Singapore, located strategically at the meeting point of the Malacca Strait and the South China Sea, has established itself as a global financial and economic hub. Despite its small geographical size, Singapore is home to over 5 million people from diverse cultural backgrounds. The city-state's medical education landscape has evolved significantly over the past century. Originally, Singapore had only one undergraduate medical school, the NUS Yong Loo Lin School of Medicine, established in 1905. Over time, this institution has grown into Singapore's largest and oldest medical school. NUS Medicine's vision centres on developing highly competent, values-driven, and inspired healthcare professionals to transform the practice of medicine and improve health worldwide. A curriculum overhaul in 2020 introduced new educational components to prepare future healthcare professionals for the challenges of Singapore's resilient healthcare system. This includes proficiency in integrated care, collaboration across disciplines, and leveraging AI and data science in clinical decision-making. The introduction of a common curriculum in August 2023 for Medicine, Nursing, Dentistry, and Pharmacy undergraduates further aligns with Singapore's 'Healthier SG' vision, ensuring that graduates are well-equipped to meet the evolving needs of the healthcare landscape. The common curriculum aims to address professional hierarchies and foster interprofessional collaboration among students from diverse academic backgrounds. By promoting frequent interaction and a team-oriented mindset, the curriculum seeks to instil a collective approach to healthcare, emphasising the importance of interprofessional practice in achieving the broader goals of healthcare delivery. This paper describes the reforms that took place and how the challenges were mitigated in a research-intensive top-ranked academic medical institution. This strategic alignment of medical education with national healthcare priorities underscores NUS Medicine's commitment to transforming medical practice and improving health outcomes in Singapore and beyond.
Stroke prevalence data among mixed Asian populations are lacking. Prevalence rates of stroke were studied among Singaporeans aged > or =50 years of Chinese, Malay, and Indian origin.
OATP1B1 is a liver-specific transporter that mediates the uptake of various endogenous and exogenous compounds including many clinically used drugs from blood into hepatocytes. This study aims to identify genetic variations of SLCO1B1 gene in three distinct ethnic groups of the Singaporean population (n=288). The coding region of the gene encoding the transporter protein was screened for genetic variations in the study population by denaturing high-performance liquid chromatography and DNA sequencing. Twenty-five genetic variations of SLCO1B1, including 10 novel ones, were found: 13 in the coding exons (9 nonsynonymous and 4 synonymous variations), 6 in the introns, and 6 in the 3' untranslated region. Four novel nonsynonymous variations: 633A>G (Ile211Met), 875C>T (Ala292Val), 1837T>C (Cys613Arg), and 1877T>A (Leu626Stop) were detected as heterozygotes. Among the novel nonsynonymous variations, 633A>G, 1837T>C, and 1877T>A were predicted to be functionally significant. These data would provide fundamental and useful information for pharmacogenetic studies on drugs that are substrates of OATP1B1 in Asians.
Factor VII (FVII) is an independent risk factor for coronary artery disease. Three polymorphisms of the factor VII gene (F7) were studied in a group of healthy newborns comprising 561 Chinese, 398 Malays and 226 Asian Indians from Singapore. The allele frequencies of 3 polymorphisms (R353Q, Promoter 0/10bp Del/Ins and Intron 7) in the FVII gene were ascertained through genotyping by polymerase chain reaction and restriction digestion of amplified fragments. In Chinese the minor allele frequencies are Q: 0.04, Ins: 0.03, R7: 0.44; Malays, Q: 0.06, Ins: 0.10, R7: 0.41; and Indians, Q: 0.25, Ins: 0.23, R7: 0.43. Strong linkage disequilibrium (Delta > 0.7) is observed between the 0/10 bp and the R353Q sites in all ethnic groups. We conclude that: (i) the prevalence of the minor Q and Ins alleles of the R353Q and 0/10 bp polymorphisms are significantly higher in the Indian newborns than the Chinese and Malays; (ii) the Q allele is significantly associated (p = 0.01) with a lower plasma FVII coagulant level in the Indian and Malay neonates; and this polymorphism explains up to 3.8% of the variance in FVII coagulant levels; (iii) there is no significant difference in allele frequencies of the three polymorphisms between neonates with and without family histories of CAD.
We examined the links between the science and policy of habitat corridors to better understand how corridors can be implemented effectively. As a case study, we focused on a suite of landscape-scale connectivity plans in tropical and subtropical Asia (Malaysia, Singapore, and Bhutan). The process of corridor designation may be more efficient if the scientific determination of optimal corridor locations and arrangement is synchronized in time with political buy-in and establishment of policies to create corridors. Land tenure and the intactness of existing habitat in the region are also important to consider because optimal connectivity strategies may be very different if there are few, versus many, political jurisdictions (including commercial and traditional land tenures) and intact versus degraded habitat between patches. Novel financing mechanisms for corridors include bed taxes, payments for ecosystem services, and strategic forest certifications. Gaps in knowledge of effective corridor design include an understanding of how corridors, particularly those managed by local communities, can be protected from degradation and unsustainable hunting. There is a critical need for quantitative, data-driven models that can be used to prioritize potential corridors or multicorridor networks based on their relative contributions to long-term metacommunity persistence.
A well-supported and well-resolved phylogeny based on a concatenated data set from one mitochondrial and two nuclear genes, six morphological characters, and nine color pattern characters for 44 of the 50 species of the Southeast Asian Rock Geckos (genus Cnemaspis Strauch, 1887) is consistent with the previous taxonomy of Cnemaspis based solely on morphology and color pattern. Cnemaspis is partitioned into four major clades that collectively contain six species groups. The monophyly of all clades and species groups is strongly supported and they are parapatrically distributed across well-established, biogeographical regions ranging from southern Vietnam westward through southern Indochina, southward through the Thai-Malay Peninsula, then eastward to Borneo. Eight new species (Cnemaspis omari sp. nov. from the Thai-Malaysian border; C. temiah sp. nov. from Cameron Highlands, Pahang, Malaysia; C. stongensis sp. nov. from Gunung Stong, Kelantan, Malaysia; C. hangus sp. nov. from Bukit Hangus, Pahang, Malaysia; C. sundagekko sp. nov. from Pulau Siantan, Indonesia; C. peninsularis sp. nov. from southern Peninsular Malaysia and Singapore, and C. mumpuniae sp. nov. and C. sundainsula sp. nov. from Pulau Natuna Besar, Indonesia) are described based on morphology and color pattern and all but C. sundagekko sp. nov. are included in the phylogenetic analyses. Cnemaspis kendallii is polyphyletic and a composite of six species. An updated taxonomy consistent with the phylogeny is proposed for all 50 species and is based on 25 morphological and 53 color pattern characters scored across 594 specimens. Cladogenetic events and biogeographical relationships within Cnemaspis were likely influenced by this group's low vagility and the cyclical patterns of geographical and environmental changes in Sundaland over the last 25 million years and especially within the last 2.5 million years. The phylogeny indicates that nocturnality, diurnality, substrate preferences, and the presence of ocelli in the shoulder regions have evolved independently multiple times.
The taxonomy of three genera of little-known Phaneropterinae from Malay Peninsula (Singapore and Peninsular Malaysia) is reviewed: Cesasundana Koçak & Kemal, 2009, Elbenia Stål, 1876 and Macedna Karsch, 1891. One new species each from the genera Cesasundana and Elbenia are described from Singapore and Peninsular Malaysia respectively: Cesasundana lorniensis sp. n. and Elbenia fraser sp. n. Keys to species of Cesasundana and Elbenia are also included. The taxonomic position of monotypic genus Macedna is validated, male is redescribed and the female is described for the first time.
We report the first comprehensive insecticide susceptibility status ofAedes aegypti (L.) larvae from Singapore. The study indicated that Ae. aegypti is susceptible to temephos, although resistance (RR50 = 1.29-4.43-fold) couldbe developing. Of high concern is the detection of moderate to high resistance to permethrin (RR50 = 29-47-fold) and etofenprox (RR50 = 14-34-fold). Biolarvicide Bacillus thuringiensis israelensis (Bti) remains effective. The insecticide susceptibility profile of Ae. aegypti larvae was found to be homogenous among the different sites studied across the island city. The addition of synergists piperonyl butoxide, S,S,S,-tributyl phosphorotrithioate, and triphenyl phosphate generally failed to enhance the toxicity of the insecticides investigated, suggesting an insignificant role of metabolic-based resistance, and a possible involvement of target site resistance. Further biochemical investigation of specific metabolic enzyme activities suggested that detoxifying enzymes, mono-oxygenases, esterases, glutathione S-transferases, and altered acetylcholinesterases, generally did not contribute to the resistance observed. This study clearly demonstrated that pyrethroid resistance is widespread among Ae. aegypti population and lowered susceptibility to organophosphates is developing.
Melioidosis is endemic in the South Asian regions, like Thailand, Singapore Malaysia and Australia. The disease is more pronounced in the southern part of the country. It is caused by Burkholderia pseudomallei which causes systemic involvement, morbidity and mortality associated with the disease is high. Due to highly varied clinical presentation, and low general awareness this infection is largely underdiagnosed and under reported in our country. Most laboratories in the country still rely on conventional culturing methods with their low sensitivity, adding to the under reporting. To enhance physician awareness we describe here two cases who presented to our institute after months of misdiagnosis.
Traumatic Brain injury (TBI) is one of the most common causes of death and disability worldwide, with recent interest in the use of cholinomimetics in the treatment of TBI patients for cognitive impairments. Our patient who suffered TBI was started on a trial of an acetylcholinesterase inhibitor (Donepezil) for five weeks. Cognitive and memory testing with the Mini-Mental State Examination (MMSE) and Functional Independence Measurement (FIM) showed some degree of improvement: The three item recall component of MMSE improved and the FIM Memory score increased from 1 (Complete dependence) to 6 (Functional independence). Subjective assessment of his behaviour in the ward also showed improvement. This suggests that donepezil may help improve memory and behaviour of moderately severe traumatic brain injury patients, although more research in this direction should be undertaken.
Etroplus suratensis, a southern Asian cichlid, has established populations in Singapore. The fish, which was first collected in 1995, was probably introduced via the aquarium trade or through the Johor River in Malaysia. The growth, feeding and reproductive characteristics were found to follow its ecology in its native range in southern Asia, and its establishment in Singapore could be due to the similarity in environment and availability of food. Changes in intestinal length indicated diet shifts from a predominantly herbivorous to an omnivorous one as it matured. Stomach contents did not provide comparable evidence. Diet similarity to two other introduced cichlids may imply that interspecies resource competition exists. Closer monitoring is needed to determine its effects on the local environment.
Few data are available on soil ciliates from Asia. Thus, seven samples were collected in Singapore in February 1987 and investigated between December 1987 and May 1989, using the non-flooded Petri dish method, live observation, and silver impregnation. One hundred and three ciliate taxa, all new for the fauna of Singapore and Malaysia, were found. This applies also to Hemimastix amphikineta, a highly characteristic, euglenid flagellate with Gondwanan distribution. At least three undescribed ciliate species were discovered, viz., Ottowphrya magna, which has been published by Foissner (1993), Dileptus microstoma Vd'ačný & Foissner (2008), and Suturothrix monoarmata, which is described in the present paper. The new genus Suturothrix belongs to the order Haptorida and is unique in having a heteromorphic dorsal brush consisting of three staggered rows, thus forming a suture with the last right side ciliary row. Suturothrix monoarmata is a slender, middle-sized (~ 100 × 15 μm) ciliate easily recognisable by the single or two thick extrusomes in the centre of the minute oral bulge. The species is not restricted to Asia but has been found also in soil from the Amazon floodplain, Brazil.
Up to 25% of breast cancer patients in Asia present with de novo metastatic disease. We examined the survival trends of Asian patients with metastatic breast cancer over fifteen years. The impact of changes in patient's demography, tumor characteristics, tumor burden, and treatment on survival trend were examined. Patients with de novo metastatic breast cancer from three hospitals in Malaysia and Singapore (N = 856) were grouped by year of diagnosis: 1996-2000, 2001-2005 and 2006-2010. Step-wise multivariable Poisson regression was used to estimate the contribution of above-mentioned factors on the survival trend. Proportions of patients presenting with metastatic breast cancer were 10% in 1996-2000, 7% in 2001-2005, and 9% in 2006-2010. Patients in 2006-2010 were significantly older, appeared to have higher disease burden, and received more chemotherapy, endocrine therapy, and surgery of primary tumor. The three-year relative survival in the above periods were 20·6% (95% CI: 13·9%-28·2%), 28·8% (95% CI: 23·4%-34·2%), and 33·6% (95% CI: 28·8%-38·5%), respectively. Adjustment for treatment considerably attenuated the relative excess risk of mortality in recent years, compared to other factors. Substantial improvements in survival were observed in patients with de novo metastatic breast cancer in this study.
New records of the Japanese seahorse Hippocampus mohnikei from Cambodia, Malaysia, Thailand and Vietnam, along with recently published studies from India and Singapore, have greatly expanded the known range of H. mohnikei within Southeast Asia. These new records reveal novel habitat preferences and threats to H. mohnikei in the region. Although the global conservation status of H. mohnikei is classified as Data Deficient according to the IUCN Red List of Threatened Species, new sightings indicate that this species is found in similar habitats and faces similar threats as other Hippocampus species that are considered Vulnerable.
To answer the question posed the terms of reference of local ethical committees as well as a few from overseas were reviewed. It was noted that these committees were established by various professional bodies and functioned independently. Guidelines for ethical practice and conduct were made available to the profession with compliance left to the individual doctor. Amongst the many ethical issues of concern both to the public and the profession was that of self regulation. It is being suggested that these concerns be addressed rather then set up a national body.
Use of contraceptives by some selected characteristics was studied for married women in the reproductive age range (MWRA) in three south‐east Asian countries. The data were obtained from each country's national family planning/fertility survey conducted around the mid‐seventies. Only the gross relationship between each of the selected characteristics and contraceptive use was compared. The proportion of MWRA using contraceptives for Singapore was almost twice as high as the corresponding proportions for Peninsular Malaysia and Thailand. The pattern of contraceptive use was largely similar for Thailand and Malaysia but different from Singapore. The differences were largely attributed to the absence of a large rural population in Singapore, the apparently greater tendency of women in Singapore to use reversible contraceptive methods for birth spacing and the easier access by women to family planning information and services, particularly sterilisation, than in Peninsular Malaysia and Thailand.