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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,...

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...

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...

Use of Atypical Neuroleptics in a State Mental Institute

Schizophrenia is the most severe of all mental disorders and affects about 1% of the population. The main disturbances of schizophrenia comprise positive symptoms,...

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...

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...

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...

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...

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...

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...

The Views of Mental Health Professionals Towards Psychotherapy—A Singapore Survey

There is a trend in Asia towards a greater application of psychotherapeutic approaches in multidisciplinary settings to emotional and behavioural disturbances. The inaugural issue...

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...

A Review of Cutaneous Granulomas and Lupus Vulgaris Following BCG Vaccination in a Skin Hospital in Singapore

BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in...

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...

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...

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...

Clinical Profile and Treatment Outcome of Livedoid Vasculitis: A Case Series

Livedoid vasculitis is a clinicopathological entity that has variously been referred to as atrophie blanche, livedoid vasculopathy or segmental hyalinising vasculitis. It presents with...

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...

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...

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...

Characteristics of Six Newborn Infants with Postnatal Findings of Severe Intracranial Haemorrhage

A postnatal finding of intracranial haemorrhage carries potential medico-legal implications for the obstetrician. However, one cannot exclusively attribute this to birth trauma. This article is...

Imaging Findings in Acute Neck Infection due to Pyriform Sinus Fistula

Pyriform sinus fistula is a developmental abnormality of the 3rd or 4th branchial pouch. It usually presents in childhood as acute inflammatory swelling of...

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...

Stonefish Envenomations of the Hand – A Local Marine Hazard: A Series of 8 Cases and Review of the Literature

The Singapore shoreline has changed significantly over the last 30 years, but the stonefish (Synanceia sp.) continues to inhabit our native waters and human...

Thoracic Myelopathy Secondary to Ligamentum Flavum Ossification

Acquired thoracic spinal canal stenosis is an uncommon condition compared to myelopathy and radiculopathy frequently seen in the cervical and lumbar spine, respectively. Because...

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,...

Delusional Parasitosis: Case Series of 8 Patients and Review of the Literature

Delusional parasitosis (DP), or delusional infestation, is a condition in which a person has the unshakeable and mistaken belief of being infested with parasites....

Severe Adult Chickenpox Infection Requiring Intensive Care

Chickenpox (varicella) in adults can be severe. It is frequently associated with pneumonia and immunosuppression as well as increased mortality rates. This article is available...

Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids

Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE...

Complications Relating to Intravenous Buprenorphine Abuse: A Single Institution Case Series

Buprenorphine, more commonly known as Subutex (Reckitt Benckiser Pharmaceuticals), has been released in Singapore since 2002. Initially marketed as an opiate substitute to help...

Photodynamic Therapy for Choroidal Neovascularisation Secondary to Inflammatory Chorioretinal Disease

Photodynamic therapy using verteporfin (Visudyne, Novartis Ophthalmics) has been proven safe and effective for the treatment of predominantly classic, age-related macular degeneration (AMD)-related subfoveal...

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...

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...

Neonatal Hepatic Abscess in Preterm Infants: A Rare Entity

Liver abscess has been recognised since the time of Hippocrates. The first report on liver abscess was published by Bright in 1836.1 However, reports...

Intracranial Aspergilloma in Immunocompetent Patients Successfully Treated with Radical Surgical Intervention and Antifungal Therapy – Case Series

Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly occurring in immunocompromised patients. It may present in several forms: meningitis, mycotic...

Ultrasound Assisted Thrombolysis in Acute Ischaemic Stroke: Preliminary Experience in Singapore

Most patients with acute ischaemic stroke have arterial thrombi that occlude extra- or intracranial vessels. Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and...

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...

Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children

Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share...

Computer-assisted Navigational Surgery Enhances Safety in Dental Implantology

While the surgical procedure of placing dental implants may seem technically simple, it is not straightforward and requires careful preoperative planning. This article is available...

Concurrent Chemoradiotherapy followed by Surgery in Locally Advanced Squamous Cell Carcinoma of the Oesophagus: A Single Centre Experience

Carcinoma of the oesophagus is a relatively uncommon malignancy in Singapore and incidence rates have been declining since 1968. A total of 506 cases...

Endovascular and Surgical Management of Vertebral Artery Dissecting Aneurysms Presenting With Subarachnoid Haemorrhage: Medium-term Experience

Dissecting aneurysms of the vertebral artery often present with subarachnoid haemorrhage.1 A high mortality occurs with rupture.2 Currently, the treatment options for vertebral artery...

Clinical Usefulness of Endoscopic Ultrasonography With or Without Fine Needle Aspiration in the Diagnosis and Staging of Pancreatic Carcinoma

Pancreatic cancer is notoriously known to be diagnosed in the later stages and this carries with it a poor prognosis. In particular, tumours involving...

ATRA Therapy Restores Normal Renal Function and Renal Reserve and Prevents Renal Failure

In a previous study,1 we reported that patients who had decreased proteinuria also had improvement in renal function. Three out of the 8 patients...

Vision Restoration Therapy: New Hope for Stroke Patients with Visual Field Loss

Patients suffering from visual field defects caused by optic nerve or post-chiasmatic injury commonly experience many limitations in their daily activities. The generally accepted...

Holoprosencephaly: An Antenally-diagnosed Case Series and Subject Review

Holoproscencephaly (HPE) is an uncommon congenital developmental defect of the forebrain structures to divide into separate hemispheres and ventricles during embryogenesis. The prevalence rate...

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...

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...

Corticospinal Tract Degeneration in Amyotrophic Lateral Sclerosis: A Diffusion Tensor Imaging and Fibre Tractography Study

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterised by spinal and cortical motor neuron degeneration. Although electro myography, muscle biopsy and motor...

Angioplasty in Critical Limb Ischaemia: One-year Limb Salvage Results

Critical limb ischaemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb to maintain...

Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined

Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications...

Intraocular Avastin (Bevacizumab) for Neovascularisation of the Iris and Neovascular Glaucoma

Neovascularisation of the iris is associated with many ischaemia retinal disorders and elevated levels of the vascular endothelial growth factor is found in patients...

EUS-FNA of the Left Adrenal Gland is Safe and Useful

The occurrence of an adrenal mass in patients with an underlying malignancy may represent distant metastases, precluding curative surgical resection of the primary malignancy....

Late Complications Following Tetralogy of Fallot Repair: The Need for Long-term Follow-Up

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease with an incidence of approximately 0.5/1000 live births (5% to 7% of...

Arteriovenous Fistula Aneurysm – Plicate, Not Ligate

Arteriovenous fistulae (AVF) are created for haemodialysis in patients with end-stage renal failure. While AVF is a lifeline for these patients, its creation is...

Cluster of Staphylococcus aureus and Dengue Co-infection in Singapore

In recent years, Singapore has seen a resurgence of dengue fever despite the seemingly successful implementation of a nationwide Aedes mosquito control programme,1 culminating...

Application of the McDonald MRI Criteria in Multiple Sclerosis

Since its advent in 1982, magnetic resonance imaging (MRI) has become an important component in the evaluation of multiple sclerosis (MS). MRI is a...

Extracranial Non-vestibular Head and Neck Schwannomas: A Ten-year Experience

Schwannomas, also known as neurilemmomas, neuromas, or neurinomas, are uncommon nerve sheath neoplasms that may originate from any peripheral, cranial or autonomic nerve of...

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...

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...

Sudden Deafness Due to Intralabyrinthine Haemorrhage: A Possible Rare Late Complication of Head and Neck Irradiation

The auditory apparatus and vestibular part of the inner ear are often included in the radiation field treatment of patients with head and neck...

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...

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...

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...

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...

Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics

In recent decades, medical advances and economic pressures have shifted medical student training from hospital inpatient to ambulatory settings such as hospital outpatient and...

An Eight Year Review of Exercise-related Cardiac Arrests

Exercise-related cardiac arrest is uncommon, however it is devastating when it occurs in otherwise healthy adults. In young adults, vigorous physical exercise trigger cardiac...

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...

Severe Infection with H1N1 Requiring Intensive Care – Lessons for Preparedness Programmes

Severe cases of influenza have traditionally generated much interest. The pandemic of 1957 provided instructive materials on the subject, with publications on the pulmonary...

Complete Atrioventricular Block Complicating Acute Anterior Myocardial Infarction can be Reversed with Acute Coronary Angioplasty

Complete atrioventricular block (AVB) develops in more than 5% of patients with myocardial infarction (MI). These patients have poorer outcomes compared to those without...

Socio-demographic Profile and Psychiatric Comorbidity of Subjects with Pathological Gambling

Gambling has been defined as a wager of any type of item or possession of value upon a game or event of uncertain outcome...

Chronic Achilles Tendon Rupture Treated with Two Turndown Flaps and Flexor Hallucis Longus Augmentation – Two-year Clinical Outcome

Chronic Achilles tendon rupture is a disabling condition resulting in ankle pain, weakened ankle plantarflexion and abnormal gait. Management of chronic ruptures is technically...

Neonatal Ovarian Cysts: Role of Sonography in Diagnosing Torsion

Simple cysts are commonly seen in neonatal ovaries. Majority of them are small and resolve spontaneously. Complications such as torsion and haemorrhage rarely occur,...

Selection of Resistant Fungi in Liver Transplant Recipients During Use of Newer Antifungal Agents — A Report of Two Cases

Invasive fungal infections (IFI) are associated with a high mortality in liver transplant recipients. The incidence of fungal infections after liver transplantation ranges from...

Supplementary Breast Ultrasound Screening in Asian Women with Negative But Dense Mammograms—A Pilot Study

Mammogram has been the gold standard for breast cancer screening and Magnetic Resonance Imaging (MRI) has been advocated for screening of high- risk individuals....

Male Breast Cancer in Singapore: 15 Years of Experience at a Single Tertiary Institution

Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its...

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,...

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...

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...

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...

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...

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...

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...

Accuracy of self-reported height, weight and BMI in a multiethnic Asian population

Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight...

Carbamazepine-induced toxic epidermal necrolysis in a patient despite testing negative for HLA B*15:02 allele

Carbamazepine (CBZ) has been used in Singapore since 19881 as an effective drug for the treatment of conditions such as epilepsy, neuropathy, neuralgia and...

Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians

In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which...

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...

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...

Assessing the Content Validity of the EQ-5D Questionnaire Among Asians in Singapore: A Qualitative Study

EQ-5D is a tool to measure and value health status. It is a standardised questionnaire that comprises 2 components: a Descriptive System (DS) on...

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...

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...

Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore

Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million...

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...

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...

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...

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...