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Studies have shown that medical therapy with renin-angiotensin blockers (RABs) may benefit patients with aortic stenosis (AS). However, its use and efficacy remains controversial, including in patients with low flow (LF) with preserved left ventricular ejection fraction (LVEF). We examined the effects of RAB use on LV remodeling in patients with severe AS with preserved LVEF, analyzing the differential effects in patients with LF compared with normal flow (NF). This is a retrospective study of 428 consecutive subjects from 2005 to 2014 with echocardiographic diagnosis of severe AS and preserved LVEF. Clinical and echocardiographic parameters were systematically collected and analyzed. Two hundred forty-two (57%) patients had LF. Sixty-four LF patients (26%) were treated with RAB. Patients on RAB treatment had a higher incidence of hyperlipidemia (69% vs 44%) and diabetes mellitus (53% vs 34%). Severity of AS in terms of valve area, transvalvular mean pressure gradient, and aortic valve resistance were similar between both groups as was the degree of LV diastolic function. The RAB group demonstrated significantly lower LV mass index with a correspondingly lower incidence of concentric LV hypertrophy. Regardless of the duration of RAB therapy, patients had increased odds of having a preserved LV mass index compared with those without RAB therapy. In conclusion, RAB therapy may be associated with less LV pathological remodeling and have a role in delaying patients from developing cardiovascular complications of AS.

Air pollution has emerged as one of the world’s largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from “slash-and-burn” farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.

Background Bloodstream infections with the non-fermenting Gram-negative organisms Stenotrophomonas maltophilia , Elizabethkingia spp. or Chryseobacterium spp. are observed in nosocomial settings. Comparative description of their clinical presentation, microbiological characteristics, treatment options and outcomes remain to be investigated. Methods We performed a retrospective single-centre analysis of bloodstream infections with the abovementioned three organisms from 1 Jan 2012 to 30 Jun 2024. Results A total of 349 distinct encounters (from 322 unique patients) were identified with bacteraemia. Stenotrophomonas maltophilia was the commonest (197/349, 56.4%), followed by Elizabethkingia spp. (127/349, 36.4%) and Chryseobacterium spp. (25/349, 7.2%). Prior carbapenem exposure was observed in 59.9% of cases. The majority were related to central lines (58.2%). Most cases were nosocomial in onset (82.5%), and a third were from the intensive care unit (32.1%). A significant proportion of our Stenotrophomonas maltophilia (32.8%) and Chryseobacterium spp. (22.7%) isolates were resistant to levofloxacin, while a majority of the organisms retained susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX) and minocycline. Dual antibiotics were used in a minority of encounters (23/349, 6.6%). Mortality was high across infections with the three organisms, but highest amongst those with Stenotrophomonas maltophilia bacteraemia (41.6%), followed by Elizabethkingia spp. (29.9%) and Chryseobacterium spp. (20.0%). Conclusions Stenotrophomonas , Elizabethkingia or Chryseobacterium spp bacteraemia was associated with significant mortality. Most cases were nosocomial in acquisition, with prior carbapenem exposure or indwelling central catheters. Fluoroquinolone resistance was common for Stenotrophomonas maltophilia and Chryseobacterium spp., but less prevalent in Elizabethkingia spp., while TMP-SMX and minocycline retained susceptibility. Monitoring these trends would be critical in guiding empiric therapy for these organisms.

Background Hospital discharge summaries are important tools for communication between healthcare professionals. They convey events that occurred during hospitalisation, as well as the subsequent follow-up plans. Artificial intelligence models can be used to summarise information succinctly from large amounts of raw data input. We explored ChatGPT’s ability to generate effective discharge summaries to assist junior doctors in writing these documents. Methods We constructed three hypothetical scenarios of inpatient encounters, with three different outcomes: i) discharge home with follow-up with a general practitioner, ii) discharge to a stepdown facility for further physical rehabilitation, iii) transfer to a tertiary centre for more advanced care. ChatGPT was used to generate discharge summaries for these three scenarios. The quality of the responses provided were evaluated. Results ChatGPT was able to provide an effective framework for discharge summaries. It processed large volumes of text, summarising pertinent issues and communicating follow-up plans clearly. It is a potentially useful tool for documentation for clinicians. However, pitfalls remain, where close reading is still required to ensure the veracity of the output provided. Conclusions ChatGPT was able to synthesize patient information from a long prosaic format to provide a structured discharge summary. Future prospective study could evaluate if this framework provided by ChatGPT is helpful to aid junior doctors in learning about and writing discharge summaries more efficiently.

The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.

Surgical weight loss (SWL) improves myocardial mechanics as measured by speckle-tracking imaging. However non-surgical versus SWL and the subsequent impact on myocardial function in overweight Asian subjects has not been evaluated. 66 patients underwent a 16-week lifestyle intervention (LSI) programme consisting of dietary interventions and exercise prescription. Echocardiography with speckle tracking was performed at baseline and post-intervention. This group was compared against a group of 12 subjects who had undergone bariatric surgery and a control group of 10 lean Asian subjects. A generalised structural equation model (gSEM) was constructed to ascertain the effect of modality of weight loss on strain parameters, adjusting for BMI. Participants attained significant weight loss after LSI (28.2 ± 2.66 kg/m 2 vs. 25.8 ± 2.84 kg/m 2 , p  = 0.001). This was associated with a non-significant trend towards improvement in strain parameters. SWL participants had significant improvement in the left ventricular global longitudinal strain (− 20.52 ± 3.34 vs. − 16.68 ± 4.15, p  < 0.01) and left atrium reservoir strain (44.32 ± 14.23 vs. 34.3 ± 19.31, p  = 0.02). Lean subjects had significantly higher strain parameters than overweight subjects. The gSEM model demonstrated surgical modality of weight loss as an independent predictor of improvement in strain parameters. Significant improvement in echocardiographic parameters were documented in patients who underwent bariatric surgery.

The epidemiology of different respiratory viral infections is believed to be affected by prior viral infections in addition to seasonal effects. This PROSPERO-registered systematic review identified 7388 studies, of which six met our criteria to answer the question specifically. The purpose of this review was to compare the prevalence of sequential viral infections in those with previously documented positive versus negative swabs. The pooled prevalence of sequential viral infections over varying periods from 30–1000 days of follow-up was higher following a negative respiratory viral swab at 0.15 than following a positive swab at 0.08, indicating the potential protective effects of prior respiratory viral infections. However, significant heterogeneity and publication biases were noted. There is some evidence, albeit of low quality, of a possible protective effect of an initial viral infection against subsequent infections by a different virus, which is possibly due to broad, nonspecific innate immunity. Future prospective studies are needed to validate our findings.

Background Community-acquired respiratory infections are a leading cause of illness and death globally. The aetiologies of community-acquired pneumonia remain poorly defined. The RESPIRO study is an ongoing prospective observational cohort study aimed at developing pragmatic logistical and analytic platforms to accurately identify the causes of moderate-to-severe community-acquired pneumonia in adults and understand the factors influencing disease caused by individual pathogens. The study is currently underway in Singapore and has plans for expansion into the broader region. Methods RESPIRO is being conducted at three major tertiary hospitals in Singapore. Adults hospitalised with acute community-acquired pneumonia or lower respiratory tract infections, based on established clinical, laboratory and radiological criteria, will be recruited. Over the course of the illness, clinical data and biological samples will be collected longitudinally and stored in a biorepository for future analysis. Discussion The RESPIRO study is designed to be hypothesis generating, complementary to and easily integrated with other research projects and clinical trials. The detailed clinical database and biorepository will yield insights into the epidemiology and outcomes of community-acquired lower respiratory tract infections in Singapore and the surrounding region and offers the opportunity to deeply characterise the microbiology and immunopathology of community-acquired pneumonia.

Dengue fever places a substantial burden on healthcare systems in endemic areas. Traditional inpatient management places strain on hospital capacity during seasonal surges. This study evaluates an expanded nurse-led Dengue Outpatient Management (DOM) program at a tertiary centre in Singapore. A prospective observational study was conducted from January 2023 to August 2024. DOM inclusion criteria were broadened to include older adults and patients with comorbidities, if clinically stable. Patients received physician evaluation, a nurse-led symptom-based assessment and vital signs monitoring. There were 167 patients managed in DOM in the study period. The model saved an average of 3.3 bed-days per patient, amounting to approximately 231 bed-days saved in 2023. This expanded nurse-led outpatient dengue management model demonstrates safety, feasibility, and resource efficiency. With structured patient selection and monitoring protocols, DOM significantly reduces hospital bed occupancy while offering a scalable solution for dengue-endemic regions.

Background Several specific risk scores for Coronavirus disease 2019 (COVID-19) involving clinical and biochemical parameters have been developed from higher-risk patients, in addition to validating well-established pneumonia risk scores. We compared multiple risk scores in predicting more severe disease in a cohort of young patients with few comorbid illnesses. Accurately predicting the progression of COVID-19 may guide triage and therapy. Methods We retrospectively examined 554 hospitalised COVID-19 patients in Singapore. The CURB-65 score, Pneumonia Severity Index (PSI), ISARIC 4C prognostic score (4C), CHA 2 DS 2 -VASc score, COVID-GRAM Critical Illness risk score (COVID-GRAM), Veterans Health Administration COVID-19 index for COVID-19 Mortality (VACO), and the “rule-of-6” score were compared for three performance characteristics: the need for supplemental oxygen, intensive care admission and mechanical ventilation. Results A majority of patients were young (≤ 40 years, n = 372, 67.1%). 57 (10.3%) developed pneumonia, with 16 (2.9% of study population) requiring supplemental oxygen. 19 patients (3.4%) required intensive care and 2 patients (0.5%) died. The clinical risk scores predicted patients who required supplemental oxygenation and intensive care well. Adding the presence of fever to the CHA 2 DS 2 -VASc score and 4C score improved the ability to predict patients who required supplemental oxygen (c-statistic 0.81, 95% CI 0.68–0.94; and 0.84, 95% CI 0.75–0.94 respectively). Conclusion Simple scores including well established pneumonia risk scores can help predict progression of COVID-19. Adding the presence of fever as a parameter to the CHA 2 DS 2 -VASc or the 4C score improved the performance of these scores in a young population with few comorbidities.