Mahesh Choolani

Today is World Prematurity Day 2025 — an important reminder of the ongoing challenge posed by preterm birth, particularly in twin pregnancies. Over 50% of twins are born prematurely, with a significantly higher risk of neonatal morbidity and mortality compared to singletons. These early births are often the result of spontaneous preterm labour or medically indicated delivery due to complications such as selective growth restriction. Twin pregnancies require tailored surveillance and proactive management. As clinicians, we must continue to: 🔹 Recognise and stratify risk early 🔹 Optimise antenatal monitoring 🔹 Plan timing and mode of delivery based on the best available evidence Improving outcomes for twins born too soon is possible — but it demands collaboration, expertise, and continued research. @TwinsTrust @tapssupport @RCObsGyn @NHSE_WTE @NHSEngland @ISUOG #WorldPrematurityDay #Prematurity #Twins #MaternalFoetalMedicine #PerinatalCare #Obstetrics #HighRiskPregnancy

Rethinking Stroke Rehabilitation: Why Traditional Recovery Goals Are No Longer Enough As we mark World Stroke Day, the Singapore Medical Journal's October Editorial by Jack Lo Yu Tung, Benjamin YQ Tan and Ramani, Narayanaswamy Venketasubramanian tackles an urgent reality: stroke is increasingly affecting younger adults, challenging traditional assumptions about who it impacts. The Changing Face of Stroke in Singapore: 1) Nearly 1 in 3 of the 9,700 annual stroke cases occur in people under 60. 2) Stroke cases have risen by over 50% from 2012 to 2022. 3) >15% of all strokes now affect individuals under 50. 4) For younger, digitally-native survivors navigating careers and complex social lives, achieving "independent walking" or "basic activities of daily living" is no longer sufficient for meaningful reintegration into modern society. Enter the Technological Revolution: Brain-computer interfaces (BCIs) and neurorehabilitative technologies are transforming what's possible. By decoding motor intention directly from cortical neurons, BCIs can bypass damaged neural circuitry—translating thoughts into action through: 1) Robotic limbs 2) Functional electrical stimulation 3) Virtual reality platforms 4) Even wheelchair control for severe cases This isn't just biomechanical restoration—it's the re-establishment of cognitive agency. The Path Forward: While early evidence is encouraging (meta-analyses show BCI-guided therapy enhances upper limb function beyond conventional therapy), challenges remain: cost, accessibility, scalability, and the need for clinical workflow integration. But the possibilities are vast. As Singapore becomes a super-aged society by 2026, it's time for clinicians, researchers, and policymakers to reimagine functional restoration in stroke care. After all, the mind is our greatest untapped resource in neurological recovery. Read the full editorial in SMJ October 2025 issue: journals.lww.com/smj/fulltext/2… #WorldStrokeDay #Neurorehabilitation #MedicalInnovation #HealthcareTransformation #StrokeRecovery #BrainComputerInterface

Calling all early clinician researchers… Interested in the SMJ Editorial Fellowship? Find out more here! #SMJ #EditorialFellow

📝 Mid-Year Reflections from the SMJ EIC As we pass the midpoint of 2025, Editor-in-Chief Dr Ang Tiing Leong shares key highlights in a special mid-year editorial. 🌟 What we’ve achieved so far: 👩‍⚕️ Launched the SMJ Editorial Fellowship to nurture the next generation of clinician-editors 📄 Published a Quick Peer Review Guide created by one of our editorial fellows 🧠 Spotlighted key clinical issues: 🧑‍🤝‍🧑 Adolescent mental health in Singapore ❤️ Improving neurological outcomes after cardiac arrest 🌱 Climate-conscious healthcare and green transitions 🩺 Healthier SG, preventive care, and primary care transformation 🧪 Cancer screening, HIV strategy, and chronic viral hepatitis elimination 📈 SMJ’s 2024 Impact Factor has risen to 1.9, reflecting the collective commitment of our authors, reviewers, and editorial board to advancing medical knowledge. 📖 Read the full editorial here: 👉 journals.lww.com/smj/fulltext/2…

👁️‍🗨️ Visual Impairment and Obesity in Rural China A study of over 39,000 students in rural northwest China reveals a significant association between visual impairment (VI) and obesity in school-age children. 📍 Key findings: 📊 1 in 3 students had visual impairment ⚖️ Obesity was linked to higher odds of VI, especially among: 🧒 Primary school students 🧬 Han students 📍 Residents of Ningxia ⚠️ The findings highlight the dual burden of VI and obesity in underserved rural areas, pointing to the need for integrated school-based interventions — promoting both healthy vision and active lifestyles. 🔍 Read the full article: journals.lww.com/smj/fulltext/2…

It was a great honour to have been given the opportunity to serve with and alongside some of the brightest medical colleagues in ASEAN! Leaders, Editors-in-Chief, and people who have transformed healthcare through ASEAN nations. Heartiest Congratulations to A/Prof Maria Ventura

SMJ’s Senior Deputy Editor, Prof @Mahesh_Choolani concluded his term as Chair of the MASEAN Group of Journals (GoJ) at the recent GoJ Seminar for Authors of Medical Journals in Thailand 🇹🇭, held alongside the MASEAN Mid-Term Meeting. The Seminar for Authors of Medical Journals on 17 July 2025 saw an impressive turnout of 208 participants, hosted by the Medical Association of Thailand and MASEAN GoJ. Over the past 2 years, Prof Choolani spearheaded regional initiatives including medical writing workshops in 🇵🇭 🇮🇩 🇲🇾 🇸🇬. We thank him for his dedicated leadership and look forward to his continued contributions as GoJ Advisor and Singapore’s representative on the Board. Warm congratulations to incoming Chair A/Prof Maria Christina Ventura (Editor-in-Chief, Journal of the Philippine Medical Association)!

🌟 Be Confident, Be Yourself 😎 Prof Reshma Taneja, Head of the Department of Physiology at #NUSMedicine, is leading advancements in childhood cancer research while opening doors for more women in science and leadership.

A comprehensive panel of experts from all three government hospitals in Singapore 🇸🇬 (KK Women's and Children's Hospital, Singapore General Hospital, National University Hospital), together with experts from National University of Singapore and Cincinnati Children's Hospital 🇺🇸, have developed a consensus statement and recommendations as to how we administer antenatal steroids. This rigorous statement draws on human clinical data, experimental studies, and computational modeling. 🔬📊 The consensus article suggests that adopting internationally validated antenatal steroid regimens could improve outcomes while potentially reducing risks. ✅ This represents an important step toward aligning Singapore's practices with global evidence-based standards in preterm care. 🌍 Published in the Singapore Medical Journal 📖, this article provides detailed pharmacokinetic analysis and comprehensive recommendations for clinical practice. This collaborative effort demonstrates Singapore's commitment to continuously improving perinatal care through rigorous scientific evaluation. Read the full consensus statement to learn about the specific dosing recommendations, the scientific evidence behind them, and how this change could benefit preterm infants and their families. 👨‍👩‍👧‍👦💙 journals.lww.com/smj/fulltext/9… #AntenatalSteroids #Singapore #Obstetrics #Neonatology @Mahesh_Choolani

🎉 Here’s to 100 years of discovery and a future sparked by curiosity! As part of their 100th anniversary celebrations, the Department of Microbiology and Immunology (@nusmicroimmuno) at #NUSMedicine invited over 1,000 students and teachers to immersive workshops

🎉 We're excited to share that the Singapore Medical Journal has achieved a 2024 Journal Impact Factor of 1.9 (📈 up from 1.7), placing us in the Q2 quartile within the Medicine, General & Internal category, as reported in the Journal Citation Reports™️ by Clarivate. This reflects our journal's growing influence and the high quality of research published by our contributing authors. 🌟 We extend our heartfelt gratitude to: • ✍️ Our dedicated authors – for trusting us with their important research • 🧠 Our rigorous peer reviewers – for upholding our high standards • 📘 Our editorial team – for their tireless commitment to excellence • 👩‍⚕️👨‍⚕️ Our readers – for engaging with our published work As we continue to evolve in the dynamic landscape of medical publishing, we remain committed to providing a platform for impactful research that contributes to better patient outcomes and medical advancement. 🏥🔬 #SMJ #Research

Out today in the Lancet. So proud to be working with such brilliant individuals, especially in Sierra Leone. The number needed to treat with 2YoungLives to prevent one maternal or perinatal death was 18 (95% CI 10 to 92).

🎉 Congrats to our brilliant clinician-scientists and researchers who were awarded national grants for advancing patient care through impactful research! 🔗 Meet the winners: duke-nus.edu.sg/newshub/our-st… #DukeNUS #ResearchImpact #PatientCare @SingHealth

Mustafa et al. developed a prediction model for hypertensive disorders of pregnancy and gestational diabetes mellitus in twin #pregnancy, and their findings suggest that machine learning could improve predictive accuracy and personalise care. Read the #openaccess article in the May #UOGJournal. bit.ly/4dEuOB3

Congratulations to Prof Wong Tien Yin on his election as a Fellow of @royalsociety! A testament to his impactful leadership and innovative work in #AI and digital technologies. Read more about it at duke-nus.edu.sg/newshub/our-st… #DukeNUS #AI #MedicalResearch

🏆 2024 SMJ Best Research Paper Award Winner 📌 Featured Article Clinical profile and outcomes in patients with moderate to severe aortic stenosis with or without concomitant chronic kidney disease 👨‍⚕️ Lead Author: Dr Ngiam Jinghao Nicholas, Adj Asst Prof Sia Ching Hui 📖 Singapore Med J. 2024;65(11):624–630 🔗 Read the article: journals.lww.com/smj/fulltext/2… 🩺 When heart and kidney disease collide In this study of 727 patients with moderate to severe aortic stenosis (AS), coexisting chronic kidney disease (CKD) was linked to higher mortality, more heart failure admissions, and lower rates of valve replacement—despite similar AS severity. CKD patients also showed signs of adverse cardiac remodeling, suggesting an independent role of CKD in worsening outcomes. The findings highlight a critical treatment gap and underscore the need for tailored approaches, including earlier consideration of transcatheter valve therapy in high-risk patients. 👏 Congratulations to Dr Ngiam, Dr @chinghuisia and the entire research team on this important work advancing care in complex cardio-renal disease. 🎉 Professor @WilliamKokFaiK1 received the award on behalf of the team. @NUHCS

🏆 2024 SMJ Best Research Paper Award Winner 📌 Featured Article Clinical characteristics and outcomes in Asian patients with heart failure with mildly reduced ejection fraction 👨‍⚕️ Lead Author: Dr Julian Cheong Kiat Tay, Clinical A/Prof Jonathan Yap 📖 Singapore Med J. 2024;65(7):389–396 🔗 Read the article: journals.lww.com/smj/fulltext/2… 🫀 What do we know about heart failure with mildly reduced ejection fraction (HFmrEF) — particularly in Asian populations? This large-scale national study of over 16,000 patients reveals that HFmrEF is a unique clinical phenotype, carrying an atherosclerotic burden and mortality risk between HFrEF and HFpEF. The findings underscore the need for targeted strategies to manage this under-recognised subgroup of heart failure. 👏 Congratulations to Dr Tay, @Jonyap88 et al. for this impactful contribution to cardiovascular medicine research.

🌟 Excellence in Medical Research: SMJ Best Paper Award Recipients Honoured at SMA Annual Dinner 2025! We're proud to honour the outstanding recipients of our 2024 SMJ Best Research Paper Awards at yesterday's Singapore Medical Association Annual Dinner. Congratulations to these exceptional research teams: Improving children’s cooperativeness during magnetic resonance imaging using interactive educational animated videos: a prospective, randomised, non-inferiority trial (Evelyn Gabriela Utama et al.) Clinical characteristics and outcomes in Asian patients with heart failure with mildly reduced ejection fraction (Julian Cheong Kiat Tay et al.) Clinical profile and outcomes in patients with moderate to severe aortic stenosis with or without concomitant chronic kidney disease (Jinghao Nicholas Ngiam et al.) These papers exemplify the highest standards of research excellence in our medical community. 🔬✨ Thank you to all our judges!

Bedridden patients are increasing worldwide with our aging population. New #CME article in #SMJ by @lifeng_t addresses this challenge with a multidisciplinary approach to prevent complications, initiate timely end-of-life discussions, and coordinate community resources. Essential reading for #PrimaryCare journals.lww.com/smj/fulltext/2…

I'm looking forward to speaking at the 'Expert in Obstetrics & Gynaecology meeting (Fetal Medicine) at the Royal College of Physicians, London. Hope to see you there and meeting new and old friends @EIOG2025