Original Article
Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes
Sudden cardiac death in athletes during exercise is rare, with an estimated incidence of 1–2 per 100,000 people per year in young athletes,1 and...
Editorial
Improving electrocardiogram interpretation in Asian athletes: A call to action
The field of sports cardiology has evolved substantially over the past 2 decades due to improved understanding of the athlete’s heart, causes of sudden...
Commentary
Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore
Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED)...
Original Article
Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns
Emergency department (ED) overcrowding is a growing issue that threatens public health in various parts of the world,1 including the US,2 UK,3 Australia,4 Japan5...
Editorial
Frequent attenders to multiple emergency departments in Singapore
The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its...
Original Article
Epidemiological trends and outcomes of children with aural foreign bodies in Singapore
Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to...
Review Article
Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents
The World Health Organization’s Global action plan for the prevention and control of noncommunicable diseases 2013–2020 provided guiding principles for national efforts in controlling...
Review Article
Determinants of emergency department utilisation by older adults in Singapore: A systematic review
Older adults in Singapore contribute to a disproportionately higher number of visits to the emergency department (ED), mirroring trends around the world.1,2 For instance,...
Original Article
Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial
Critically ill patients in the emergency department (ED) have shorter safe apnoea times due to physiological distress from decreased cardiac output, increased shunting and...
Original Article
Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis
End-stage renal failure (ESRF) is a major cause of morbidity and mortality worldwide, including Asia.1 In Singapore, incidence of chronic kidney disease (CKD) stage...
Editorial
Survival outcome of haemodialysis and peritoneal dialysis
End-stage renal disease (ESRD) is a challenging and growing health issue, with number of patients increasing globally. The use of dialysis has greatly improved...
Original Article
A Review of Pedestrian Fatalities in Singapore from 1990 to 1994
Fatal road accidents are by no means uncommon in Singapore, a modern tropical metropolis with a population of approximately 3 million. Statistics provided by...
Original Article
Radiotherapy as Local Adjuvant Treatment for Endometrial Carcinoma—A Review of 45 Patients
Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control...
Original Article
Patients Admitted to an Intensive Care Unit for Poisoning
The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed...
Original Article
A Retrospective Study of Near-drowning Victims Admitted to the Intensive Care Unit
Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present.
This article...
Original Article
Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team
Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute...
Original Article
Extent and Appropriateness of Emergency Department Services Usage by Foreign Workers in Singapore
Singapore employs more than 350,000 foreign workers currently. With this influx of foreign workers into our city-state which has limited land and resources, it...
Original Article
Drowning and Near-drowning—Some Lessons Learnt
Drowning is defined as suffocation from submersion in a liquid with death within the first twenty-four hours. Near-drowning implies that recovery has occurred, at...
Original Article
Extended Resection of Locally Advanced (T4) Stomach Cancer
Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years,...
Original Article
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...
Commentary
Preparing for the silver boom: A falls prevention tool for older adults in the emergency department
Each year, 28–35% of community dwelling adults over 65 years fall.1 This figure increases to about 50% for those above 80 years old.2 Falls...
Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...
Others
Primary Anorectal Malignant Melanoma: Clinical Features and Results of Surgical Therapy in Singapore—A Case Series
Malignant melanoma arising from the anal canal was first described in 1857. It is uncommon, comprising only about 1% of all anal canal tumours.
This...
Original Article
Intravenous Adrenaline or Vasopressin in Sudden Cardiac Arrest: A Literature Review
Of the approximately 15,000 deaths that occur in Singapore every year, about 25% are from cardiac causes; of which, some 30% to 40% occur...
Review Article
The Growth and Development of Orthopaedic Sports Medicine in Singapore
Orthopaedic sports medicine in Singapore took form as a subspecialty of orthopaedic surgery over a number of years. Several individuals contributed to it being...
Original Article
Audit of Total Parenteral Nutrition in an Adult Surgical Intensive Care
Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to...
Original Article
Acute Coronary Syndrome—Factors Causing Delayed Presentation at the Emergency Department
Acute coronary syndrome (ACS) refers to a continuum of clinical entities ranging from unstable angina pectoris (UAP) to Q-wave myocardial infarction. Mortality rates from...
Original Article
The Acute Presentation of Pulmonary Thromboembolism: A Retrospective Viewpoint
Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition...
Original Article
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous...
Original Article
Outcomes of Acute Arthroscopic Repair and Conservative Treatment Following First Traumatic Dislocation of the Shoulder Joint in Young Patients
Traumatic dislocation of the shoulder is a serious problem especially in active and young patients. Shoulder instability and recurrent dislocation hinder patient activities.
This article...
Others
Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations
It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in...
Others
Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital
Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly...
Letter to the Editor
Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study
Dear Editor,
The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of...
Original Article
Rising Trend of Anterior Cruciate Ligament Injuries in Females in a Regional Hospital
Female athletes are at a greater risk for injuries involving the anterior cruciate ligament (ACL) than their male counterparts in high schools and colleges...
Original Article
Work-related Injury Sustained by Foreign Workers in Singapore
Singapore has a resident population of 3.26 million and 0.53 million foreign workers. Of these half a million foreigners, 450,000 are work permit holders,...
Others
Potentially Fatal Paracetamol Overdose and Successful Treatment with 3 Days of Intravenous N-acetylcysteine Regime – A Case Report
Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in...
Commentary
Clinical Cases Seen in Tsunami Hit Banda Aceh – From a Primary Health Care Perspective
Earthquakes and tsunamis can cause massive destruction over large areas, affecting the lives of many in areas hit by such disasters. The local health...
Letter to the Editor
Pitfalls in the Use of Allometry in Accounting for Differences in Body Mass in Relation to Maximal Oxygen Uptake in Trained Athletes
We thank the author of the letter to the editor for his interest in our study.
This article is available only as a PDF. Please...
Letter to the Editor
The Perils of Allometric Scaling
I read with interest the paper by Chia and Aziz. Using allometric scaling, the authors adjusted peak oxygen uptake (VO2max) for the confounding influence...
Letter to the Editor
Important Considerations for Recommending Hydration Studies
We read with interest the study by Sun and colleagues published in the recent April Sports Medicine edition. The study investigated fluid balance associated...
Original Article
Observational Study to Determine Factors Associated with Blood Sample Haemolysis in the Emergency Department
Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in...
Original Article
Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative
Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms...
Letter to the Editor
Renal Artery Embolism in a Patient with Vague Abdominal Pain
Thromboembolism is a well-known complication of mitral stenosis especially when it is associated with cardiac dysrhythmias. However, renal artery embolism is a disease that...
Others
Clinical Characteristics of Renal Infarction in an Asian Population
Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months.
This article...
Others
Magnetic Resonance Imaging of Sports Injuries of the Knee
Sports-related knee injuries are common, with contact sports and sports involving twisting movements being the most frequent causes. Sports injuries may affect any of...
Review Article
Human Thermoregulation and Measurement of Body Temperature in Exercise and Clinical Settings
The ability to sense and regulate body temperature is a key feature of human survival. A deviation of ± 3.5°C from the resting temperature...
Review Article
Hamstring Injuries: Risk Assessment and Injury Prevention
The aim of this article is to outline the factors involved with, and a potential strategy for preventing, one of the most common injuries...
Review Article
Isokinetic Dynamometry in Anterior Cruciate Ligament Injury and Reconstruction
Of all the ligaments of the knee joint, the anterior cruciate ligament (ACL) is the most frequently injured despite its structural proficiency and its...
Review Article
Knee and Ankle Ligaments: Magnetic Resonance Imaging Findings of Normal Anatomy and at Injury
Ligamentous injuries of the knee and ankle are a common entity among athletes. Knee sprains can account for up to 30% of injuries in...
Original Article
Recurrent Patellar Dislocation: Reappraising our Approach to Surgery
Traumatic patellar dislocations affect mainly adolescents and young adults. Up to 44% of patients will develop recurrent dislocation.
This article is available only as a...
Original Article
Common Lower Limb Sports-related Overuse Injuries in Young Athletes
Treating sports injuries in children and adolescent presents a unique challenge to the physician. They are different anatomically and physiologically from adults.
This article is...
Original Article
Plasma Endotoxin and Immune Responses During a 21-km Road Race Under a Warm and Humid Environment
During intense exercise, immune disturbances can occur through an increase in plasma pro- and anti-inflammatory cytokines and lipopolysaccharide (LPS) concentrations, and post-exercise leukocytosis and...
Original Article
Modelling Maximal Oxygen Uptake in Athletes: Allometric Scaling Versus Ratio-Scaling in Relation to Body Mass
Aerobic fitness data of Singaporean athletes are relatively scarce. Yet these data are important as aerobic fitness forms the basis of all training programmes...
Original Article
Triple Endobuttton Technique in Acromioclavicular Joint Reduction and Reconstruction
Acromioclavicular joint (ACJ) dislocation is a common injury often affecting young athletes. Cyclist, ice hockey players, weight lifters, rugby players and martial exponents are...
Original Article
Effects of a 12-week Exercise Training Programme on Aerobic Fitness, Body Composition, Blood Lipids and C-Reactive Protein in Adolescents with Obesity
The prevalence of obesity in children and adolescents is increasing rapidly worldwide. A rising rate of obesity in epidemic proportions also brings about economic...
Original Article
Concurrent Validity of Power Output Derived from the Non-motorised Treadmill Test in Sedentary Adults
The use of the Wingate Anaerobic Test (WAnT) for assessing all-out intensity short-duration sprint cycling lasting between 10 and 40 seconds is pervasive. Many...
Original Article
Return to Sports After Anterior Cruciate Ligament Reconstruction – A Review of Patients with Minimum 5-year Follow-up
Complete anterior cruciate ligament (ACL) rupture results in a mechanically unstable knee. ACL reconstruction is recommended in athletes to help restore knee stability for...
Original Article
Clinical Evaluation of Arthroscopic-assisted Allograft Meniscal Transplantation
The menisci of the knee are fibro-cartilaginous structures essential for the normal biomechanic of the knee joint. They play a critical role in shock...
Original Article
Dehydration Rates and Rehydration Efficacy of Water and Sports Drink During One Hour of Moderate Intensity Exercise in Well-trained Flatwater Kayakers
Flatwater kayaking has been gaining popularity in the world and steep growth has been observed in the Asian region. Long distance paddling is often...
Editorial
Sports Medicine
The National Survey on Sports Participation showed that the number of Singaporeans who exercised regularly at least once a week doubled from 24% in...
Review Article
Osteochondral Lesions of the Talus
Osteochondral lesions of the talus are a known cause of chronic ankle pain. They are frequently found in the active population after ankle sprains.
This...
Original Article
Arthroscopic Management of Superior Labral Anterior and Posterior (SLAP) and Associated Lesions: Clinical Features and Functional Outcome
A superior labral lesion is a pathologic abnormality at the site of the long head of the biceps tendon insertion into the superior labrum...
Review Article
The Role of Surgery in High-grade Glioma – Is Surgical Resection Justified? A Review of the Current Knowledge
High-grade glioma (malignant glioma) is the most common primary intra-axial tumour of the central nervous system (CNS). Despite recent therapeutic advances in glioma treatment,...
Original Article
Survival of Small-cell Lung Cancer and its Determinants of Outcome in Singapore
Lung cancer is the leading cause of cancer mortality around the world.1 Small-cell lung cancer (SCLC) constitutes about 15% to 25% of all lung...
Original Article
Characteristics of unplanned hospitalisations among cancer patients in Singapore
Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the...
Editorial
The case for better hospitalisation selection in cancer patients
Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been...
Original Article
Retinoblastoma: A Recent Experience at the National University Hospital, Singapore
Retinoblastoma is the most common primary intraocular malignancy in infants and children.1 Worldwide, the incidence is 1 in 18,000 to 34,000 live births with...
Letter to the Editor
Reply from Author: Putting the Wedge under Pressure
We thank the authors for their interest in our study and their insightful comments. We agree that filling pressures such as the central venous...
Letter to the Editor
Putting the Wedge under Pressure
We would like to thank Dr Huck Chin Chew et al for sharing their findings and we are appreciative of their work, “Oesophageal Doppler...
Original Article
Epidemiology of Snakebites from A General Hospital in Singapore: A 5-year Retrospective Review (2004-2008)
Snakes are present even in an industrialised country like Singapore. A bite from a venomous snake can inflict much morbidity and occasionally, it can...
Original Article
Are New Resuscitation Guidelines Better? Experience of an Asian Metropolitan Hospital
Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have...
Original Article
The Need for a System of Prognostication in Skeletal Metastasis to Decide Best End-of-life Care – A Call to Arms
Decisions regarding potential surgery for metastatic disease are influenced by estimates of patient survival. For example, patients with long life expectancy may be appropriately...
Original Article
A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore
Our tertiary hospital has a 9-bed Surgical Intensive Care Unit (SICU) that caters to all surgical disciplines except Cardio-Thoracic and Vascular Surgery (which has...
Original Article
Vascular Endothelial Growth Factor C as a Predictor of Early Recurrence and Poor Prognosis of Resected Stage I Non-small Cell Lung Cancer
Non-small-cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide, with a 5-year survival of around 15%. Approximately 20% of patients present...
Original Article
Neonatal and Paediatric Extracorporeal Membrane Oxygenation (ECMO) in a Single Asian Tertiary Centre
Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass technique (CPB) introduced by Bartlett in 1972, which provides life-saving support in patients with refractory yet...
Original Article
Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study
Since the first case of coronavirus disease 2019 (COVID-19) was reported in China in late December 2019, the pandemic has spread throughout the world,...
Original Article
Singapore Rhabdomyosarcoma (RMS) Experience: Shall We Change Our Practice?
Rhabdomyosarcoma (RMS) constitutes nearly 4% of all children diagnosed with cancer in the ethnically diverse small island city of Singapore. It is the most...
Review Article
Cognitive Aspect of Diagnostic Errors
It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were...
Letter to the Editor
Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive...
Editorial
Emergency Medicine Residency Programme in Singapore—Where Are We at Since Inception?
It has been 4.5 years since the Accreditation Council for Graduate Medical Education (ACGME-I) accredited competency-based emergency medicine residency programmes were started in July...
Original Article
A review of child sexual abuse cases presenting to a paediatric emergency department
Child sexual abuse (CSA) is a global public health issue with adverse short- and long-term repercussions. Formal definitions of CSA and the age for...
Letter to the Editor
Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore
The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work...
Original Article
Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there...
Editorial
Community-level interventions for out-of-hospital cardiac arrests in Singapore: Yay or nay?
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and a significant public health problem globally. In Singapore, OHCA affected 11,061 adults between...
Original Article
Survival and Predictors of Mortality in Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis
Approximately one in ten patients admitted to an intensive care unit (ICU) develops acute kidney injury (AKI), an important complication of ICU patients, and...
Letter to the Editor
Circulatory collapse from rupture of splenic artery aneurysm: A case study
Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted...
Original Article
Emergency airway management in a Singapore centre: A registry study
Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to...
Letter to the Editor
Decrease in emergency department attendances during COVID-19 especially in school-going children
Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with...
Original Article
Virtual reality mobile application to improve videoscopic airway training: A randomised trial
Emergency airway management is a keystone of emergency medicine practice and critical skill in residency training. An accredited emergency attending is expected to handle...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases...
Original Article
Epidemiology and risk stratification of minor head injuries in school-going children
Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports...