Environmental damage affects many aspects of healthcare, from extreme weather events to evolving population disease. Singapore's healthcare sector has the world's second highest healthcare emissions per capita, hampering the nation's pledge to reduce emissions by 2030 and achieve net zero emissions by 2050. In this review, we provide an overview of the impact environmental damage has on healthcare, including facilities, supply chain and human health, and examine measures to address healthcare's impact on the environment. Utilising the 'R's of sustainability - rethinking, reducing/refusing, reusing/repurposing/reprocessing, repairing, recycling and research - we have summarised the opportunities and challenges across medical disciplines. Awareness and advocacy to adopt strategies at institutional and individual levels is needed to revolutionise our environmental footprint and improve healthcare sustainability. By leveraging evidence from ongoing trials and integrating sustainable practices, our healthcare system can remain resilient against environment-driven challenges and evolving healthcare demands while minimising further impacts of environmental destruction.
Humans ; Climate Change ; Delivery of Health Care ; Singapore ; Conservation of Natural Resources ; Sustainable Development ; Environment

Hypoglycemic disorders are rare in persons without diabetes, and clinical evaluation to identify its etiology can be challenging. We present a case of insulin autoimmune syndrome induced by carbimazole in a middle-aged Chinese man with underlying Graves’ disease, which was managed conservatively with a combination of dietary modification and alpha-glucosidase inhibitor.
Hypoglycemia ; Hyperinsulinism ; Insulin Antibodies

Introduction: The dietary intake of adults in Brunei Darussalam has not been thoroughly investigated via the food frequency questionnaire (FFQ). This study aimed to establish, validate and test the reproducibility of an FFQ to determine and evaluate the adult dietary intake in Brunei Darussalam. Methods: Participants were divided into; (1) development phase (50 adults); (2) validation phase (100 adults); (3) reproducibility phase (subsample of 40 adults). 3-day dietary record (3DR) was used in development phase to gather food items consumed. 2-day dietary record(2DR) was used as a reference method in validation. Nutrients analyze were energy, macronutrients, calcium, and vitamins A and C. Validation analysis were spearman correlation, mean difference, Bland-Altman plot, cohen’s kappa and cross-classification analyses. Reliability analyses were intra-class correlation coefficient (ICC), Cronbach’s alpha and cross classification to compare repeat FFQ administered with 1 to 3 months interval. Results: The FFQ consisted 138 food items from 12 food groups. In validation, mean difference between FFQ and 2DR exceeded 10%, spearman correlation were significantly strong (r=0.994 to r=0.107). Cross-classification demonstrated > 50% of nutrients were correctly and adjacently classified, Bland-Altman plots were relatively consistent for the two methods. Cohen’s kappa ranged from 0.081 to 0.040, demonstrating weak agreement. In reproducibility, ICC outcomes for FFQ1(0.463) and FFQ2(0.978), Cronbach’s alpha was > 0.8, and > 95% of the nutrients were correctly or adjacently classified. Conclusion: The FFQ designed in this study was valid due to the consistency with the dietary records; hence, a reliable tool to predict the dietary intake of Brunei Darussalam adults.

Background: Gliomas, characterized by their invasive persistence and tendency to affect critical brain regions, pose a challenge in surgical resection due to the risk of neurological deficits. This study focuses on a personalized approach to achieving an optimal onco-functional balance in glioma resections, emphasizing maximal tumor removal while preserving the quality of life. Methods: A retrospective analysis of 57 awake surgical resections of gliomas at the NationalUniversity Hospital, Singapore, was conducted. The inclusion criteria were based on diagnosis, functional boundaries determined by direct electrical stimulation, preoperative Karnofsky Performance Status score, and absence of multifocal disease on MRI. The treatment approach included comprehensive neuropsychological evaluation, determination of suitability for awake surgery, and standard asleepawake-asleep anesthesia protocol. Tumor resection techniques and postoperative care were systematically followed. Results: The study included 53 patients (55.5% male, average age 39 years), predominantlyright-handed. Over half reported seizures as their chief complaint. Tumors were mostly low-grade gliomas. Positive mapping of the primary motor cortex was conducted in all cases, with awake surgery completed in 77.2% of cases. New neurological deficits were observed in 26.3% of patients at 1 month after operation; most showed significant improvement at 6 months. Conclusion The standardized treatment paradigm effectively achieved an optimal onco-functional balance in glioma patients. While some patients experienced neurological deficits postoperatively, the majority recovered to their preoperative baseline within 3 months. The approach prioritizes patient empowerment and customized utilization of functional mapping techniques, considering the challenge of preserving diverse languages in a multilingual patient population.