide guidance on the screening, diagnosis and management of adults with OSA. Additionally, 23 statements on the screening, diagnosis and management of paediatric OSA achieved consensus. These 72 consensus statements considered not only the latest clinical evidence but also the benefits and harms, resource implications, feasibility, acceptability and equity impact of the recommendations. CONCLUSION The statements presented in this paper aim to guide clinicians based on the most updated evidence and collective expert opinion from sleep specialists in Singapore. These recommendations should augment clinical judgement rather than replace it. Management decisions should be individualised, taking into account the patient's clinical characteristics, as well as patient and caregiver concerns and preferences.
Humans ; Sleep Apnea, Obstructive/diagnosis* ; Singapore ; Consensus ; Adult

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.
Adult ; Allopurinol ; Anaphylaxis ; Anti-Bacterial Agents ; Asia ; Asian Continental Ancestry Group ; Aspirin ; Asthma ; Carbamazepine ; Child ; Cicatrix ; Contrast Media ; Coronary Artery Disease ; Diagnostic Tests, Routine ; Drug Hypersensitivity ; Ethnic Groups ; Humans ; Hypersensitivity ; Penicillins ; Percutaneous Coronary Intervention ; Phenotype ; Recurrence ; Skin Tests

A total of 573 patients hospitalized in National Seoul Mental Hospital and 76 of healthy persons as control were examined by indirect latex agglutination test in order to evaluate Toxoplasma antibody titers in mental patients. Throughout this survey, 1:32 or more titers of diluted sera were regarded as positive. The 573 samples of test sera showed negative in 386 cases (67.4 percent), 1:2 in 93 cases (16.2 percent), 1:4 in 57 cases (9.9 percent), 1:8 in 14 cases (2.4 percent), 1:16 in 12 cases (2.1 percent), 1:32 in 5 cases (0.9 percent), 1:64 in 1 case (0.2 percent), 1:128 in 3 cases (0.5 percent) and 1:256 in 2 cases (0.3 percent) respectively. Among total 573 mental patients, 11 cases (19 percent) showed positive, and they were 9 cases (1.8 percent) of schizophrenia and 2 cases (7.4 percent) of manic depression. One case (1.3 percent) out of 76 control sera showed positive result.
parasitology-protozoa ; Toxoplasma gondii ; immunology ; indirect latex agglutination test ; schizophrenia ; manic depression

Changes of abdominal organs in early paragonimiasis are described in dogs and cats. Experimental infection was induced by feeding 40-50 and 20-30 metacercariae of Paragonimus westermani to 15 dogs and 15 cats respectively. These animals were killed sequentially starting from 8 days to 120 days after infection. Complete autopsies were carried out in all animals and the tissues were examined microscopically with the main emphasis on changes of the liver and the diaphragm. A definite bout of acute diffuse fibrinoexudative peritonitis with ascites ranging from 5 to 20 ml was present in both dogs and cats at the time of 20 days after infection. This was also the period of the maximum liver damage and diaphragmatic injuries. The peritonitic changes became minimized after 45 days of infection. The liver changes were of two folds. The first one was characterized by numerous pin-point or linear tissue defects on the surface of the lobes, which were often covered with fibrin clots. Some of these defects were impacted by the larvae. These 'scratch' marks appeared to be of mechanical effect, and the margins were often banal without a significant inflammatory reaction. The scratch marks were no longer observed in animals examined after 45 days. The second was noted in the Kupffer cells of the liver. A large amount of hemosiderin pigment was noted in the Kupffer cells and became prominent by 20 days through 45 days. Hemosiderin-laden macrophages were found also in the spleens of these animals. Some animals in 30 days group showed the most Kupffer cells heavily loaded with hemosiderin. However, no associated degenerative changes were noted in these cells. The diaphragm was quite unique in early phase of infection in all animals examined. Numerous pinpoint perforative lesions could definitely be seen grossly, and some of these lesions included migrating larval worms inside the tunnels. These lesions were microscopically characterized by tract or tunnel formation with accompanying tissue reaction. The diaphragmatic changes were manifest by 20 days after infection. The tracts of tunnels appeared to have been made by pressure necrosis and surrounding edema, and subsequently were associated with a massive eosinophilic influx and myocytolysis. The eosinophilic abscess and multinucleated giant cells were often observed in the animals of the 30 days group. The diaphragmatic changes seemed to be repaired with or without fibrous scar formation which was occasionally seen in 45 days and later.
parasitology-helminth-trematoda ; Paragonimus westermani ; paragonimiasis ; diaphragm ; dog ; cat ; pathology ; peritonitis

This study was conducted to determine the effect of oxantel/pyrantel tablets, oxantel suspension, pyrantel dry syrup and pyrantel tablets against T. trichiurus and A. lumbricoides infections. Twenty-four cases of mixed infections of T. trichiurus and A. lumbricoides were treated with oxantel/pyrantel tablets at a single dose of 20 mg/kg of body weight, and 49 cases of single infection of T. trichiurus were administered oxantel suspension at a single dose of 15 mg/kg of body weight. On the other hand, single infection of A. lumbricoides in 18 cases was administered pyrantel dry syrup at a single dose of 5 mg/kg of body weight. In the above 91 cases, the negative conversion rate and the egg reduction rate of egg out-put before and after the drug administration were examined by the cellophane thick smear method and Stoll's egg counting technique. A follow-up examination was carried out 3-4 weeks after the drug administration. Other 59 cases of single and mixed infection of T. trichiurus and A. lumbricoides were examined by the cellophane thick smear method only and administered pyrantel tablets at a single dose of 2.5 mg/kg of body weight. The results were summarized as follows: The prevalence rates of T. trichiurus and A. lumbricoides infection in this study were 42.8% and 27.2% respectively by the cellophane thick smear method among 1,066 stool specimens. The egg negative conversion rate and the egg reduction rate in the administration of oxantel/pyrantel tablets at a single dose of 20 mg/kg body weight were 75.0% and 97.8% respectively in T. trichiurus infection and 100% each in A. lumbricoides. The egg negative conversion rate and the egg reduction rate in the administration of oxantel suspension at a single dose of 15 mg/kg body weight were 85.7% and 93.0% respectively in sinlge infection of T. trichiurus. The egg negative conversion rate and the egg reduction rate in the administration of pyrantel dry syrup at a single dose of 5 mg/kg body weight were 100% each in single infection of A. lumbricoides. The qualitative evaluation in cases of single and mixed infection of T. trichiurus and A. lumbricoides were by means of pyrantel tablets at a single dose of 2.5 mg/kg body weight, the cure being 100% against A. lumbricoides but 17.0% against T. trichiurus. There were no undesirable side effects in this study and oxantel suspension and pyrantel dry syrup were well accepted and tolerated.
parasitology-helminth-nematoda ; Trichuris trichiurus ; Ascaris lumbricoides ; chemotherapy ; oxantel ; pyrantel