Correctional facilities are a major hub of hepatitis C virus (HCV), with rates far higher than those observed in the general population. Once considered an intractable crisis, the current situation offers a unique opportunity. The advent of direct-acting antivirals has changed the HCV treatment landscape, making its elimination possible. This review summarises the scientific evidence and progress towards HCV elimination in correctional health systems. It outlines the evolution of 'test-and-treat' models, assesses micro-elimination success worldwide, especially in Singapore, and highlights collaborative efforts between Changi General Hospital and Singapore Prison Services. Their implementation of HCV treatment guidelines serves as a key case study in this context. This review also analyses the various barriers - structural, financial, clinical and logistical - that hinder progress. It consolidates strong evidence that prison-based HCV treatment is cost-effective, promotes health equity, supports the World Health Organization 2030 goals and reduces the societal burden of HCV.
Humans ; Singapore ; Antiviral Agents/therapeutic use* ; Hepatitis C, Chronic/epidemiology* ; Prisons ; Prisoners ; Disease Eradication ; Cost-Benefit Analysis ; Hepacivirus ; Correctional Facilities

Background: s/Aims: Given the high mortality associated with gallbladder cancer (GBC), the efficacy of adjuvant therapy (AT) remains controversial. We audited our data over an 11-year period to assess the impact of AT. Methods: This study included all patients who underwent curative resection for GBC from 2007 to 2017. Analyses were conducted of clinicopathological characteristics, surgical details, and postoperative therapeutic records. The benefits of adjuvant chemotherapy (CT) or chemoradiotherapy (CTRT) were evaluated against surgery alone using SPSS version 20 for statistical analysis. Results: The median age of patients (n = 142) was 50 years. The median overall survival (OS) was 93, 34, and 30 months with CT, CTRT, and surgery alone respectively (p = 0.612). Multivariate analysis indicated that only disease stage and microscopically involved margins significantly impacted OS and disease-free survival (DFS). CT showed increased effectiveness across all prognostic subsets, except for stage 4 and margin-positive resections. Following propensity score matching, median DFS and OS were higher in the CT group than in the CTRT group, although the differences were not statistically significant (p > 0.05). Conclusions Radically resected GBC patients appear to benefit more from adjuvant CT, while CTRT should be reserved for cases with high-risk features.

During routine dissection, we observed a unique case of unilateral polydactyly in the left foot of a 61-year-old male cadaver. We observed the medial head of the quadratus plantae (QP) muscle, which gave off an additional tendinous slip before joining the lateral head of QP. The 4th tendon of the flexor digitorum longus (FDL) was bifurcated into two tendinous parts after receiving a thin fibrous slip from the tendinous slip of the medial head of QP. The medial division of the 4th tendon of FDL passed forward and attached to the base of the distal phalanx of the 5th toe. The extra tendinous slip from the medial head of QP was attached distally to the lateral division of the 4th tendon of FDL and formed a common anomalous tendon to the 6th toe. The knowledge of this variation would be helpful in reconstructive foot surgeries and correction of congenital deformities.

During routine dissection, we observed a unique case of unilateral polydactyly in the left foot of a 61-year-old male cadaver. We observed the medial head of the quadratus plantae (QP) muscle, which gave off an additional tendinous slip before joining the lateral head of QP. The 4th tendon of the flexor digitorum longus (FDL) was bifurcated into two tendinous parts after receiving a thin fibrous slip from the tendinous slip of the medial head of QP. The medial division of the 4th tendon of FDL passed forward and attached to the base of the distal phalanx of the 5th toe. The extra tendinous slip from the medial head of QP was attached distally to the lateral division of the 4th tendon of FDL and formed a common anomalous tendon to the 6th toe. The knowledge of this variation would be helpful in reconstructive foot surgeries and correction of congenital deformities.

Background: s/Aims: Given the high mortality associated with gallbladder cancer (GBC), the efficacy of adjuvant therapy (AT) remains controversial. We audited our data over an 11-year period to assess the impact of AT. Methods: This study included all patients who underwent curative resection for GBC from 2007 to 2017. Analyses were conducted of clinicopathological characteristics, surgical details, and postoperative therapeutic records. The benefits of adjuvant chemotherapy (CT) or chemoradiotherapy (CTRT) were evaluated against surgery alone using SPSS version 20 for statistical analysis. Results: The median age of patients (n = 142) was 50 years. The median overall survival (OS) was 93, 34, and 30 months with CT, CTRT, and surgery alone respectively (p = 0.612). Multivariate analysis indicated that only disease stage and microscopically involved margins significantly impacted OS and disease-free survival (DFS). CT showed increased effectiveness across all prognostic subsets, except for stage 4 and margin-positive resections. Following propensity score matching, median DFS and OS were higher in the CT group than in the CTRT group, although the differences were not statistically significant (p > 0.05). Conclusions Radically resected GBC patients appear to benefit more from adjuvant CT, while CTRT should be reserved for cases with high-risk features.

During routine dissection, we observed a unique case of unilateral polydactyly in the left foot of a 61-year-old male cadaver. We observed the medial head of the quadratus plantae (QP) muscle, which gave off an additional tendinous slip before joining the lateral head of QP. The 4th tendon of the flexor digitorum longus (FDL) was bifurcated into two tendinous parts after receiving a thin fibrous slip from the tendinous slip of the medial head of QP. The medial division of the 4th tendon of FDL passed forward and attached to the base of the distal phalanx of the 5th toe. The extra tendinous slip from the medial head of QP was attached distally to the lateral division of the 4th tendon of FDL and formed a common anomalous tendon to the 6th toe. The knowledge of this variation would be helpful in reconstructive foot surgeries and correction of congenital deformities.