Alexandra Hospital (AH) is a hospital located in Queenstown, Singapore that provides acute and community care under the National University Health System.The hospital's colonial-style buildings were constructed in the late 1930s on 110,000 square metres (1,200,000 sq ft) of land. Under British rule, it was known as the British Military Hospital and was the site of a massacre in February 1942 by the Japanese as they took over Singapore in World War II. After the liberation of Singapore, the hospital was returned to its British administration, before being handed over to the Singapore government on 11 September 1971. Since then, it has gone through four changes of administration, most recently on 1 June 2018, to a team of long-term stewards under the National University Health System..
To identify ethnic differences among women with gestational diabetes mellitus (GDM) in a multiethnic cohort. This observational study included pregnant women with GDM (IADPSG criteria) attending a tertiary centre between January 2020-December 2023, classified according to their ethnic group as White, Black, Asian, or Other. Multivariable logistic and linear regression analyses were performed. A total of 633 women (513 White, 64 Black, 32 Asian, and 24 Other/Middle Eastern) were considered eligible for inclusion. Asian women had higher HbA1c than White, Black, and Other (5.5
The phase 1/2 BelaRd study (NCT04808037) evaluated the efficacy and safety of belantamab mafodotin (belamaf) combined with lenalidomide and dexamethasone in unfit and frail transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). Part 1 (n=36) established a recommended belamaf phase 2 dose (RP2D) of 1.9mg/kg every 8 weeks (median follow-up: 39.3 months). In Part 2, 30 patients were randomized 1:1 in Group A (n=15), where belamaf dosing was guided by ophthalmologist-assessed Ocular Adverse Events (OAEs), whereas in Group B (n=15) belamaf dosing was based on hematologist-led Vision-Related Anamnestic (VRA) tool and ophthalmologist-assessed Gr≥3 OAEs. Among the RP2D patients (n=42), ORR was 97.6%, median PFS/OS have not been reached yet and the 18-month PFS and TTP rates were 83.0% and 97.2%, respectively. Ocular toxicities were similar between assessments by hematologists and ophthalmologists and no ophthalmologist withholding of a hematologist-led dosing occurred. Less than 1% of patients stopped driving/reading because of OAEs. Median time to belamaf re-infusion was 13 weeks. Overall, BelaRd is an effective regimen for transplant-ineligible NDMM patients and warrants a phase 3 study in this setting. OAEs’ impact to quality of life appears limited and implementation of the hematologist-led VRA tool may eventually reduce the necessity for ophthalmologist assessments.
Background and Objectives: Dysphagia is a frequently reported symptom among patients undergoing thyroidectomy, yet its incidence, underlying mechanisms, and temporal progression remain insufficiently clarified. The aim of the present systematic review was to synthesize the existing literature on the occurrence and evolution of swallowing disorders following thyroidectomy, without restriction regarding the extent of surgery, surgical approach, indication, or concomitant complications. Materials and Methods: A systematic literature review, according to PRISMA guidelines, was conducted in the electronic databases PubMed, MEDLINE, and SciELO, using the terms “dysphagia”, “deglutition disorder”, “swallowing disorder”, “thyroid surgery” and “thyroidectomy” in the appropriate combinations. A narrative synthesis of the results followed. Results: 31 eligible studies encompassing a total of 64,123 patients were included in the systematic review and analyzed concerning their type, sample, follow-up and results regarding thyroidectomy-related dysphagia. Data regarding pre- and postoperative dysphagia were extracted and compared. Both subjective patient-reported outcomes and objective assessments were considered. Reported preoperative dysphagia incidence varied widely (3.3–77.8%), with a pooled mean of approximately 25%. Dysphagia rates increased significantly within the first 1–2 postoperative weeks but generally declined to near preoperative levels by 2–3 months, with further improvement observed up to 4–6 months. Several factors were associated with persistent or more severe dysphagia, including the extent of surgery, older age, surgical techniques, central or lateral lymph node dissection, and the need for adjuvant therapies such as radioactive iodine or external beam radiotherapy. Conclusions: Dysphagia after thyroidectomy appears as a common but typically transient symptom, with the highest incidence occurring in the immediate postoperative period and a progressive return to baseline within three months. Although most patients experience improvement, a subset may report persistent symptoms with measurable impact on quality of life. Methodological heterogeneity, variability in symptom assessment tools, and limited long-term follow-up restrict the strength of available evidence. Standardization of outcome measures and longer follow-up periods are needed to achieve more reliable and generalizable conclusions.
BACKGROUND:Heart failure-related mortality in older patients has increased. Guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF) remains insufficient in this population. This study assessed the survival benefit of GDMT in elderly patients aged ≥65 years old with HFrEF. METHODS:MEDLINE, EMBASE and Cochrane Library were searched from inception to 5 February 2025. Inclusion criteria were age ≥65 years old with HFrEF, GDMT vs no GDMT and reported survival data. Pooled prevalence, HR and risk ratio (RR) with 95% CI were analysed. Heterogeneity was further explored through subgroup analyses. We evaluated potential small-study effects using Begg's rank correlation test, Egger's regression test, funnel plot inspection and trim-and-fill analysis. Publication bias was analysed visually using a funnel plot. RESULTS:34 studies with 92 916 patients from 1994 to 2024 were included. The GDMT group received three of the four main drug classes in three studies, two drug classes in four studies and at least one class in the remaining studies. There were no reported data on the survival benefits of older patients receiving four classes of GDMT. Frail older patients were less likely to receive GDMT (RR 0.63 (0.45-0.89), I2 50%, p=0.009). There was a survival benefit of GDMT in older patients with left ventricular (LV) systolic dysfunction (HR 0.69 (0.64-0.74) p<0.001, Tau2 0.03, I2 71%). Older patients receiving beta-blockers were more likely to develop bradycardia (RR 3.98 (2.72-5.82), p<0.001, I2 0%). There was no difference in hypotension, acute renal impairment and hypoglycaemia between the GDMT and control group. CONCLUSIONS:The use of GDMT in older patients with LV systolic dysfunction was associated with a survival benefit. However, the presence of frailty may limit the successful implementation and tolerability of these therapies. High-quality studies are urgently needed to guide the development of novel strategies aimed at optimising the management of older, frail patients with LV systolic function.
BACKGROUND:Transdermal estradiol (tE2) is an alternative to luteinizing hormone-releasing hormone (LHRH) agonists as androgen-deprivation therapy in patients with prostate cancer. With tE2, testosterone is suppressed, and the side effects of estrogen depletion due to LHRH agonists and the thromboembolic side effects of oral estrogen are mitigated. METHODS:In this phase 3, noninferiority, randomized trial, we assigned men with locally advanced (M0 and N0 or N+) prostate cancer to receive tE2 patches (100 μg of estradiol every 24 hours) or LHRH agonists. The primary outcome was 3-year metastasis-free survival. The noninferiority margin was 4 percentage points; this corresponded to a target hazard ratio of 1.31, as derived from the observed 3-year metastasis-free survival in the LHRH agonist group. Secondary outcomes included castrate levels of testosterone (<1.7 nmol per liter), overall survival, and safety. RESULTS:Between 2007 and 2022, we recruited 1360 patients at 75 U.K. centers. The median age of the patients was 72 years (interquartile range, 68 to 77); 85% had a T3 tumor stage and 65% an N0 nodal stage. Observed 3-year metastasis-free survival was 87.1% with tE2 and 85.9% with LHRH agonists (hazard ratio for confirmed metastasis or death, 0.96; upper limit of the one-sided 95% confidence interval [CI], 1.11, which met the criterion for noninferiority). Among patients continuing the assigned treatment, castrate levels of testosterone were sustained during the first year after randomization in 85% in each group. Observed 5-year overall survival was 81.1% with tE2 and 79.2% with LHRH agonists (hazard ratio for death, 0.90; 95% CI, 0.75 to 1.07). During treatment, hot flashes occurred in 44% of the patients who received tE2 and 89% of those who received LHRH agonists (grade ≥2 events, 8% and 37%, respectively) and gynecomastia in 85% and 42% (grade ≥2 events, 37% and 9%). CONCLUSIONS:In patients with locally advanced prostate cancer, tE2 was noninferior to LHRH agonists for 3-year metastasis-free survival, with a lower incidence of hot flashes but a higher incidence of gynecomastia. (Funded by Cancer Research U.K. and the U.K. Research Institute Medical Research Council; PATCH ClinicalTrials.gov number, NCT00303784; STAMPEDE-1 ClinicalTrials.gov number, NCT00268476.).
