Ask MEDICUS

 

Ask MEDICUS

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In our previous issue, you asked for insights on the availability of vaccines and how the body responds to burns.

In this issue, experts from Duke-NUS and the wider SingHealth Duke-NUS Academic Medical Centre once again answer your questions, sharing their knowledge on the correlation between science, medicine and solving real-life issues; the latest updates on tackling kidney diseases; and, last but not least, how you can further your studies at Duke-NUS.

Our mailbox is always open and we’d love to hear your burning questions for our experts from our Signature Research Programmes and Centres as well as our clinical specialists and faculty. While we can’t answer questions beyond our fields of expertise, we promise to answer those we can.

So, continue to send us your burning questions and we’ll sate your scientific curiosity.

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Have a question? Send it in and it may be answered in the next issue of MEDICUS!

ASK MEDICUS


Duke-NUS building

Can I go straight from college to Duke-NUS?

- Brianna Harris via email

You can apply to enrol in Duke-NUS’ MD and/or MD-PhD programmes after graduating from college with a Bachelor’s degree.

You can also apply when you are nearing the final year of your studies, as long as you’ll receive your degree from an accredited college or university by the time of matriculation.

There are two main deadlines every year for those applying to either the MD programme or the MD-PhD track: the early acceptance deadline falls on 1 September, while the regular admissions deadline falls on 31 January of every year.

You will need to complete and submit your online application by the above deadlines, with the following documentation ready:

  • an undergraduate basic degree or higher in any discipline
  • results of your Medical College Admission Test or Graduate Medical School Admissions Test
  • three to five recommendation letters
  • transcripts from your undergraduate institution (and graduate institution, if applicable), and
  • if you’re a student from outside Singapore or the US, a World Education Services International Credential Advantage Package report is also required

For more information on our admissions requirements, you may refer to the information on our webpage.

If you require additional information about our application process and programmes, then I suggest attending one of our information sessions hosted by the recruitment team, where you’ll get the opportunity to any questions you may have.


Ms Lynn Ng
Senior Associate Director, Admissions




research and science

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Medicine is built on the foundation of evidence-based research (or science). Is science the only approach to understanding medicine? Then could science help solve real-world issues?

Zachary via email

This is an interesting question and the answer depends on one’s definition of science. Taken in a narrow sense, natural sciences such as chemistry and biology are, indeed, the bedrock of modern medicine. They help us understand the mechanistic aspect of health and diseases, leading to the development of interventions and treatments such as drugs and vaccines. 

However, in a broader sense, science should also encompass both natural and social sciences. Social sciences, including social anthropology, psychology and political science, provide a more nuanced understanding of the multifaceted nature of health. For example, these disciplines help us to understand how social and cultural norms affect health outcomes through our health-seeking behaviour. They underscore the importance of social determinants of health and health equity, two aspects that are also critical for the implementation of medical interventions and healthcare policies in the real world.

The recent pandemic provides a textbook illustration of why both branches are needed to solve real-world problems. The knowledge that we gain from natural sciences through next-generation sequencing and mRNA technology has helped the world develop an effective vaccine for COVID-19 in record time. However, we had largely failed in addressing challenges through the lenses of social anthropology and political science.

Therefore, the science of medicine is not limited to the natural sciences alone. It is a multidisciplinary field that leverages insights from both natural and social sciences. Together, they provide a holistic understanding of health and help inform the development and implementation of effective healthcare strategies. It is through these multi-sectoral approaches that practical applications of scientific knowledge can effect real-world change to tackle real-world problems.


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Clinical Associate Professor Tan Hiang Khoon 
Director, SingHealth Duke-NUS Global Health Institute
Group Director, International Collaboration Office, SingHealth
Deputy CEO (Future Health System), Singapore General Hospital




kidney

iStock.com / unomat 

What are some of the latest updates on interventions for chronic kidney diseases and kidney failure?

Muhammed Yeasin Paik Bari via email

The incidence of end-stage kidney failure in Singapore is among the highest in the world, and this is driven primarily by the very high incidence of kidney disease caused by diabetes.

One approach for preventing kidney failure is through early detection and timely institution of treatments.  However, because kidney disease doesn’t cause any symptoms until very late in the course, the majority of affected individuals go undiagnosed.  In this group of individuals, kidney disease can only be detected through blood and urine tests.  Thus, it is important that screenings are carried out to identify those who need treatments and interventions. To help address this problem, we have been working with the National Kidney Foundation and hospitals around Singapore to raise awareness on the importance of widespread screening for kidney disease.

Thankfully, there are now several drugs available for slowing the progression of kidney injury in individuals with chronic kidney disease. Aside from the long-standing pillars of treatment like Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin-receptor blockers (ARBs), powerful new therapies for chronic kidney diseases have been identified and approved for use in recent years. 

One class of such agents are Sodium-glucose Cotransporter-2 Inhibitors, or SGLT2 inhibitors. These drugs were initially developed as treatment for diabetes, but were found to be very effective in slowing the progression of both diabetic and non-diabetic kidney diseases. Another diabetes drug, GLP-1 agonists, also seems to have similar benefits.

A different class of drugs, called mineralocorticoid antagonists, have also been used to complement existing therapies for kidney disease. When used in combination with ACE inhibitors or ARBs, they slow the progression of kidney disease, delaying the need for dialysis. 

SGLT2 inhibitors, GLP-1 agonists and the mineralocorticoid antagonists are examples of new drugs with good efficacy. While they help slow the progression of disease, they do not offer a cure for kidney disease. 

On the other hand, drugs that can block the major pathways leading to kidney disease might restore kidney function, possibly reversing and maybe “curing” kidney diseases.

In this regard, one of the most promising innovations in the pipeline is an interleukin11 (IL11) antibody developed by Professor Stuart Cook and his team from the Duke-NUS Cardiovascular and Metabolic Diseases programme. 


In preclinical studies, antibody therapy blocking the actions of IL11 dramatically reduced and even reversed manifestations of kidney disease when used in combination with existing therapies. They also seemed to induce regeneration of lost kidney tissue in some settings.  However while they seem very promising, these agents are still in early human safety trials and yet to be approved for use in kidney disease. 

Nonetheless, as clinical trials progress over the next few years, I remain hopeful that this powerful class of drugs will make the journey from bench to bedside to benefit patients.


 
Compiled and edited by Chua Li Min and Levin Tan
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