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Doctors a step closer to give liver cancer patients more healing opportunities

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Researchers from the National Cancer Centre Singapore (NCCS) and the A*STAR’s Genome Institute of Singapore (GIS) supported by the National Medical Research Council (NMRC) Translational and Clinical Research (TCR) flagship program Precision Medicine in Liver Cancer across Asia-Pacific Network (PLANET) have made a discovery that could transform the treatment of Hepatocellular carcinoma (HCC), the most common but deadly type of liver cancer.
The discovery revealed that the genetic characteristics of liver cancer tumours can vary widely, not only across different patients but also within a single tumour.
This hinted that healing the patient needs a precision medicine, which is a treatment customised to the needs of each patient.
Until the discovery was found, it has been assumed that each case of liver cancer was caused by a single type of genetic mutation, but doctors have been wondering why Sorafenib, the standard drug used for liver cancer, has been ineffective in preventing recurrence in most patients after the tumour has been removed by surgery.
In fact, the tumour can contain several mutations – which differ widely across patients – and the key to successful treatment may lie in identifying and targeting those mutations responsible for recurrence.
Joint-lead author and GIS Human Genetics Group Leader Associate Prof Roger Foo said, “Our approach reveals that liver cancer may contain many more genetic mutations, targetable by drugs that are already available.”
“Re-positioning of drugs offers the hope of immediate treatment, on top of ongoing strategies for new drug discovery. We hope to build on our study to devise ever more means of precision therapy for liver cancer,” Prof Foo said.
The fact was not previously known because the cancer has traditionally been diagnosed with a single biopsy, a procedure which extracts a single tissue sample from the liver.
Prof Pierce Chow, the liver surgeon leading the NCCS team in this collaboration said, “Although early stage HCC can be well treated by surgical resection and transplantation, no subsequent adjuvant systemic therapy is currently available. Thus long-term outcomes even in early HCC are significantly poorer compared with other common cancers where good adjuvant systemic therapy is available after surgical resection.”
Prof Chow said this will help both early and late stage patients with HCC.
“The data from this study and our prospective multi-centre study will potentially enable treatment to be individualised to the genomic and immunological make-up of each patient,” he said.
Comparing cancer that has recurred at another part of the liver after surgery, to that of the original tumour, they further found that the cancer cells giving rise to the recurrent cancer can arise from before or after genetic diversification of the original tumour.
These recurrent tumours diversified more quickly than expected in the distant sites, into many different clones, suggesting that each patient with HCC needs to be treated differently.
Co-lead author Dr Zhai Weiwei, Senior Research Scientist of Human Genetics at GIS commented, “This work sheds light on the genomic profile and evolutionary trajectories of HCC. The deeper understanding of HCC gained from our study provides a solid foundation for future therapeutic strategies.”
The researchers now looking at existing drugs used for other cancers that might work on liver cancer, since some of the mutations they found are also present in other cancers.
Their findings were recently published in the journal Nature Communications.
With funding from Singapore’s National Medical Research Council, they are also collaborating with scientists in other Asia-Pacific countries, extending their study to more patients to collect further data to better understand and more effectively treat liver cancer across different ethnic groups.
Liver cancer is the second deadliest cancer in the world after lung cancer, the median five-year survival rate for liver cancer is 57 percent.

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Survey reveals one-third of Singaporean youth struggle with severe mental health issues

A national study by the Institute of Mental Health reveals that 30.6% of Singaporean youth suffer from severe symptoms of depression, anxiety, or stress, driven by factors like excessive social media use, body image concerns, and cyberbullying. The findings emphasize the need for early intervention and targeted mental health strategies.

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A significant portion of Singapore’s youth are experiencing severe mental health challenges, according to a comprehensive national survey conducted by the Institute of Mental Health (IMH).

The National Youth Mental Health Study (NYMHS), released on 19 September 2023, found that 30.6% of individuals aged 15 to 35 reported severe or extremely severe symptoms of depression, anxiety, or stress, with key risk factors including excessive social media use, body shape concerns, and experiences of cyberbullying.

The study, which surveyed 2,600 Singaporean citizens and permanent residents, highlights the growing mental health concerns among Singaporean youth and suggests the need for more targeted interventions and support systems.

Mental Health Issues Prevalent Among Youth

Anxiety was the most common mental health issue, with 27% of respondents reporting severe or extremely severe symptoms, followed by depression (14.9%) and stress (12.9%).

These findings underscore the high prevalence of mental health issues among young people, particularly in those aged 15 to 24, who were more likely to report severe symptoms compared to older participants.

According to the IMH, young people who were female, single, unemployed, or had lower levels of education or household income were more prone to severe mental health symptoms.

For example, youth with monthly household incomes below S$5,000 were more likely to experience severe anxiety​.

Key Risk Factors: Social Media, Body Image, and Cyberbullying

The study identified three major factors linked to severe mental health symptoms:

  1. Excessive Social Media Use: Around 27% of respondents reported using social media for more than three hours daily, which was associated with a significantly higher likelihood of severe mental health issues. Youth with excessive social media use were 1.5 to 1.6 times more likely to experience severe symptoms of depression, anxiety, or stress​.
  2. Body Shape Concerns: About 20.2% of youth had moderate to severe concerns about their body image. These individuals were 4.9 times more likely to experience severe depression, 4.3 times more likely to experience severe anxiety, and 4.5 times more likely to suffer from severe stress​. Such concerns were often linked to social media exposure, which can perpetuate unrealistic beauty standards and increase dissatisfaction with one’s body.
  3. Cyberbullying: One in five youth (21%) reported being victims of cyberbullying. These individuals were approximately twice as likely to report severe mental health symptoms compared to those who had not experienced such harassment​. The anonymity and pervasive nature of online bullying exacerbates the mental health toll on young people, according to the study.

Demographics at Higher Risk

The study found that specific demographics were more vulnerable to mental health issues. Young people aged 15 to 24 were more likely to experience anxiety, depression, and stress, particularly females, those who were single, and those with lower levels of education, such as junior college or vocational qualifications​.

The Malay ethnic group was also found to have a higher prevalence of severe mental health symptoms compared to other ethnic groups​.

Barriers to Seeking Help and Sources of Support

Although about 69.1% of those with severe mental health symptoms sought help—primarily from family and friends—a significant portion of young people hesitated to seek professional support.

The top reasons included concerns about privacy, fear of judgment, and doubts about the effectiveness of professional services​.

Among those who sought help, family and friends were the most common sources of support (57.9%), followed by self-help measures (31.1%) and medical services (20.1%)​.

However, the reluctance to seek professional help highlights the need for continued efforts to destigmatize mental health treatment and increase awareness of available services.

Protective Factors: Resilience, Social Support, and Self-Esteem

The study also identified factors that helped mitigate mental health challenges. Youth who reported higher levels of resilience, perceived social support, and self-esteem were significantly less likely to experience severe symptoms of depression, anxiety, or stress.

This suggests that fostering strong support networks and building resilience in youth could play a critical role in improving their mental well-being​.

Government Response and Preventive Measures

The findings of the NYMHS support Singapore’s broader National Mental Health and Well-Being Strategy, launched in October 2023, which adopts a whole-of-government and whole-of-society approach to addressing mental health concerns. Schools have already begun integrating mental health education into their curricula, equipping students with the knowledge and skills to manage their well-being.

Additionally, the government introduced the Parenting for Wellness toolbox in September 2023 to help parents manage their children’s screen time and promote healthy social media usage.

A guide on responsible social media use, expected to be released by mid-2025, will offer further strategies to mitigate the negative impacts of excessive screen time and online harassment​.

Future Implications and Policy Development

Associate Professor Swapna Verma, chairman of IMH’s medical board and co-principal investigator of the study, emphasized the importance of early intervention.

“Not all individuals with severe or extremely severe symptoms of depression or anxiety have a clinical condition, but being in such states for a prolonged period of time can be detrimental to their well-being,” she said​.

The study’s data will help policymakers and healthcare providers develop more targeted approaches to address the mental health needs of Singapore’s youth, especially those most at risk.

Associate Professor Mythily Subramaniam, IMH’s assistant chairman of medical board (research), stressed the need to pay attention to issues like excessive social media use and cyberbullying, noting their “tremendous impact on youth mental health” and the importance of preventive measures​.

Support for Youth Facing Mental Health Challenges

Young people dealing with mental health challenges in Singapore have access to various resources:

  • CHAT (Centre of Excellence for Youth Mental Health): CHAT offers a safe and confidential space for youth to seek help through online and face-to-face mental health assessments and support.
  • Institute of Mental Health (IMH): IMH provides a comprehensive range of mental health services, including outpatient consultations and inpatient care. Youth in crisis can also seek immediate assistance from the 24-hour Mental Health Helpline at 6389 2222.
  • Samaritans of Singapore (SOS): SOS offers emotional support for those feeling distressed or experiencing suicidal thoughts. Their 24-hour hotline is 1767.
  • Health Promotion Board’s National Care Hotline: This hotline provides immediate emotional support for those in need and can be reached at 1800-202-6868.
  • Counselling Services: School-based counsellors, as well as community-based services such as TOUCH Youth, provide further avenues of support for young people grappling with mental health issues.
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Malaysia reports new mpox case in man without recent international travel

Malaysia has confirmed its first mpox case of 2024 in a male patient, the Health Ministry reported. The patient is in isolation and stable, with authorities monitoring his contacts. This brings the total confirmed cases since July 2023 to ten, all from clade II.

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MALAYSIA: The Malaysian Health Ministry confirmed a new case of monkeypox (mpox) in a male citizen, marking the country’s first confirmed case of 2024.

The patient, who began showing symptoms on 11 September, is currently in isolation and in stable condition.

The ministry, in a statement issued Tuesday (17 September), revealed that the patient first experienced fever, sore throat, and cough, followed by the appearance of rashes on 12 September.

He has no recent history of international travel within the past 21 days, and authorities are in the process of identifying and monitoring his close contacts, following strict standard operating procedures (SOPs).

“Out of the 58 suspected mpox cases referred to the ministry this year, one case has been confirmed positive for mpox clade II as of 16 September,” the ministry stated.

“All 10 cases reported in Malaysia since July 2023 have been from clade II.”

The Health Ministry had earlier reported that Malaysia recorded a total of nine mpox cases since the first detection on 26 July 2023, with the most recent case reported in November 2023.

All previous cases had links to high-risk activities, but no deaths were reported.

Global Context and National Preparedness

Mpox was declared a Public Health Emergency of International Concern (PHEIC) for the second time on 14 August this year, due to the rapid spread of the clade Ib variant, particularly from the Democratic Republic of Congo (DRC) and neighboring African nations.

In response, Malaysia’s Health Ministry activated its national crisis response centre on 16 August to enhance readiness and coordinate preventive measures.

The ministry advised the public to take precautions, including maintaining personal hygiene and avoiding direct contact with individuals suspected or confirmed to be infected with mpox.

High-risk individuals experiencing symptoms such as fever, swollen lymph nodes, and rashes are urged to seek immediate medical attention.

Mpox is caused by the monkeypox virus (MPVX) and spreads through close contact with symptomatic individuals.

The incubation period is typically between 5 and 21 days, and patients remain contagious until all lesions have dried up and fallen off.

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