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

INTRODUCTION: Management of aortic stenosis (AS) in patients with chronic kidney disease (CKD) may often be overlooked, and this could confer poorer outcomes. METHODS: Consecutive patients ( n = 727) with index echocardiographic diagnosis of moderate to severe AS (aortic valve area <1.5 cm 2 ) were examined. They were divided into those with CKD (estimated glomerular filtration rate < 60 mL/min) and those without. Baseline clinical and echocardiographic parameters were compared, and a multivariate Cox regression model was constructed. Clinical outcomes were compared using Kaplan-Meier curves. RESULTS: There were 270 (37.1%) patients with concomitant CKD. The CKD group was older (78.0 ± 10.3 vs. 72.1 ± 12.9 years, P < 0.001), with a higher prevalence of hypertension, diabetes mellitus, hyperlipidaemia and ischaemic heart disease. AS severity did not differ significantly, but left ventricular (LV) mass index (119.4 ± 43.7 vs. 112.3 ± 40.6 g/m 2 , P = 0.027) and Doppler mitral inflow E to annular tissue Doppler e' ratio (E: e' 21.5 ± 14.6 vs. 17.8 ± 12.2, P = 0.001) were higher in the CKD group. There was higher mortality (log-rank 51.5, P < 0.001) and more frequent admissions for cardiac failure (log-rank 25.9, P < 0.001) in the CKD group, with a lower incidence of aortic valve replacement (log-rank 7.12, P = 0.008). On multivariate analyses, after adjusting for aortic valve area, age, left ventricular ejection fraction and clinical comorbidities, CKD remained independently associated with mortality (hazard ratio 1.96, 95% confidence interval 1.50-2.57, P < 0.001). CONCLUSION Concomitant CKD in patients with moderate to severe AS was associated with increased mortality, more frequent admissions for cardiac failure and a lower incidence of aortic valve replacement.
Humans ; Aortic Valve Stenosis/surgery* ; Male ; Female ; Renal Insufficiency, Chronic/complications* ; Aged ; Aged, 80 and over ; Middle Aged ; Severity of Illness Index ; Glomerular Filtration Rate ; Proportional Hazards Models ; Echocardiography ; Kaplan-Meier Estimate ; Retrospective Studies ; Aortic Valve/surgery* ; Echocardiography, Doppler

Introduction: Massive open online courses (MOOCs) are designed to accommodate large numbers of geographically dispersed learners. Few healthcare students receive exposure in travel medicine. We aimed as partner medical universities to develop a novel introductory MOOC in travel medicine suitable for undergraduate healthcare students, and to evaluate it among a cohort of learners. Methods: A course development team, comprising a senior travel medicine academic from National University of Ireland Galway, local International Medical University faculty and instructional/graphic designers, was convened in November 2017. The MOOC proposal was subsequently refined. Course construction commenced in December 2017 and involved communication between team members based in Malaysia and Ireland. Lectures were recorded in January-July 2018. Development of learning and assessment material and the pilot phase were completed in December 2019. Course evaluation was based on the results of a questionnaire and qualitative free text comments from users. Results: The MOOC is being delivered to a multinational cohort on a rolling basis. It is organised into five four-themed units: travel health risk assessment; pre-travel health advice; tropical infectious diseases; specialised travellers; and illness in returned travellers. Pedagogical methods include short video lectures, journal articles, a discussion forum, and self-assessment quizzes. Learners have the option of completing an online test to receive a certificate of achievement. Participant evaluation from the first run of the MOOC has revealed very high levels of satisfaction with content and mode of delivery. Conclusions This is the first MOOC in travel medicine and it may provide a model for development of other collaborative international e-learning courses. It will address a significant deficit in undergraduate health professional education.
Travel Medicine ; Global Health ; Education, Medical

BACKGROUND/AIMS: There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. METHODS: Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. RESULTS: Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. CONCLUSIONS: Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.
Anti-Bacterial Agents ; Asia ; Asian Continental Ancestry Group ; Consensus ; Constipation ; Diagnosis ; Diarrhea ; Diet ; Epidemiology ; Gastrointestinal Diseases ; Humans ; Intestines ; Irritable Bowel Syndrome ; Life Style ; Methods ; Probiotics

Clitoria ternatea or Commonly known blue pea, is a perennial climber crop native to Asian countries. The current study was aimed to evaluate the antimicrobial activity C. ternatea extract on food borne microorganisms and its antifungal effect on Penicillium expansum. The extract showed significant antimicrobial activity against 3 Gram positive bacteria, 2 Gram negative bacteria and 1 filamentous fungus on disc diffusion assay. The extract also showed good biocidal effect on all Gram positive bacteria tested and P. expansum. However, the kill curve analysis revealed that the fungicidal activity of the extract against P. expansum conidia was depend on the concentration of the extract and the time of exposure of the conidia to the extract. The scanning electron micrograph of the extract treated P. expansum culture showed alterations in the morphology of fungal hyphae. The germination of P. expansum conidia was completely inhibited and conidial development was totally suppressed by the extract, suggesting the possible mode of action of anthocyanin. Besides, the extract also exhibited 5.0-log suppression of microbial growth relative to control in the rice model. The results indicate the potential use of the C. ternatea anthocyanin as food biopreservative.
Anthocyanins* ; Asian Continental Ancestry Group ; Clitoria* ; Diffusion ; Fungi ; Germination ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Hyphae ; Peas ; Penicillium* ; Spores, Fungal

BACKGROUND/AIMS: Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. METHODS: Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group. RESULTS: Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added. CONCLUSIONS: This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians.
Asia ; Asian Continental Ancestry Group ; Consensus ; Dyspepsia ; Electronic Mail ; Helicobacter pylori ; Humans ; Life Style ; Physicians, Primary Care ; Politics ; Prevalence

Pulmonary involvement is more common in systemic lupus erythematosus (SLE) than in any other connective tissue disease, and more than half of patients with SLE suffer from respiratory dysfunction during the course of their illness. Although sepsis and renal disease are the most common causes of death in SLE, lung disease is the predominant manifestation and is an indicator of overall prognosis. Respiratory disease may be due to direct involvement of the lung or as a secondary consequence of the effect of the disease on other organ systems.
Cause of Death ; Connective Tissue Diseases ; Humans ; Lung ; Lung Diseases ; Lupus Erythematosus, Systemic* ; Prognosis ; Sepsis

Unilateral or, particularly, bilateral congenital agenesis of the internal carotid artery is a rare anomaly. We report an occurrence of the condition, arising bilaterally, and report the findings of magnetic resonance imaging and magnetic resonance angiography.
Carotid Artery, Internal* ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging

Pineal germinoma is the commonest pineal region tumor of childhood and adolescence. Metastatic germinoma most commonly occurs via the cerebrospinal fluid (CSF), and it is usually limited to the cerebrospinal axis. Extacranial hematogenous metastasis is known to be very rare. We report here on a case of pineal germinoma with gradual extracranial metastases that occurred both through the CSF pathway and by hematogenous spread. The patient had multifocal CSF seeding after his surgery for pineal germinoma, and the left iliac metastasis and lung metastasis then occurred.
Adolescent ; Axis, Cervical Vertebra ; Cerebrospinal Fluid ; Germinoma* ; Humans ; Lung ; Lung Neoplasms ; Neoplasm Metastasis* ; Spinal Cord

PURPOSE: To determine, by means of a phantom study, the distortion-related factors and appropriate iodine concentration for three-dimensional reconstruction rotational angiography. MATERIALS AND METHODS: Four phantoms were created: crossed metal rods, one metal rod, one contrast rod, and a contrast rod under water. Iodine concentrations were 300, 250, 200, and 150 Img/ml, respectively. For each phantom, rotational angiography was performed in the rotational, right-angled (90 degree to rotational), intermedial (45 degree), close to rotational (20 degree), and close to right-angled (70 degree) planes. Two-dimensional projection images were transferred to a workstation at which 3D images were produced using the volume rendering technique. Image quality in each plane was evaluated in terms of opacity, homogeneity, and margin sharpness, which were graded as low, intermediate or high by two neuroradiologists who used images obtained in the right-angled plane as the standard reference. The same assessors evaluated in terms of the same parameters, cross-sectional images obtained at the central, intermedial, and peripheral portions of one metal rod positioned in the right-angled, close to right-angled, and intermedial planes, and in order to compare the values at different sites, one neuroradiologist measured the horizontal and vertical diameters of each cut image. RESULTS: Three-dimensional images of all four phantoms were high quality in the close to right-angled and intermedial plane, but in the rotational and close to rotational plane were degraded. In particular, metal rod images obtained in the rotational plane were poor for all three items. In these two planes, image quality was better for the contrast rod than the metal rod, and at 200 and 250 Img/ml concentrations than at 300 and 150 Img/ml concentrations. There was no significant difference in image quality, nor in measured values of the diameter between cut images. CONCLUSION: A three-dimensional image was more distorted when a linear object was placed at a lesser angle to the rotational plane and when inherent X-ray attenuation was greater, a finding which must be closely related to the beam-hardening artifact. Distortion was least at 200-250 Img/ml of iodine concentration, the concentration thought to be most appropriate for in-vitro 3D angiography.
Angiography ; Angiography, Digital Subtraction ; Artifacts ; Imaging, Three-Dimensional ; Iodine ; Water