Purpose: To evaluate whether using flexible and navigable suction ureteral access sheath can obviate insertion of double J stent and establish the safety of overnight ureteric catheter placement as alternative following flexible ureteroscopy for kidney stones. Materials and Methods: Five hundred forty adults were prospectively enrolled across 25 centers (from April 2023 to January 2024). Patients were divided into group 1 (overnight ureteric catheter), and group 2 (double J stent). Surgeons could choose either modality as per their discretion. One-to-one propensity score-matching for age, sex, pre-stenting, Hounsfield units, stone volume and location was performed. Thirty-day computed tomography scan was done to estimate stone-free status. Results: After matching, 120 patients were included in each group. Group 1 had significantly shorter lasing, ureteroscopy, surgical time. Median day 1 loin pain score was similar (1 [1, 2] in both groups). Median postoperative stay was shorter in group 1 (0 days [0, 1] vs. 1 day [0, 2], p<0.001). One patient in group 2 required a blood transfusion. Incidence of fever was similar (5.0% vs. 0.8%).Loin/abdominal pain requiring medication occurred in one patient in group 2. Stent-related symptoms occurred in 2 patients in group 1. Three patients (2.5%) in group 1 and 2 patients (1.7%) in group 2 required readmission. Thirty-day stone-free status was higher in group 1 patients (79.2% vs. 56.7%). Conclusions In selected patients after thorough inspection to ensure no injury or residual fragments remain, placing an overnight ureteric catheter can be a safe alternative to a double J stent.

With the advent of artificial intelligence (AI), machines are increasingly being used to complete complicated tasks, yielding remarkable results. Machine learning (ML) is the most relevant subset of AI in medicine, which will soon become an integral part of our everyday practice. Therefore, physicians should acquaint themselves with ML and AI, and their role as an enabler rather than a competitor. Herein, we introduce basic concepts and terms used in AI and ML, and aim to demystify commonly used AI/ML algorithms such as learning methods including neural networks/deep learning, decision tree and application domain in computer vision and natural language processing through specific examples. We discuss how machines are already being used to augment the physician's decision-making process, and postulate the potential impact of ML on medical practice and medical research based on its current capabilities and known limitations. Moreover, we discuss the feasibility of full machine autonomy in medicine.
Humans ; Artificial Intelligence ; Machine Learning ; Algorithms ; Neural Networks, Computer ; Medicine

Humans ; Urology ; Pandemics ; COVID-19/epidemiology* ; SARS-CoV-2

Problem: Emergency medical teams (EMTs) deployed to mass casualty incidents (MCIs) are required to work outside their usual settings and according to different principles, which may affect their performance and the survival of casualties. Prior to 2013, training offered to domestic EMTs was limited to ad hoc and infrequent simulation exercises. Context: Domestic EMTs are activated from public tertiary hospitals to provide pre-hospital medical support to the Singapore Civil Defence Force and establish a first-aid post (FAP) for triaging, stabilizing and treating casualties. These casualties are then evacuated to public hospitals for further management. Action: Recognizing the need for a more systematic approach to the training of domestic EMTs, the Disaster Medical Responder’s Course (the Course) was developed as a multi-institutional collaboration to equip EMT members attending a MCI with the necessary skills to perform effectively at the FAP. Outcome: The Course was first run in 2013 and is usually offered six to eight times a year. Since June 2019, a total of 414 health-care staff and allied health professionals have participated. There have been numerous revisions of the course content and delivery to reflect the latest concepts in operations and global best practice, as well as developments in educational methodologies. Discussion: Preparedness is crucial to optimize the survival and outcomes of casualties. The Course provides standardized training of domestic EMTs and plays a pivotal role in ensuring operational readiness for MCIs in Singapore.

Introduction: Sex shapes immune response with possible consequence on tumor immune escape. Acute lymphoblastic leukemia (ALL) predominates in males while ovarian cancer (OC) occurs in females. NK cells essential for tumor killing may have male preponderance. Association of sex, NK cell activity and malignancies is unclear. We hypothesize that sex differentially affects KIR expressions in sex-biased cancers. Method: Expression of inhibitory (KIR2DL1-5 and KIR3DL1-3) and activating (KIR2DS1-2 and 4-5 and KIR3DS1) genes in B-, T-cell ALL, OC and normal controls were determined by reverse-transcription polymerase-chain-reaction. Result: All normal males (but not females) expressed the framework genes and generally maintained haplotype A, except KIR3DL1. Normal females expressed more activating KIRs. Frequencies of KIR2DL1, 2DL4 and 2DS2 were significantly reduced among ovarian cancer patients. Sex difference in frequencies of KIR expression was not detected in ALL as majority were undetectable except framework gene KIR3DL2, was more frequent among T-ALL. Conclusion: Cancers may be associated with reduced KIR expression and influence of sex requires investigation.

Humans ; Infant ; Prevalence ; Risk Factors ; Vitamin D Deficiency/epidemiology*

INTRODUCTION: Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS. METHODS: Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled. Factors associated with both mortality and differences between high (<40mL/cm H RESULTS: A total of 102 patients with COVID-19 who required invasive mechanical ventilation were analysed; 15 (14.7%) did not survive. Non-survivors were older (median 70 years, interquartile range [IQR] 67-75 versus median 61 years, IQR 52-66; CONCLUSION COVID-19 ARDS patients with higher compliance on the day of intubation and a longitudinal decrease over time had a higher risk of death.
COVID-19 ; Humans ; Lung Compliance ; Phenotype ; Respiratory Distress Syndrome/therapy* ; SARS-CoV-2

The last review on epilepsy in Southeast Asian (SEA) countries was reported in 1997. This review aimed to update the understanding of epilepsy management in this region over the past 23 years. There has been significant increase in the epidemiological studies which reported a prevalence of 4.3-7.7 per 1,000 populations in this region. Reversible aetiologies of epilepsy such as head injury, birth trauma, cerebrovascular disease, and intracranial infections (neurocysticercosis or meningoencephalitis) are still prevalent, with a surge in autoimmune encephalitis. There was a surge in genetic studies which suggest ethnic variation. Treatment gap is still high especially in the rural and less developed areas, and the availability and affordability of newer anti-epileptic drugs (AEDs) is still a major challenge in SEA. Alternative medicine is a common practice but varies among different ethnic groups. AEDs hypersensitivity especially on the association between HLA-B*1502 and carbamazepine-related severe cutaneous reaction had been extensively studied and proven in nearly all SEA countries. However, HLA-B*1502 screening is not widely available in SEA and the cost-effectiveness of the screening is questionable. Stigma and its psychosocial consequences are still a major concern despite enormous efforts to study the public attitudes towards epilepsy and change of epilepsy naming in a few countries. The number and complexity of epilepsy surgery are progressing, but it is still under-utilized in many SEA countries, related to cost, cultural perception and lack of facilities. More resources should also be channelled in training adequate number of epileptologists who can spearhead epilepsy care around the region, as well as public education and research in epilepsy. In conclusion, there is an increase in epilepsy research in this region, gradual increase in trained neurologists and facilities, and efforts to reduce the knowledge and treatment gap, but the epilepsy management gap is still a battle to fight.