In 2024, the United Nations Children’s Fund (UNICEF) reported that 1 in 8 women (370 million) experienced sexual assault before the age of 18 years, and 8% of these are from East and Southeast Asia.1 In Singapore, 38.6% of 11,868 sexual assault cases from 2018 to 2022 involved children aged under 16 years.2 These children are at risk of pregnancy, sexually transmitted infections (STIs) and post-assault trauma in the short term, and face wide-ranging long-term psychosocial and health consequences, including psychiatric disorders and human immunodeficiency virus (HIV) infection.3 A systematic review of children and adolescents exposed to sexual abuse found that STI detection varied from <1% to 61% in different settings and by type of STI.4 In a Singapore review of 790 patients aged 0 to 16 years who presented to a paediatric emergency department (ED) for sexual abuse/assault from 2016 to 2020, 6.2% had an STI, with the majority having chlamydia followed by gonorrhoea.5

Acute coronary syndrome (ACS) carries a high early risk of recurrent events, yet time-to-target low-density lipoprotein cholesterol (LDL-C) is often prolonged, and goal attainment is suboptimal in real-world practice. The authors aimed to develop expert consensus recommendations for post-ACS lipid management in Singapore, focusing on LDL-C targets, pharmacotherapy, escalation strategies, and implementation tools to improve adherence and reduce therapeutic inertia. A modified Delphi methodology was employed with a panel of 10 members. Evidence was synthesised from guidelines, randomised trials, metaanalyses, and observational studies. Thirty-two statements were drafted across 5 domains (LDL-C targets; timing/ monitoring; pharmacotherapy; special populations; implementation/adherence/health-system strategies) and rated anonymously on a 5-point Likert scale. Consensus thresholds were defined as high (≥75% concordant), moderate (55-74%), and low (<55%). After the final round, 30 of 32 statements achieved high consensus, and 2 received low consensus. Key agreements included measuring lipids within 24 hours of admission and retesting at 4-6 weeks, early initiation of high-intensity statins, and upfront combination therapy with statin + ezetimibe when monotherapy is unlikely to achieve the goals. Consideration of a proprotein convertase subtilisin/kexin type 9 inhibitor at discharge was recommended if LDL-C remained >1.4 mmol/L. Special considerations included older adults, familial hypercholesterolaemia, lower statin adherence among women, and the role of lipoprotein(a). The panel recommended adopting objective metrics, integrating electronic health record prompts, and developing localised pathways to harmonise care transitions. The consensus recommendations provide a tailored approach for Singapore, emphasising early action, proactive escalation, and systems-level interventions to improve post-ACS outcomes.

Despite the association between sepsis and carotid-femoral pulse wave velocity, the relationship between estimated pulse wave velocity (ePWV) and sepsis remains unclear. This study investigated the correlation between ePWV and 28-day mortality in patients with sepsis. Using data from the Medical Information Mart for Intensive Care IV database between 2008 and 2019, the association between ePWV and 28-day mortality was analysed with Kaplan-Meier curves, Cox models, and res-tricted cubic splines (RCS). Subgroup analysis was performed to validate the findings. A combined model was constructed by screening variables via Cox-least absolute shrinkage and selection operator (LASSO), with its incremental predictive value evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Survival analysis showed an inverse association between ePWV and survival rates (log-rank test P<0.001). Cox analysis demonstrated that each increase in ePWV was associated with a significantly higher risk of 28-day mortality in patients with sepsis (hazard ratio 1.905, 95% confidence interval 1.672-2.169, P<0.001), with linearity confirmed by RCS analysis (P-nonlinear=0.3313). Subgroup analysis indicated significant interaction effects of invasive ventilation (P-interaction <0.001) and a history of malignant tumours (P-interaction =0.005) on mortality. The combined model optimised by LASSO demonstrated the best discriminative performance (ROC=0.823) and an improved net clinical benefit with the inclusion of ePWV, as confirmed by DCA. ePWV was linearly and positively correlated with the risk of 28-day mortality in patients with sepsis.

Nursing home (NH) residents are vulnerable to infections and avoidable hospital transfers. The Infectious Diseases Community Program was developed as a multicomponent intervention to strengthen infection prevention and control (IPC), improve vaccination uptake, and support clinical decisionmaking in NHs. The authors conducted a retrospective cohort study in 6 NHs in western Singapore with pre- and post-implementation data, in collaboration with an acute hospital. A total of 4801 admissions were screened, of which 2045 fever-related admissions were included. The intervention comprised IPC training, policy and process reviews, vaccination support, antimicrobial guidance, and implementation of a structured fever and desaturation pathway to standardise hospital transfer decisions. New methicillin-resistant Staphylococcus aureus (MRSA) acquisitions declined from 14.6% to 9.7% (relative reduction 33.6%, 95% confidence interval [CI] -6.8 to -3.1, P<0.001). Inappropriate fever-related transfers decreased from 12.0% (108/898) to 7.3% (61/839), a relative reduction of 39.2% (absolute reduction 4.8%, 95% CI -7.5 to -2.0, P<0.001). Influenza vaccination coverage exceeded 90% by 2022. Staff surveys indicated sustained adoption, with 84% reporting regular use of the pathway. A collaborative model integrating acute hospital expertise with NH teams was associated with improved IPC outcomes, increased vaccination coverage, and reduced inappropriate transfers, supporting safer care delivery in long-term care.

Although monocyte and albumin levels have been associated with survival in various malignant tumours, their specific prognostic significance in nasopharyngeal carcinoma (NPC) remains under-explored. This study seeks to examine the relationship between the monocyte-to-albumin ratio (MAR) and overall survival (OS) in NPC patients to create a precise prediction model. The authors retrospectively analysed data from 860 NPC patients who underwent concurrent chemoradiotherapy. The optimal cut-off for MAR was determined using the maximum selection log-rank method. Univariate and multivariate Cox proportional hazards models were applied to identify factors significantly related to OS. A predictive nomogram was then developed and rigorously validated for its accuracy. The optimal MAR threshold was determined to be 11.63, effectively categorising the 860 NPC patients into 2 prognostic subgroups (hazard ratio 0.56; 95% confidence interval [CI] 0.41-0.77, P<0.001). The predictive nomogram exhibited strong predictive capability for OS, factoring in T stage, N stage, MAR value, body mass index, and age over 45 years. The concordance index (C-index) of the traditional tumour- node-metastasis staging system was found to be 0.64 (95% CI 0.57-0.70), which was less than the C-index of the nomogram (0.68; 95% CI 0.64-0.72) for OS. MAR was identified as an innovative and independent prognostic factor in NPC patients, presenting a potential biomarker for personalised treatment strategies.