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Haemoglobin H disease and outcomes in Singapore

Dear Editor, Haemoglobin H (HbH) disease is a haemoglobinopathy affecting 3 of 4 α-globin genes on chromosome 16. It results from the deletion of 2...

A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia

Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy. This...

A Study of Idiopathic Thrombocytopenic Purpura (ITP) Patients over a Ten-year Period

Idiopathic thrombocytopenic purpura (ITP) is an immunoregulatory disorder in which antibodies damage platelets leading to their removal by cells of the reticuloendothelial system (RES)....

Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore

In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has...

Are Antacids Necessary as Routine Prescriptives with Non-steroidal Anti-inflammatory Drugs?

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic or anti-inflammatory properties in musculoskeletal pain. However, they are not without adverse effects, such...

9th Seah Cheng Siang Memorial Lecture: Gastric Cancer—Where are we now?

The last two decades have witnessed dramatic changes in the understanding of gastric cancer: a rapid decline in global incidence, its association with Helicobacter...

A Case Report of Adult T-Cell Leukaemia/Lymphoma (ATLL)

Our patient was a 71-year-old Chinese man who presented with a 6-year history of recurrent papular erythematous eruptions to the dermatologist. This article is available...

Newer Thrombolytic Agents

First-generation fibrinolytic agents (streptokinase and urokinase) are effective thrombolytic drugs, but are not fibrin specific as they also have the property to convert circulating...

Diagnosing and Managing Faecal Incontinence

Faecal incontinence is the inability to control the passage of gas, liquid or solid through the anus. Its severity varies from infrequent passage of...

Magnetic Resonance Cholangiopancreatography: Value of Using the Half-Fourier Acquisition Single-Shot Turbo Spin-Echo (HASTE) Sequence

Direct cholangiopancreatography has long been considered the standard of reference for assessment of the biliary tree and is generally safe, reliable and widely available....

8th Seah Cheng Siang Memorial Lecture: New Antithrombotic Agents

The tremendous interest in finding new anti-aggregating agents stems from the preeminent role that platelets play, not only in haemostasis and thrombosis, but also...

Activated Protein C Resistance: A Study Among 60 Thromboembolic Patients in the Singapore Population

In 1993, Dahlback and colleagues described a new hereditary thrombophilia state-activated protein C resistance (AK-R). Further studies showed this to be the commonest genetic...

Standard Oesophageal Manometry in Healthy Adults in Singapore

Although standard oesophageal manometry has been widely used in the West for many years, normal manometric values that have been well described for healthy...

Gut Barrier Dysfunction in Experimental Acute Pancreatitis

Bacterial infections are devastating and potentially lethal complications of acute pancreatitis, responsible for up to 80% of deaths in the condition. Pathogenetic studies of...

Experimental Models of Pancreatitis

From a historical perspective, the first experimental pancreatitis was induced by Claude Bernard in 1856 by the injection of bile and olive oil into...

Experimental Models of Hepatic Fibrosis in the Rat

Hepatic fibrosis and cirrhosis of the liver are complex diseases which, in man, may be caused by such varied factors as alcohol, hepatitis, schistosomiasis,...

Development of the Human Intrahepatic Biliary System

The development of the human biliary system has been studied extensively. This knowledge is essential to the understanding of the pathogenesis of a spectrum...

Experimental Study of Hypovolaemic Shock-Induced Gastric Mucosal Lesions in the Rat

Hypoxic tissue injury is not only caused by lack of oxygen as was previously believed. Now it is clear that tissue injury associated with...

The Role of Mast Cell Degranulation in Ischaemia-reperfusion-induced Mucosal Injury in the Small Intestine

Although a number of data support the notion that mast cell (MC) degranulation Is an important component of the tissue response elicited by ischaemia-reperfusion,...

Direct Mucosal Targeting of Colonic Receptors by Prokinetic Drugs in an Experimental Model

The direct intraluminal (IL) administration of drugs into the intestine may have an important regional action and therefore clinical implications in the effective management...

Antineutrophil Cytoplasmic Antibodies (ANCAs) in Patients with Inflammatory Bowel Disease Show No Correlation with Proteinase 3, Lactoferrin, Myeloperoxidase, Elastase, Cathepsin G and Lysozyme: A Singapore Study

The diagnostic tests currently employed to diagnose inflammatory bowel disease (IBD) and to differentiate between Crohn’s disease (CD) and ulcerative colitis (UC) are both...

Pseudomembranous Tracheobronchitis Caused by Aspergillus in a Patient after Peripheral Blood Stem Cell Transplantation

Pseudomembranous tracheobronchitis caused by Aspergillus is a rare and lethal variant of invasive aspergillosis. It has been reported in a few series of immunocompromised...

Philadelphia Positive Acute Lymphoblastic Leukaemia (ALL): Clinico-Haematologic Characteristics, Molecular Analyses and 3-year Follow Up—A Single Institution Study

A number of specific chromosome abnormalities are associated with acute lymphoblastic leukaemia (ALL). The commonest in adults with B lineage ALL is the Philadelphia...

Pseudomembranous Colitis in a Patient Treated with Paclitaxel for Carcinoma of the Breast: A Case Report

Paclitaxel was discovered in 1963 as a crude extract from the bark of the pacific yew Taxus brevifolia. Since its development, a range of...

Early Hepatocellular Carcinoma Presenting with Biliary Ductal Invasion—A Case Report

Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000...

Survival of Colorectal Cancer Patients in Singapore by Anatomic Subsite: A Population-based Study

Colorectal cancer incidence rates rank second in most developed countries and have been rising rapidly in urban societies of East Asia. Despite much effort...

Thrombotic and Haemorrhagic Complications in Patients with Mechanical Heart Valve Prostheses Attending the Singapore General Hospital Anticoagulation Clinic

Patients with mechanical heart-valve prosthesis receive lifelong anticoagulation. The management of these patients taking oral anticoagulants is aimed at achieving and maintaining adequate levels...

Shigella Septicaemia in Adults: Report of Two Cases and Mini-Review

Shigellosis is generally considered to be confined to the gastrointestinal tract. Septicaemic infections with Shigella species are extremely rare in adults. This article is available...

Psychiatric Illness, Personality Traits and the Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder seen by gastroenterologists and has been found to account for 50% of referrals...

Clinical Update on Helicobacter pylori

Helicobacter pylori is one of the commonest infections in human, affecting 30% to 50% of people worldwide. It is associated with the development of...

Treatment of Acute Promyelocytic Leukaemia Using a Combination of All-trans Retinoic Acid and Chemotherapy

Acute promyelocytic leukaemia (APL), or acute myeloid leukaemia (AML)-M3 under the French-American-British (FAB) classification, is characterised by the following: a distinct expansion of promyelocytes...

Perioperative Treatment with Bactericidal/Permeability-Increasing Protein (rBPI21) in Major Liver Surgery: A Concise Summary

Primary and secondary hepatic malignancies constitute a major health problem. Hepatocellular carcinoma accounts for 90% of all primary hepatic malignancies in the world. While...

Book Review

The third edition of this manual of gastroenterology by regional experts from Malaysia and Singapore consists of 27 short chapters packaged in 2 sections...

CD4 Lymphocyte Enumeration in Patients with Human Immunodeficiency Virus Infection Using Three-Colour and Four-Colour Dual-Platform Flow Cytometry: An Inter-Laboratory Comparative Evaluation

Clinical flow cytometry provides a precise technology for the multiparameter analysis of the morphological (scatter) and immunofluorescence properties of stained leukocyte populations, as well...

Deep Vein Thrombosis is Not Rare in Asia—The Singapore General Hospital Experience

Deep vein thrombosis (DVT), pulmonary embolism (PE), the postphlebitic syndrome and recurrent venous thromboembolism (VTE) are important and often preventable causes of early morbidity...

High-dose Therapy followed by Autologous Haematopoietic Stem Cell Transplantation in Multiple Myeloma

Multiple myeloma (MM) is a disorder in which malignant plasma cells accumulate in the bone marrow and produce an immunoglobulin, usually monoclonal IgG or...

New Aspects of the Blood Coagulation Cascade, Anticoagulants and Vein Thrombosis in Asia

Injury to blood vessels triggers haemostasis, a process that has evolved to achieve two superficially incompatible outcomes: arresting blood loss while protecting vessel patency...

Four Pregnancies in Two Patients with Essential Thrombocythaemia—A Case Report

Essential thrombocythaemia (ET) is a rare myeloproliferative disease which manifests with an elevated platelet count. It presents predominantly in the middle-aged population, occurring slightly...

Idiopathic Thrombocytopenia in Pregnancy

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which platelets are sensitised with an antiplatelet autoantibody and then destroyed by the reticuloendothelial system.1...

Thrombophilia in Pregnancy

A clear understanding of thrombophilia is becoming increasingly important in the practice of high-risk obstetrics. In addition to their role in thromboembolic disease, there...

Management of Haematologic Malignancies in Pregnancy

Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The...

Pregnancy in Women with Idiopathic Thrombocytopaenic Purpura

Idiopathic thrombocytopaenic purpura (ITP) is the most common autoimmune haematological disorder in pregnancy. The pathophysiology of the disease is peripheral destruction of platelets mediated...

Clinical Update on Deep Vein Thrombosis in Singapore

Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It...

Case Report on Recombinant Coagulation Factor VIIa in the Treatment of Three Haemophilia A Patients with Inhibitors in Singapore

Development of inhibitors against factor VIII is one of the main complications in the treatment of haemophiliacs. Inhibitors block the procoagulant effects of factor...

Current Status in the Surgical Management of Adult Polycystic Liver Disease

Adult polycystic liver disease (APLD) is a rare benign condition that is characterised by the growth of multiple cystic lesions in the liver. More...

Evaluation on the Use of a Portable Unit Versus the Laboratory for the Monitoring of International Normalized Ratio (INR) in Orally Anticoagulated Patients

Oral anticoagulation therapy is used for a number of conditions, namely deep venous thrombosis, pulmonary embolism, mechanical heart valves, embolic stroke as well as...

Boerhaave’s Syndrome Presenting as a Right-sided Pleural Effusion

A 79-year-old Chinese woman with no significant past medical history was admitted to another hospital with symptoms of abdominal pain and haemetemesis of approximately...

Modern Management of Colorectal Polyps: Are They All Premalignant?

Polyps of the colon and rectum are relatively common lesions. Most colorectal polyps are either adenomas or hyperplastic polyps. This article is available only as...

Autoimmune Liver Disease in Children

Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1)...

Trauma-induced coagulopathy: Mechanisms and clinical management

Globally, trauma accounts for the highest number of mortalities in adolescents and young adults up to 49 years old.1 Of these deaths, a large...

Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

The practice of gastrointestinal (GI) endoscopy over the last 3 decades has seen both a rise in volume of routine procedures, and an increase...

The impact of deprescribing interventions on oral proton pump inhibitor utilisation in a Singapore tertiary hospital: A quality improvement initiative

The established efficacy of proton pump inhibitors (PPIs) in the treatment of upper gastrointestinal (GI) disorders, coupled with their perceived safety, have led to...

Coagulopathy related to trauma: Is it time for a goal-directed approach?

Trauma represents a leading cause of death globally, and post-traumatic haemorrhage accounts for 40% of early mortality in spite of recent improvements in modern...

Ensuring safe sedation during gastroendoscopy

Gastrointestinal (GI) endoscopy started in Singapore in 1968 with diagnostic endoscopic gastric examination, using flexible fibre-optics GI endoscopy. Fibre-optic flexible sigmoidoscopy and colonoscopy were...

Inflammatory Fibroid Polyp of the Caecum in a Patient with Neurofibromatosis

Inflammatory fibroid polyp is an uncommon nonneoplastic lesion found in the gastrointestinal tract. It is a benign, non-encapsulated submucosal lesion, composed mainly of loose...

Clinico-pathological Analysis of Myelodysplastic Syndromes According to French-American-British Classification and International Prognostic Scoring System

Myelodysplastic syndromes (MDS) are a heterogeneous group of acquired clonal haemopoietic stem cell disorders characterised by ineffective haematopoiesis and peripheral cytopenia. The natural history...

In vitro Biological Characteristics of Human Cord Blood-derived Megakaryocytes

Haematopoietic stem cell transplantation (HSCT) is now a well-established therapeutic modality for a broadening spectrum of medical problems. Umbilical cord blood (CB) has emerged...

Unrelated Umbilical Cord Blood Transplantation in Children and Adults

Allogeneic haematopoietic stem cell transplantation (HSCT) is an established form of treatment for many high-risk haematological malignancies and marrow failure syndromes. The use of...

Haematopoietic Graft Engineering

Haematopoietic stem cell transplantation (HSCT) has become an established modality for the treatment of cancer and diseases of the bone marrow and immunological system....

Stem Cells: Current Usage and Future Potentials

In recent years, the term “haematopoeitic stem cell transplantation” has replaced “bone marrow transplantation”. It is more precise and emphasises the “haematopoeitic stem cell”...

Appropriateness of the Use of Parenteral Nutrition in a Local Tertiary-Care Hospital

Parenteral nutrition (PN) is an important supportive and often life-saving therapy for patients with gut failure. However, it is expensive and carries significant complications...

A Rare Case of Porphyria

Porphyrias are a rare and intriguing group of metabolic disorders. We report a case of congenital erythropoietic porphyria, one of the infrequent forms of...

Extensive Calcinosis Cutis in Relapsed Acute Lymphoblastic Leukaemia

Calcinosis cutis is characterised by the aberrant deposition of calcium salts in the skin. In metastatic calcinosis cutis, calcium salts are precipitated in normal...

A Bolt Out of the Blue: A Case of Unexpected Acute Liver Failure

Acute hepatitis could result from viral, autoimmune or drug-reaction causes, among others. In areas endemic with hepatitis B, acute exacerbations of chronic hepatitis B...

Does the Advent of Endoscopic Ultrasound (EUS) Sound the Death Knell for Endoscopic Retrograde Cholangiopancreatography (ERCP)?

Endoscopic retrograde cholangiopancreatography (ERCP) has been the primary method of diagnosing and treating many pancreatic and biliary diseases (PBD) over the last 3 decades....

Clinical Experience with Three Combination Regimens for the Treatment of High-risk Febrile Neutropenia

Cancer patients who become severely neutropenic as a result of intensive myelosuppressive chemotherapy are at high risk for developing life-threatening infections, and unless they...

Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis

Coronary artery disease (CAD), also called coronary heart disease, is the leading cause of death for both men and women. CAD is usually caused...

Ceftriaxone-resistant Salmonella spp. in Singapore

The utility of ceftriaxone for the treatment of Salmonella typhi bacteraemia was first demonstrated in Singapore as early as 1985. Since then, ceftriaxone has...

Ten-year Series of Splenic Abscesses in a General Hospital in Singapore

Splenic abscess is an uncommon clinical problem. Fewer than 800 cases have been reported in the literature. This article is available only as a PDF....

Charity Colonoscopy Event to Commemorate the 185th Anniversary of Singapore General Hospital

Colorectal cancer is now the cancer with the highest incidence in Singapore. Similar to many developed countries, individuals here have a moderate to high...

Use of Antibiotics in a Haematology Ward – An Audit

Rising rates of antibiotic resistance prompted a review of antibiotic use policies hospitalwide. The Department of Haematology established a new set of consensus guidelines...

An Unusual Cause of Lymphadenopathy and Rash

A 38-year-old Chinese man who was previously well, presented with one month of fever and a non-pruritic rash involving the face, trunk and upper...

Bone Marrow Cytogenetics Workup: Application of Lean Management System to Determine if Additional Cell Workup is Helpful and Necessary to Analysis

Cytogenetic studies are important to the diagnosis and monitoring of various haematopoietic disorders such as myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), acute lymphoblastic...

A Case of Congenital Haemolytic Anaemia and Thrombocytopenia

A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to...

Guidelines for Endoscopic Ultrasonography

This guideline addresses the use of endoscopic ultrasound (EUS) as part of the diagnostic evaluation of certain conditions. In addition, issues of training and...

Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore

Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A...

Diagnostic Challenge: A 79-Year-Old Woman with Calcified Lower Abdomen Mass

A 79-year-old woman presented with fever, diarrhoea, vomiting and abdominal pain for several hours. Her temperature was 39.2°C, pulse 102 beats/minute, respiratory rate 19...

Laparoscopic Common Bile Duct Exploration: Our First 50 Cases

Since its introduction a few decades ago, endoscopic retrograde cholangiopancreatography (ERCP) has brought about a significant change in the management of choledocholithiasis. With continual...

Immunophenotypic, Cytogenetic and Clinical Features of 113 Acute Lymphoblastic Leukaemia Patients in China

Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with abnormal proliferation and accumulation of immature lymphoblasts within the bone marrow (BM), peripheral blood and...

Peutz-Jeghers Syndrome: Data from the Singapore Polyposis Registry and a Shifting Paradigm in Management

Peutz-Jeghers Syndrome (PJS) is an uncommon autosomal dominant hamartomatous polyposis syndrome associated with mucocutaneous melanocytic macules. Melanin deposition occurs most commonly in the perioral...

Non-haem Iron-mediated Oxidative Stress in Haemoglobin E Beta-thalassaemia

Thalassaemia is a genetic haemoglobinopathy in which the production of normal haemoglobin is partly or completely suppressed because of a defective synthesis of 1...

When Less is More: Can We Abandon Prophylactic Platelet Transfusion in Dengue Fever?

Dengue fever (DF) is the most common mosquito-borne human viral illness worldwide, and has rapidly spread to reach hyper-endemic proportions in the urban tropics...

Thyroid Dysfunction and Long-term Outcome during and after Interferon-alpha Therapy in Patients with Chronic Hepatitis C

Hepatitis C virus (HCV) infection is a major health problem, affecting more than 170 million people worldwide. Its prevalence rates range from 0.5% to...

Fasting during Ramadan and Associated Changes in Glycaemia, Caloric Intake and Body Composition with Gender Differences in Singapore

Muslim individuals worldwide participate in obligatory abstinence from oral consumption of medications, food and liquid during the fasting month of Ramadan. Fasting during Ramadan...

Assessment of Age in Ulcerative Colitis Patients with Ileal Pouch Creation—An Evaluation of Outcomes

A total proctocolectomy is considered the standard of care in patients with ulcerative colitis (UC). The indications for this operation in patients with UC...

Medical management of PAD: Expand or consolidate?

In this issue of the Annals, a rapid review of adherence to evidence-based medical treatment highlights an important and underappreciated aspect of the management...

Congenital adhesion band causing recurrent subacute intestinal obstruction in a virgin abdomen

Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB)...

Severe COVID-19 and coagulopathy: A systematic review and meta-analysis

Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications....

Estimating the impact of COVID-19-induced coagulopathy

The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is...