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.

Objective:To investigate the clinical and pathological features of pediatric NTRK-rearranged tumors.Methods:Four NTRK-rearranged soft tissue tumors and one renal tumor at Shanghai Children′s Medical Center, Shanghai Jiaotong University and Singapore KK Women′s and Children′s Hospital from January 2017 to September 2019 were identified. Pan-TRK immunohistochemistry, and the ALK and ETV6 gene break-apart fluorescence in situ hybridizations (FISH) were performed. NTRK gene rearrangement was detected using sequencing-based methods.Results:There were 3 males and 2 females in this study. The patients were between 3 months and 13 years of age. Histologically, the tumors were infiltrative spindle cell tumors with variable accompanying inflammatory cells. Immunohistochemistry showed positive reactivity for pan-TRK in all tumors, with nuclear staining for NTRK3 fusion, and cytoplasmic staining for NTRK1 fusion. The molecular testing revealed NTRK gene fusions (one each of TPM3-NTRK1, ETV6-NTRK3 and DCTN1-NTRK1, and two cases of LMNA-NTRK1). Two patients were receiving larotrectinib. The others were are well without disease, with follow-up durations of 9 to 29 months.Conclusions:NTRK-rearranged mesenchymal tumors from soft tissue sites and kidney are identified. A novel DCTN1-NTRK1 fusion is described. Pan-TRK immunohistochemistry is useful for diagnosis. NTRK-targeted therapy may be an option for unresectable, recurrent or metastatic cases.

Major depression is common in the primary care setting. In the final article of this series, we illustrate the approach to the management of depression in primary care. Psychotherapy has been shown to be as effective as antidepressants for mild to moderate major depression. The common myth that antidepressants are addictive should be addressed. Antidepressants should be started at a subtherapeutic dose to assess tolerability, then gradually increased until a minimally effective dose is achieved. Apart from pharmacotherapy and psychotherapy, management of depression should include managing stressors, engaging social and community support, dealing with stigma and discrimination, and managing concomitant comorbidities. A strong therapeutic relationship and empathic listening are important between the primary care physician and patient.

Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care.
Asia ; Depression ; diagnosis ; Hospitalization ; Humans ; Primary Health Care ; organization & administration ; Risk Assessment ; Risk Factors ; Self-Injurious Behavior ; Suicide ; prevention & control

Major depression is a common condition seen in the primary care setting, often presenting with somatic symptoms. It is potentially a chronic illness with considerable morbidity, and a high rate of relapse and recurrence. Major depression has a bidirectional relationship with chronic diseases, and a strong association with increased age and coexisting mental illnesses (e.g. anxiety disorders). Screening can be performed using clinical tools for major depression, such as the Patient Health Questionaire-2, Patient Health Questionaire-9 and Beck Depression Inventory, so that timely treatment can be initiated. An accurate diagnosis of major depression and its severity is essential for prompt treatment to reduce morbidity and mortality. This is the first of a series of articles that illustrates the approach to the management of major depression in primary care. Our next articles will cover suicide risk assessment in a depressed patient and outline the basic principles of management and treatment modalities.
Chronic Disease ; Depressive Disorder, Major ; complications ; diagnosis ; Disabled Persons ; Humans ; Mass Screening ; Primary Health Care ; methods ; Psychometrics ; Recurrence ; Risk Assessment ; Suicide ; prevention & control ; Surveys and Questionnaires

This case report highlights the challenges encountered in arriving at the diagnosis of a case with ‘behavioural variant Frontotemporal Dementia’. Methods: We report a case of ‘behavioural variant Frontotemporal Dementia’ diagnosed in a 49 year old Chinese lady. Results: This patient was misdiagnosed as Obsessive Compulsive Disorder (OCD), Parkinson Disease and Psychotic Disorder Not Otherwise Specified (NOS), deemed not responding to medications which was later complicated with Neuroleptic malignant syndrome (NMS). Her diagnosis was revised only after 2 years, after which her behavioural problems stabilised, bringing some relief to her family’s distress. Conclusion: Though not rare, ‘behavioural variant Frontotemporal dementia’ is often misdiagnosed and patients and their families suffer unnecessary suffering before the condition is finally diagnosed.

This case report highlights the clinical dilemmas encountered in deciding the diagnostic status of persons with unipolar depression who develop hypomania during antidepressant/ electroconvulsive therapy. Methods: We report a case of a 52 year-old Chinese lady, diagnosed with unipolar depression, which developed hypomania after she was started on T. Fluvoxamine 100mg daily and completed 8 sessions of Electroconvulsive therapy. Results: Her diagnosis was revised to Bipolar Disorder and she was treated with T. Sodium Valproate 400mg twice daily after which she improved. Conclusion: Treatment-emergent hypomania is likely a subtype of bipolar spectrum disorder and patients with Treatment – emergent Hypomania should be treated as Bipolar Disorder.

Objective To discuss the predictive value of magnetic resonance diffusion tensor imaging (MR-DTI) in motor function of patients with tumors in the motor areas of cerebral cortex after surgery on the hemiplegic limbs. Methods Twenty patients with tumors in the motor areas of cerebral cortex,admitted to our hospital from March 2009 to January 2011,were recruited in our study; all these patients underwent MR-DTI and motor function of the hemiplegic limbs was evaluated with Brunnstrom scale before and after the surgery.According to the results of DTI test,the injured corticospinal tract (CST) was divided into 4 grades:type Ⅰ (CST integrity),type Ⅱ (CST integrity with mild compression),type Ⅲ (CST partial disruption) and type Ⅳ (CST mostly/completely disruption).The correlations between the CST damaged level and motor function of the hemiplegic limbs before and after surgery were analyzed. Results FA values ofipsilateral brain parenchyma (0.387±0.012) were statistically lower than those of the contralateral normal brain tissue (0.498±0.015,P＜0.05).No significant differences on CST damaged level and motor function of the hemiplegic limbs were noted between before and after surgery (P＞0.05).CST damaged level and motor function of the hemiplegic limbs had a negative correlation (P＜0.05).Motor function of the hemiplegic limbs and CST damaged level before the surgery and 6 months after the surgery had a significantly negative correlation (before the surgery:r=-0.901,P=0.000; after the surgery:r=-0.912,P=0.000). Conclusion DTI can display damaged level of the tumors in the motor area of cerebral cortex and reflect the motor function of the hemiplegic limbs after the surgery.

Thorough excavation and artful utilization of various kinds concrete and invisible learning resources contribute to the cultivation of excellent postgraduates.In postgraduate education of anesthesiology Xuzhou Medical College utilizes time,network,technique platform,research outcome,self-potentiality and clinical patients resources,which produces an active effect and has important instructional significance.