Objective: A high rate of implant failure is frequently observed in osteoporotic spines. The majority of patients with osteoporosis are relatively old and are often unfit for general anesthesia due to various systemic comorbidities. Cement-augmented pedicle screw fixation is designed to improve stability and fixation strength in patients with compromised bone quality. Methods: A total of 45 patients (23 women and 22 men), with a mean age of 71.37 years (range, 53–94 years), diagnosed with osteoporosis (T score > -2.5) and deemed unfit for general anesthesia, underwent instrumentation with polymethylmethacrylate augmentation of cannulated pedicle screws. In total, 214 pedicle screws were inserted: 28 patients received 4 screws and 17 patients received 6 screws, all with cement augmentation. Preoperative and postoperative visual analogue scale (VAS) scores for pain, as well as Oswestry Disability Index (ODI) questionnaire data, were analyzed. Screw migration, defined as the distance from the screw tip to the anterior cortex and the upper endplate of the vertebra, was also evaluated immediately after surgery. The mean follow-up period was 15.3 months. Results: The mean preoperative VAS was 8.76 (range, 7–10). As intractable pain was the most common complaint, significant improvement was observed postoperatively: the mean postoperative VAS decreased to 2.24 (range, 0–5) (p<0.001). ODI scores also showed significant improvement in quality of life as measured by the ODI (p<0.001). Conclusion Our results support the use of cement-augmented pedicle screw fixation in medically unfit patients with osteoporosis. This technique appears effective in increasing stabilization of fixation and preventing screw loosening in this patient population. The main complication observed was cement leakage.

Severe alcohol-associated hepatitis (SAH) is the most aggressive form of alcohol-associated liver disease and is associated with very high short-term mortality. It is characterized by the acute onset of jaundice in the context of ongoing alcohol use, most commonly defined by a Maddrey’s discriminant function ≥32 or a model for end-stage liver disease score ≥20. Despite its increasing global burden and substantial healthcare costs, therapeutic options remain limited, and outcomes are poor. The severity of liver failure, systemic inflammation, infectious complications, and extrahepatic organ dysfunction determines the prognosis in SAH. The pathophysiology of SAH is multifactorial, involving direct hepatotoxicity from alcohol metabolites, oxidative stress, dysregulated immune activation, gut dysbiosis with increased intestinal permeability, impaired hepatic regeneration, and genetic susceptibility. These interrelated mechanisms culminate in an exaggerated inflammatory response driven by macrophage activation and cytokine release, resulting in hepatocellular injury and multi-organ failure. Glucocorticoids remain the guideline-recommended standard of care for selected patients; however, their benefit is limited to modest short-term survival gains, with high rates of non-response and infection. Numerous investigational therapies targeting inflammation, oxidative stress, liver regeneration, bile acid signalling, epigenetic regulation, and the gut-liver axis have been evaluated, with largely disappointing results. Emerging approaches, including interleukin-22 agonists and epigenetic modulators such as larsucosterol, show promise but require validation in well-designed trials. This review synthesizes current evidence on the definition, prognostic assessment, and pathophysiology of SAH, critically appraises existing and emerging therapies, and highlights the need for combination strategies, improved patient stratification, and personalized treatment approaches.

Emphysematous pyelonephritis (EPN) is a severe necrotizing kidney infection characterized by gas formation. While EPN is recognized in native kidneys and occasionally in functional renal allografts, its occurrence in nonfunctional allografts is extremely rare.We present a case of EPN in a 38-year-old female with a history of renal transplantation who developed EPN in a nonfunctional graft 1 year after returning to hemodialysis.The patient initially demonstrated excellent graft function posttransplant but later developed chronic antibody-mediated rejection and calcineurin inhibitor toxicity, which led to graft failure and resumption of hemodialysis. One year later, she presented with fever and graft site tenderness. Imaging revealed stage 3 EPN in the allograft. Empirical broad-spectrum antibiotics and percutaneous drainage were initiated, followed by graft nephrectomy due to persistent fever spikes. This case highlights the occurrence of EPN in a nonfunctional graft, even after cessation of immunosuppression. The presence of a nonfunctioning graft with impaired blood supply may have provided a nidus for infection. It underscores the importance of considering nephrectomy as a primary therapeutic approach in such cases. This case also emphasizes the need for heightened clinical suspicion and prompt intervention in transplant recipients with suspected EPN, even in the absence of a functioning graft.

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.

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.

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.

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