High CD4⁺ T-cell Responses in Seronegative Individuals Following SARS-CoV-2 Exposure during a Dormitory Outbreak.

Objectives: We studied individuals who remained uninfected by SARS-CoV-2 despite repeated exposures during a May-July 2020 dormitory outbreak in Singapore.

Methods: We compared immune profiles of those with exposed seronegative (ESN) (negative PCR and serology), with non-infected and infected groups. Following the lifting of quarantine, incident infection rates were compared between the ESN and non-infected cohorts.

Designing Sandwich ELISA with Broadly Reactive Anti-Nucleocapsid Monoclonal Antibodies to Detect Bat-Borne Merbecoviruses.

At least three betacoronaviruses have spilled over from bats to humans and caused severe diseases, highlighting the threat of zoonotic transmission. Thus, it is important to enhance surveillance capabilities by developing tools capable of detecting a broad spectrum of bat-borne betacoronaviruses. Three monoclonal antibodies (mAbs) targeting the nucleocapsid (N) protein were generated using recombinant N proteins from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

The risk of contaminated ultrasound gels in the intensive care unit: lessons from an outbreak of .

Background: is an environmental Gram-negative bacterium, resistant to many antibiotics and antiseptics, that can survive in aqueous hospital environments. We investigated an outbreak of in the intensive care unit (ICU) of Ng Teng Fong General Hospital, aiming to identify the source and prevent further transmission.

Methods: The outbreak was detected after two ICU patients developed bacteremia.

Viral non-SARS-CoV-2 etiology of community-acquired pneumonia (CAP) in Southeast Asia: a review and pooled analysis.

Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality worldwide, including in Southeast Asia (SEA). While bacterial causes are well studied, viral etiologies are less characterized. The COVID-19 pandemic has underscored the significance of viral pneumonia, alongside ongoing concerns from zoonotic influenza, human metapneumovirus, and other outbreaks.

Can ChatGPT Counter Vaccine Hesitancy? An Evaluation of ChatGPT's Responses to Simulated Queries from the General Public.

Vaccines have eradicated deadly diseases, yet vaccine hesitancy persists, leading to reduced uptake. Some individuals, mistrustful of healthcare providers, may turn to tools like ChatGPT for information. We evaluated ChatGPT's responses to common vaccine hesitancy questions.

Inflammatory phenotypes and clinical outcomes amongst patients with presumed and confirmed Pneumocystis jirovecii pneumonia without underlying human immunodeficiency virus infection.

Pneumocystis jirovecii pneumonia (PJP) has significant mortality, especially in immunocompromised hosts without underlying human immunodeficiency virus infection (HIV). Inflammatory phenotypes may influence clinical outcomes. This study examines the relationship between inflammation, as measured by C-reactive protein (CRP), and adverse outcomes in HIV-negative patients with PJP.

Rationalizing antibiotic prescribing for bacterial pneumonia in patients with reported penicillin allergy-a qualitative study.

Background: Penicillin allergy is commonly reported, yet often mislabelled. Such a label is associated with adverse outcomes in bacterial pneumonia. Despite recognition of the overlabelling of penicillin allergy and the awareness of potential adverse effects, there are limited data on the rationale for the management of patients with bacterial pneumonia and concomitant penicillin allergy.

Case Report: MOGAD - a steroid-responsive autoimmune meningoencephalitis mimicking infection.

This case series reports three patients initially managed for presumed infectious meningoencephalitis, who were ultimately diagnosed with myelin oligodendrocyte glycoprotein associated disease (MOGAD). Their clinical presentations were strikingly similar to those of acute infectious meningoencephalitis, which posed a challenge to the initial diagnostic process. Notably, despite the absence of typical radiological changes associated with MOGAD, such as cerebral cortical encephalitis, these patients exhibited focal neurological and electroencephalographic changes.

Establishing clinical research networks for future infectious disease outbreak responses in Southeast Asia: Report of a workshop on challenges and opportunities.

The COVID-19 pandemic highlighted the critical need for well-established clinical research networks capable of rapid response during infectious disease outbreaks. In Southeast Asia, the absence of active research networks at the onset of the COVID-19 contributed to gaps in regional preparedness. This manuscript discusses the challenges and opportunities identified during a regional workshop held in Singapore (February 26 to March 1, 2024), which brought together 130 stakeholders from across the region.

Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial.

Background: The REGARD-VAP trial showed that individualised shortened antibiotic therapy was non-inferior to usual care for mortality and pneumonia recurrence in patients with ventilator-associated pneumonia (VAP). We aimed to assess the cost-effectiveness of an individualised shortened antibiotic therapy approach in this planned economic analysis.

Methods: REGARD-VAP was a phase 4, multicentre, open-label, randomised trial to assess a short-course antibiotic treatment strategy for treatment of VAP.

Role of cerebrospinal fluid adenosine deaminase measurement in the diagnosis of tuberculous meningitis: an updated systematic review and meta-analysis.

Introduction: Tuberculous meningitis (TBM) can be difficult to diagnose. Elevated cerebrospinal fluid (CSF) adenosine deaminase (ADA) is often seen in TBM, but its reliability has been questioned. A previous meta-analysis in 2017 had demonstrated the diagnostic utility of CSF ADA in TBM versus non-TBM.

Adding Hyponatremia to the "Rule-of-6" Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes.

The 'rule-of-6' prediction tool was shown to be able to identify COVID-19 patients at risk of adverse outcomes. During the pandemic, we frequently observed hyponatremia at presentation. We sought to evaluate if adding hyponatremia at presentation could improve the 'rule-of-6' prediction tool.

Trends in electrocardiographic and cardiovascular manifestations of patients hospitalised with COVID-19.

Introduction: Early in the coronavirus disease 2019 (COVID-19) pandemic, a low incidence of cardiovascular complications was reported in Singapore. Little was known about the trend of cardiovascular complications as the pandemic progressed. In this study, we examined the evolving trends in electrocardiographic and cardiovascular manifestations in patients hospitalised with COVID-19.

ChatGPT as a tool to improve access to knowledge on sexually transmitted infections.

Objectives: Specific to sexual health, individuals in need of information may be adolescents who have limited ability to formally access healthcare. These digital natives may turn to ChatGPT to address their concerns on sexually transmitted infections (STI). We sought to evaluate the veracity of ChatGPT's responses to commonly asked questions on STIs.

Elevated serum lactate dehydrogenase aids prediction of mortality in Pneumocystis jirovecii pneumonia without underlying human immunodeficiency virus infection - Derivation of a clinical risk score.

Pneumocystis jirovecii pneumonia (PCP) is associated with significant mortality amongst patients without underlying human immunodeficiency virus infection (HIV). We sought to develop a risk score to predict mortality in this population. We reviewed patients with a presumed or confirmed PCP and a negative HIV test from 2006-2023.

Infectious etiologies of persistent and chronic diarrhea in Asian developing countries: A systematic review and meta-analysis.

Infectious causes of diarrhea contribute significantly to morbidity in Asia. We conducted a systematic review and meta-analysis of the prevalence of infectious etiologies of persistent and chronic diarrhea in Asian adults. Searches were performed on PubMed and Scopus for studies from January 1, 1970, to May 30, 2023.

Individualised, short-course antibiotic treatment versus usual long-course treatment for ventilator-associated pneumonia (REGARD-VAP): a multicentre, individually randomised, open-label, non-inferiority trial.

Background: Ventilator-associated pneumonia (VAP) is associated with increased mortality, prolonged hospitalisation, excessive antibiotic use and, consequently, increased antimicrobial resistance. In this phase 4, randomised trial, we aimed to establish whether a pragmatic, individualised, short-course antibiotic treatment strategy for VAP was non-inferior to usual care.

Methods: We did an individually randomised, open-label, hierarchical non-inferiority-superiority trial in 39 intensive care units in six hospitals in Nepal, Singapore, and Thailand.