Mount Elizabeth Hospital

IntroductionRespiratory syncytial virus (RSV) is a public health concern, particularly among neonates/young infants, in individuals with chronic medical conditions, and for older adults. In contrast to children, limits in surveillance and substantial underreporting obscure the full impact of RSV infections on adults. A structured process for adult RSV disease decision-making can guide public health epidemiology and planning.MethodsTwelve experts from six Asian countries (Indonesia, Malaysia, Philippines, Singapore, Taiwan, and Thailand) participated in a modified Delphi consensus study to guide surveillance, diagnosis, and impact of RSV in adults in Asia. The expert recommendations could be organized into four themes: epidemiology and surveillance, diagnosis, high-risk groups, and healthcare utilization.ResultsThe expert panel recommended strengthening RSV disease monitoring through integration within current influenza and COVID-19 surveillance systems. Furthermore, to standardize RSV case definitions, it was recommended that the RSV respiratory infection clinical criteria exclude fever. Although rapid antigen tests are employed as standard of care, polymerase chain reaction (PCR) testing should be utilized whenever feasible. Along with year-round testing in Asia to establish incidence, an adjustment factor of at least 2.2-fold was recommended to address the underestimation of RSV-related hospitalization rates based on single-specimen PCR testing. For all adults aged ≥ 75 as well as for those adults aged ≥ 60 with comorbid or immunocompromising conditions, or those residing in long-term care facilities, the experts recommended universal RSV vaccination (contingent upon vaccine licensure), and cost-effectiveness analyses should be used to inform region-specific policy decisions.ConclusionsPriority actions proposed for adult RSV infection and disease include streamlining diagnostic testing processes, launching disease awareness campaigns, and engaging public health authorities to advance prevention programs in coordinated efforts with policymakers and payers.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-025-00321-2.

Colorectal cancer(CRC) remains a significant global health challenge,ranking third in incidence and second in mortality among cancers worldwide.This review addresses the complex landscape of CRC, focusing on incidence,mortality trends, preventive strategies, and the evolving therapeuticapproaches, particularly highlighting the role of platinum-based drugslike oxaliplatin (OXP). It also underscores the increasing burdenof CRC, with factors such as westernized diets, aging populations,and genetic predispositions contributing to its prevalence. Therapeutically,early detection greatly enhances survival rates, emphasizing the importanceof regular colonoscopies and stool tests. For advanced CRC, chemotherapyremains pivotal, with OXP as a cornerstone treatment despite its associatedchemotherapy-induced peripheral neurotoxicity (CIPN). The review exploresinnovative strategies to overcome challenges related to chemotherapy,such as drug resistance and side effects, highlighting recent developmentsin the field, such as Pt­(IV) prodrugs and immunotherapeutic approachesto enhance efficacy while minimizing toxicity. Additionally, thismanuscript examines experimental models for drug screening, emphasizingthe role of murine models and advanced 3D in vitro systems in CRC research. Overall, the review advocates for a comprehensiveapproach, integrating prevention, early detection, and personalizedtreatments to alleviate the global burden of CRC.

Chronic low back pain (CLBP) is a common health problem and a major cause of patient disability worldwide. The number of people with low back pain (LBP) and their years lived with disability are increasing despite technological advances. There remains a definitive gap between the evidence for effective management of CLBP and current practices. Degenerative disc disease is a major contributor to chronic back pain and also leads to activity limitation and work absence. CLBP is a complex, multidimensional condition yet to be fully understood. In many patients with LBP, magnetic resonance imaging scans show no obvious neural compression. Sensitized nociceptors within the posterior annulus have long been identified as a source of discogenic pain. However, the recent literature also supports the nociceptive capacity of the basiverterbal nerve, which carries vertebrogenic pain from the endplates. In degenerative disc disease, there is pathological neurotization of the sinuvertebral and basivertebral nerves due to stimulation of inflammatory pathways resulting from endplate damage. Radiofrequency ablation of the sinuvertebral nerve and basivertebral nerve provides effective and well-sustained pain relief to patients with LBP. The popularity of endoscopic spine surgery is increasing because of its magnified and clear visualization due to constant water irrigation. The objective of this manuscript is to provide a comprehensive review of discogenic pain, vertebrogenic pain, pathoanatomy, pathophysiology, and the pain generation pathways involved in degenerative disc disease and the role of endoscopic radiofrequency ablation in sinuvertebral and basivertebral neuropathy.

Abstract Background Suboptimal control of inflammatory bowel disease (IBD) can lead to clinical relapse and disease progression. The STRIDE-II consensus in 2021 encompasses recommendations for short term, intermediate, and long-term targets involving clinical, biochemical and endoscopic remission respectively in a ‘Treat to Target’ strategy to improve IBD-related clinical outcome . We aim to assess the rates of biochemical and endoscopy assessments in our cohort. Methods This was a multi-center retrospective study involving four hospitals in Singapore. Between 1 January 2021 to 1 June 2022, we included patients who were initiated on or had a change in advanced therapies and followed up for up to 18 months. Clinical remission was defined as per STRIDE-II treatment targets for Patient Reported Outcomes 2. Biochemical remission defined as CRP <5mg/L or fecal calprotectin (FC) levels <250μg/g. Complications were defined as IBD-related hospitalisation or surgery. Results A total of 107 patients were included. The median age was 37 years, 75 (69.4%) were male and 69 (64.4%) had Crohn’s disease (CD). Seventy-three (68.2%) patients had a history of steroid use and 62 (57.9%) were on immunomodulators (Table 1). Eighty-seven (81.3%) were biologics naïve. Ninety-one (85.1%) required new initiation and 16 (14.9%) required a switch of advanced therapy. Eighty-three (76.6%) were started/switched to anti-TNF. During study period, CRP, FC and endoscopic evaluation was done in 64 (59.8%), 79 (73.9%) and 67 (62.6%) patients respectively. By end of follow up, 100 (93.4%) patients had at least one assessment done. The median time to CRP evaluation was 51 (24-126) days, 92 (49-197) days for FC, 363 days (218-463) for endoscopy. Eighty-one patients (75.7%) were in clinical remission at the end of follow up. Assessment of CRP within 90 days of treatment change was associated with CRP <5mg/L (p=0.037) but not clinical remission or complication rates. Assessment of FC within 90 days was also associated with clinical remission (p=0.02) only. Sub-analysis of UC patients demonstrated association of timely CRP and FC assessment with biochemical remission (p=0.02) and reduction in complications (p=0.05). Sub-analysis of CD patients did not show any significant associations. Conclusion Around 60% of patients had biochemical and endoscopic assessment within the first 18 months from change in therapy. Timely biochemical assessments within 90 days was associated with clinical remission.

Introduction: To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum®) and prostatic urethral lift (Urolift®). To identify predictive factors for treatment failures in both treatments. Materials & Methods: Prospective clinico-epidemiological data of patients who underwent Urolift® or Rezum® in a single institution for benign prostatic hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. Results: From October 2019 to October 2022, 86 patients underwent Rezum®, and 62 patients underwent Urolift®. Rezum® involved a longer indwelling catheter duration (12.38 ± 5.548 vs 1.39 ± 3.010 days, p < 0.001) compared with Urolift®. Rezum® was associated with more complications compared with Urolift® (36 [41.9%] vs 10 [16.1%] cases, p < 0.001). Rezum® had more cases of hematuria (17 [19.8%] vs 4 [6.5%] cases [p = 0.022]) and urinary tract infections (27 [31.4%] vs 3 [4.8%] cases, p < 0.001) compared with Urolift®. There were no significant differences in Clavien-Dindo Grade 3-5 complications between the interventions. Urolift® was associated with higher reoperation rates (5 [8.1%] vs 0 [0%] cases, p = 0.010) compared Rezum®. Rezum® had higher anticholinergic usage rates compared with Urolift® post-operation (22 [25.6%] vs 8 [12.9%] cases, p = 0.024). Both interventions showed improvement in the International Prostate Symptom Score (IPSS), quality of life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, preoperation IPSS ≥16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. Conclusions: There was no difference in clinical outcomes of patients who underwent Rezum® and Urolift®. However, patients who had undergone Rezum® faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS ≥16 would unlikely benefit from either intervention.

Pain is common in older adults and managing pain in this population can be challenging owing to altered pharmacokinetics, multimorbidity, polypharmacy, cognitive impairment, and physical frailty. A fixed-dose combination (FDC) analgesic contains two or more pharmaceutical ingredients in a single pill and may offer more benefits when compared with loose-dose formulations. The benefits include reduced pill burden and better adherence, a broader analgesic spectrum well-suited to multimechanistic pain conditions and more predictable pharmacokinetic and pharmacodynamic properties. These advantages may outweigh disadvantages such as reduced flexibility in dose adjustment. Most of the commonly used FDC analgesics are made up of a combination of paracetamol, muscle relaxant, nonsteroidal anti-inflammatory drug or opioid. They have been shown to have better efficacy and similar safety profiles compared with individual drugs. Adverse effects from the use of FDC analgesics in older patients were comparable with that observed in younger populations. With proper patient selection and continuous surveillance, FDC analgesics will likely benefit older adults by simplifying dosing regimen and improving compliance.

Chronic Obstructive Pulmonary Disease (COPD) is a medical condition with a long and varied history. Centuries prior to the establishment of the term COPD in the late 1950s, the sub-components of ‘pulmonary emphysema’ and ‘chronic bronchitis’ have already been described in medical literature. The term COPD has been increasingly accepted and used by both healthcare institutions and the wider public since its inception, especially when compared to the usage of one of its primary components, ‘emphysema’. As such the recently proposed and adopted changes to the definition, nomenclature and taxonomy (classification) of COPD by the Global Strategy for Prevention, Diagnosis and Management of COPD is of prime interest as they denote significant amendments to the decades-long understanding of COPD. This book chapter summarizes the rationale behind the recent revisions of the basic conceptions of COPD and discusses the implications of these contemporizing changes for clinicians and researchers.