Background/Objectives: BRCA1 pathogenic variant (PV)-associated breast cancers are most commonly seen in hereditary genetic conditions such as the autosomal-dominant Hereditary Breast and Ovarian Cancer (HBOC) syndrome, and rarely in sporadic breast cancer. Such breast cancers tend to exhibit greater aggressiveness and poorer prognoses due to the influence of BRCA1 pathogenic variants (PVs) on the tumour microenvironment. Additionally, while the genetic basis of BRCA1 PV breast cancer is well-studied, the role of epigenetic mediators in the tumourigenesis of these hereditary breast cancers is also worth exploring. Results: PVs in the BRCA1 gene interact with stromal cells and immune cells, promoting epithelial–mesenchymal transition, angiogenesis, and affecting oestrogen levels. Additionally, BRCA1 PVs contribute to breast cancer development through epigenetic effects on cells, including DNA methylation and histone acetylation, leading to the suppression of proto-oncogenes and dysregulation of cytokines. In terms of epigenetics, lysine-specific demethylase 1 (LSD-1) is considered a master epigenetic regulator, governing both transcriptional repression and activation. It exerts epigenetic control over BRCA1 and, to a lesser extent, BRCA2 genes. The upregulation of LSD-1 is generally associated with a poorer prognosis in cancer patients. In the context of breast cancer in BRCA1/2 PV carriers, LSD-1 contributes to tumour development through various mechanisms. These include the maintenance of a hypoxic environment and direct suppression of BRCA1 gene expression. Conclusions: While LSD-1 itself does not directly cause mutations in BRCA1 or BRCA2 genes, its epigenetic influence sheds light on the potential role of LSD-1 inhibitors as a therapeutic approach in managing breast cancer, particularly in individuals with BRCA1/2 PVs. Targeting LSD-1 may help counteract its detrimental effects and provide a promising avenue for therapy in this specific subgroup of breast cancer.

Clostridium tetani, the causative organism of tetanus, is unusual in developed countries including Singapore and to our knowledge, only three known cases of Clostridium tetani bacteraemia have been reported worldwide. This case report describes a case of Clostridium tetani bacteraemia in a Singaporean patient without clinical manifestations of tetanus, likely arising from a sacral sore, highlighting the need for early recognition and targeted antimicrobial treatment for the condition and its complications.

Background: Salter-Harris Type I (SH1) fractures of the distal fibula are inherently stable and can be managed conservatively with immobilisation. Numerous immobilisation techniques are used in clinical practice, with no gold standard currently established. This systematic review aims to evaluate the functional and patient-reported outcomes of traditional, rigid immobilisation techniques compared to less restrictive ones that allow earlier mobilisation. Methods: The PubMed, MEDLINE Ovid, Embase and Cochrane Library databases were searched systematically for studies on skeletally immature children and adolescents with isolated distal fibula SH1 fractures. Those with polytrauma or pre-existing musculoskeletal or developmental conditions were excluded. Quality assessment was conducted using Cochrane risk-of-bias and JBI tools. Narrative analysis was employed in conjunction with Synthesis Without Meta-analysis (SWiM). Results: Six studies involving 349 participants were included, of which four were randomised controlled trials (RCTs) and two were observational studies. Within the RCT group, three compared casting to bracing, tubular bandaging or controlled ankle motion (CAM) boot wearing, while one compared posterior splinting to bracing. Both observational studies only reported outcomes of one immobilisation technique – one on casting and the other on bracing. Nine outcomes were reported, with less restrictive immobilisation having more favourable results in six – time to return to normal levels of activity, functional scores, satisfaction, complications, cost-effectiveness and hours of school missed. The remaining three outcomes – pain, duration of analgesia and weight-bearing – were comparable in both immobilisation groups. Discussion: Collectively, the findings underscore the adequacy and benefits of using less restrictive immobilisation for SH1 distal fibula fractures, which is in keeping with the current trend towards less rigid immobilisation techniques in clinical practice. Limitations of this review include reporting biases and lack of certainty of evidence from small sample sizes. Level of evidence: II.

Clostridium tetani, the causative organism of tetanus, is unusual in developed countries including Singapore and to our knowledge, only three known cases of Clostridium tetani bacteraemia have been reported worldwide. This case report describes a case of Clostridium tetani bacteraemia in a Singaporean patient without clinical manifestations of tetanus, likely arising from a sacral sore, highlighting the need for early recognition and targeted antimicrobial treatment for the condition and its complications.

Clostridium tetani , the causative organism of tetanus, is unusual in developed countries, including Singapore, and to our knowledge, only three known cases of C. tetani bacteraemia have been reported worldwide. This case report describes a case of C. tetani bacteraemia in a Singaporean patient without clinical manifestations of tetanus, likely arising from a sacral sore, highlighting the need for early recognition and targeted antimicrobial treatment for the condition and its complications.