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A 52-year-old woman with beading of intracranial arteries

A 52-year-old woman of Indian ethnicity with a history of well-controlled hypertension, hyperlipidaemia and recurrent transient ischaemic attacks presented with altered mentation and slurred...

Creutzfeldt-Jakob Disease Presenting with Visual Blurring, Diplopia and Visual Loss: Heidenhain’s Variant

The electroencephalographic pattern is distinctive in many but not in all patients with Creutzfeldt-Jakob disease (CJD). Often, it is one of diffuse and non-specific...

The Profile of Hospitalised Patients with Parkinson’s Disease

Prevalence studies in various parts of the world have shown that Parkinson’s disease (PD) is relatively common among the aged in all countries. Crude...

Academic Medicine in Singapore

Academic medicine is currently grappling with the problem of whether the triple-threat academician is a species threatened with extinction in the 21st century, given...

The Alien Hand Sign–Case Report and Review of the Literature

The alien hand sign or “strange hand sign”, first coined by Brion and Jedynak in 1972, refers to a feeling that the hand is...

Electrophysiological Features in the Management of Meralgia Paraesthetica

Meralgia paraesthetica is a condition resulting from entrapment of the lateral femoral cutaneous nerve at the region of the anterior superior iliac spine, when...

Foregoing Life Support in Medically Futile Patients

The origins of withholding medical support are found in ancient times. More than two millennia ago, Hippocrates (460 to 361 BC) stated that the...

Nitric Oxide in Septic Shock: Directions for Future Therapy?

In 1980, Furchgott and Zawadzki demonstrated that the relaxation of isolated arteries to acetylcholine required the presence of endothelial cells. This response was mediated...

Critical Care Medicine in the Western Pacific Region

The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and...

Critical Care—The Worldwide Perspective

Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s....

Malaria Requiring Intensive Care

Malaria is an important and common infectious parasitic disease globally. It is associated with significant morbidity and mortality, especially in endemic areas. This article is...

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...

Ergotism and Vascular Insufficiency: A Case Report and Review of Literature

Toxicity from ergot and its derivative is well known. Great epidemics occurred during the middle ages due to consumption of rye contaminated with the...

A Retrospective Review of Patients with Clinically Definite Multiple Sclerosis

Genetic susceptibility and environmental factors influence the prevalence and clinical manifestations of multiple sclerosis (MS). Since MS is rare in Southeast Asia, descriptions of...

Plasma Vitamins A, C and E in the General Population of Singapore, 1993 to 1995

The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3%...

Chronic Subdural Haematoma Presenting with Transient Ischaemic Attacks— A Case Report

Transient ischaemic attacks (TIA) are commonly seen in neurologic practice. They are most commonly associated with cerebrovascular insufficiency, either from a thrombotic or embolic...

Palatal Myoclonus—A Case Report

Palatal myoclonus is a rare movement disorder characterised by rhythmic recurring jerky movements of the soft palate, pharynx, larynx and rarely diaphragm, trunk and...

Intravital Microscopy for the Study of the Microcirculation in Various Disease States

It is more than 150 years ago when the first detailed description of intravital microscopy was given by Waller, demonstrating in the frog tongue...

Potentiation of Acetylcholine-induced Smooth Muscle Contraction in Rat Ileum by Lead

It is known that exposure of animals and humans to heavy metals such as lead can result in neurological dysfunction. Pharmacodynamic effects of lead...

Extensor Pollicis Longus Paralysis Following Thoracoscopic Sympathectomy

A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla. This article is available only...

Role of Magnetic Resonance Imaging and Magnetic Resonance Angiography in Patients with Hemifacial Spasm

Hemifacial spasm (HFS), characterized by intermittent twitching of muscles supplied by one facial nerve is commonly due to compression of the facial nerve by...

The Reliability and Validity of the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the Elderly Chinese in Hong Kong

The Alzheimer’s Disease Assessment Scale (ADAS) is a 21-item scale designed to assess the severity of cognitive and non-cognitive impairment in patients with Alzheimer’s...

The Current State of Multiple Sclerosis Genetic Research

It was Charcot (1868) who first made the formal pathological correlation between lesions in the central nervous system (CNS) and a disorder termed, ‘la...

The Genetics of Human Epilepsies

Epilepsies are one of the most common neurological disorders, affecting about 3% of individuals at least once in a lifetime. It thus represents a...

Sleep/Wake Cycle and Circadian Disturbances in Shift Work: Strategies for Their Management—A Review

Humans have primarily been active/awake during the day and inactive/asleep at night. The discovery of artificial light and introduction of electric power generator have...

Incidence and risk factors of delirium in post-anaesthesia care unit

Post-anaesthesia care unit (PACU) delirium is defined as a disorder in thought processes that affect cognition in terms of memory, comprehension and attention.1 It...

Delirium in patients following general anaesthesia

Delirium is a disturbance of consciousness characterised by an acute onset and fluctuating course of inattention, accompanied by either a change in cognition or...

Listeria Meningoencephalitis: Two Cases and a Review of the Literature

The general experience of local physicians and available data suggest that listerial infections of the central nervous system (CNS) are uncommon among adults in...

Panhypopituitarism due to Pituitary Cyst of Rathke’s Cleft Origin—Two Case Reports

Rathke’s cleft cysts are non-neoplastic cystic epithelial lesions of the sellar and suprasellar region which are thought to originate from the remnants of Rathke’s...

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...

Advances in Neurointensive Care

Neurointensive care has come into being in the past decade as a recognised subspecialty. Pioneering neurointensivists in the United States, such as Allan Ropper...

The Eye in Neurology: Evaluation of Sudden Visual Loss and Diplopia—Diagnostic Pointers and Pitfalls

The first step in the evaluation of sudden visual loss is to determine if the visual loss is monocular or binocular. The first diagnostic...

Neuroprotection in Acute Stroke

The neuronal cells of the central nervous system are especially susceptible to various forms of insult such as trauma and ischaemia. Once the ischaemic...

Current and Emerging Treatments in Parkinson’s Disease

Parkinson’s disease (PD) affects 1% of adults above the age of 65 years. It is characterised histologically by the loss of neurons in the...

Trinucleotide Repeat Analysis of Huntington’s Disease gene in Singapore

Huntington’s disease (HD) is an autosomal dominantly inherited disease, affecting 1 in 10,000 individuals of European origin. The incidence in the Asian population is...

Gemella Empyema Cured without Antibiotics: A Case Report

Gemella are gram-positive anaerobic bacteria that rarely produce serious human infections. We describe a case of thoracic empyema that occurred in an elderly Chinese...

Aseptic Meningitis in Children—The Singapore Experience

Aseptic meningitis is a common diagnosis among infants admitted for fever without an obvious source. In cases where the aetiologic agent could be identified,...

Update in the Management of Stroke

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders...

The Clinician Meets the Computer—Uneasy Bedfellows

Information technology has become a cornerstone of civilization as we know it. In its broadest definition, information technology encompasses all forms of technology required...

Leveraging on Information Technology to Enhance Patient Care: A Doctor’s Perspective of Implementation in a Singapore Academic Hospital

Information technology (IT) has become truly pervasive in everyday life; however, in the field of medicine, we have yet to fully harness its full...

Internal Medicine

It has taken a long time to plan for this November issue in Internal Medicine. The topic is so wide and often neglected as...

General Medicine—Revisited, Rejuvenated, Revitalised and Reemphasised

“The irresistible swing towards medical specialisation has brought advantages for patients but arguably this has gone too far.” It is time to review the...

A Countrywide Approach to the Control of Non-communicable Diseases—The Singapore Experience

In the area of health, the last two decades has seen a decline or eradication of deadly diseases, such as smallpox and polio, the...

Causes for the Evolution of Case Management and the Development of a Working Model in an Acute Care Hospital in Singapore

In 1999, significant changes to the healthcare funding structure were introduced to public sector hospitals in Singapore. This was the advent of casemix-based funding...

Stroke Disease Management—A Framework for Comprehensive Stroke Care

Disease management (DM) is an approach to patient care that coordinates medical resources for patients across the entire healthcare delivery system. It requires a...

Evidence-based Medicine: The Key to Guidelines, Disease and Care Management Programmes

Health care in America and the rest of the industrialised world continues to reinvent itself at an ever-accelerating rate. The societal pressures for high...

Variance Analysis Applied to a Stroke Pathway: How This Can Improve Efficiency of Healthcare Delivery

Stroke is the fourth principal cause of death in Singapore, and the leading cause of long-term disability amongst developed countries. Due to the spiralling...

National Disease Management Plans for Key Chronic Non-communicable Diseases in Singapore

Like most other newly industrialised economies, Singapore has undergone a rapid epidemiological transition over the last 50 years. Chronic, non-communicable diseases have replaced infectious...

Chronic Disease Management: Challenges for Clinicians and the Way Forward

The healthcare, financial and social burden of chronic diseases, such as diabetes mellitus, coronary heart disease, asthma, chronic obstructive airway disease, hypertension, chronic depression,...

Measuring Health-related Quality of Life in Singapore: Normal Values for the English and Chinese SF-36 Health Survey

Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many...

Should Ethical Issues in Biotechnology Research be Decided by Physicians-Scientists or by Lawyers?

As with clinical practice, the practice of biomedical research is a moral activity. We have to think about what we should do, not just...

Seeing How We Think About Words Using BOLD Contrast fMR Imaging

Functional brain imaging refers to a set of non-invasive imaging techniques that are used to infer linkages between brain structure and function. In this...

Nipah Encephalitis Outbreak in Malaysia

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started...

Patterns and predictors of sound levels in hospital rooms

Dear Editor,      Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also...

MELAS: A Case Report

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...

1st College of Physicians Lecture: The Role of Internal Medicine as a Specialty in the Era of Subspecialisation

It humbles me to accept the invitation to give this lecture, the First College of Physicians Lecture, titled “The Role of Internal Medicine as...

Standards and Revalidation or Recertification

In my Gordon Arthur Ransome Oration and other papers, I have described the nature and development of patient-centred professionalism, the key features of which...

Continuing Professional Development – a Surrogate for Recertification?

The Hong Kong Academy of Medicine is a statutory body set up in 1993 with the objectives of fostering the development of postgraduate medical...

Teaching and Learning of Professionalism in Medical Schools

There is now worldwide consensus that the elements of medical professionalism need to be enhanced and explicitly taught in medical schools. Medical schools in...

The Challenge of Teaching Professionalism

For the past 25 years, professionalisation, industrialisation, large-scale infusions of technology into the healthcare system and consumerism, to name a few factors, have definitely...

2004 Runme Shaw Memorial Lecture: Professionalism – A Concept in Need of Nurturing

It is a great honour to be invited to deliver the Runme Shaw Memorial Lecture. I am grateful to the Runme Shaw Foundation for...

17th Gordon Arthur Ransome Oration: Patient-centred Professionalism

When sickness strikes we all need doctors. People everywhere know that the quality of medical care can affect the outcome and possible consequences of...

Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore

Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to...

Axoglial Interaction via the Notch Receptor in Oligodendrocyte Differentiation

Oligodendrocytes (OLs) derived from the common neural progenitor cells in the central nervous system (CNS) ensheathe the nude axon to form the myelin that...

Refining Clinical Practice: Transforming Science Research into the Art of Medicine

I am humbled by the invitation given to me by Changi General Hospital to deliver this lecture at your 5th Annual Scientific Meeting with...

Hemifacial Spasm in Singapore: Clinical Characteristics and Patients’ Perceptions

Hemifacial spasm (HFS) is a movement disorder characterised by intermittent involuntary contractions of the facial muscles. It begins with contractions of the orbicularis oculi,...

Characteristics and Acute Rehabilitation of Guillain-Barré Syndrome in Singapore

The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is...

Extended-spectrum Beta-lactamases in Clinical Isolates of Escherichia coli and Klebsiella spp. in a Singapore Hospital: Clinical Spectrum

Extended-spectrum beta-lactamases (ESBLs) in gram-negative bacillary pathogens are a growing and important problem in hospital practice and it is tied to extensive use of...

Routine Microbiological Screening in Septic Patients in a Cardiac Surgical Intensive Care Unit

Compared to in-hospital patients, patients treated in an intensive care unit (ICU) have the highest risk of contracting an infection. The risk correlates well...

Medical Education in Asia: Is it a Time for Optimism?

Asia, the largest continent, is also an immensely diverse region with countries that vary in their socio-economic status, degree of urbanisation and health and...

Issues and Priorities of Medical Education Research in Asia

Medical schools traditionally rest on the “three-legged stool” of research, education and service. Hence, medical teachers are sometimes referred to as “triple-threat academicians”. This article...

Genital Herpes in a Sexually-transmitted Infection Clinic in Singapore: A 1-year Retrospective Study

Genital herpes simplex virus (HSV) infection is a commonly notified sexually transmitted infection (STI). Genital herpes can be caused by both herpes simplex virus...

Clinical Indications for Positron Emission Tomography (PET) Scanning

The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their...

Positron Emission Tomography – A Vital Component of Molecular Imaging

Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of...

Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association

The spinocerebellar ataxias (SCAs) are a rare group of neurodegenerative disorders that are clinically and genetically heterogeneous. Almost all SCAs are due to trinucleotide...

Professionalism: Looking For Your Blind Spots

In 1996 a major breakthrough was reported in the medical literature. A 5-week ectopic pregnancy was re-implanted into the uterus via the cervix, and...

Identification of a Common Genetic Risk Variant (LRRK2 Gly2385Arg) in Parkinson’s Disease

For diseases with complex inheritance, the age-old debate regarding the relative contribution of gene-environment interaction never fails to generate interest, discussion and hypothesis within...

Neural Progenitor and Stem Cells in the Adult Central Nervous System

Seminal studies in the 1960s, using -thymidine autoradiography, reported that neurogenesis occurs in discrete areas of the adult mammalian brain, in rodents. Studies in...

Methodological Aspects of Traditional Chinese Medicine (TCM)

Traditional Chinese Medicine (TCM) has a long history but its efficacy is not as well-documented as one would hope. Proof of efficacy has to...

A Practical Way of Research in Chinese Medicine

Chinese medicine individualises its treatment plan and practice and refutes any general law. Therefore, Chinese medicine practitioners do not have the tradition of research. This...

Complementary and Alternative Medicine, and Traditional Chinese Medicine: Time for Critical Engagement

Practice outside of mainstream or conventional medicine has always been an important part of public healthcare in some countries, particularly in the developing world....

Student Academic Committees: An Approach to Obtain Students’ Feedback

The shift of medical curricula from a traditional subject based to an integrated module-based system can be seen in many medical schools worldwide. The...

Curricular Trends in Malaysian Medical Schools: Innovations Within

Medical educators continue to evaluate and introduce innovations into their curriculum with the objective of achieving appropriate outcomes for their graduates so that they...

A Problem-Based Learning Pathway for Medical Students: Improving the Process Through Action Research

Problem-based learning (PBL) is a student-centred, self-directed, integrated and contextual mode of learning. It has been widely perceived by many to confer advantages in...

A Simple Instrument for the Assessment of Student Performance in Problem-based Learning Tutorials

Assessment can be done in a variety of ways, for many purposes, and for different populations. It can occur at the classroom level, programme...

An Online Evaluation of Problem-based Learning (PBL) in Chung Shan Medical University, Taiwan – A Pilot Study

The goal of problem-based learning (PBL) is to motivate students to develop self-learning skills in a small group. PBL embraces principles of good learning...

Evidence-based Medicine in Clinical Curriculum

Evidence-based medicine (EBM) is “the conscientious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients.” Considering...

Leadership and Professionalism Curriculum in the Gross Anatomy Course

Healthcare delivery systems worldwide are currently undergoing significant changes to create resilient learning organisations that are able to adapt with ever-increasing speed to shifting...

Constructing Multiple Choice Questions as a Method for Learning

Students in general and medical students in particular are often described as “strategic learners”, but in reality many become superficial learners out of necessity...

Computer-based Versus Pen-and-paper Testing: Students’ Perception

Computer-based testing (CBT) has gained popularity as a testing modality, with large-scale professional examinations such as the United States Medical Licensing Examination (USMLE) adopting...

Curriculum TIPS For All of Us

Medical education is a lifelong learning process. Just as we remind our students and ourselves that the practice of medicine is a lifelong process...

Community-associated Methicillin-resistant Staphylococcus aureus: Overview and Local Situation

The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates from the community that are distinct from their archetypal healthcare-associated counterparts (HA-MRSA) marked a...

Translational Research – A Multidisciplinary Approach

Translational research aims to convert laboratory discoveries into therapeutic gains for patients – in oncology, drug development is a prime example. This multifaceted process...

A Complex, Contagious, Evolutionary Habit

Yawning is often noted in medical seminars and conferences – be they surgical, orthopaedic, gastroenterological, endocrinological or neurological. Yet, this condition receives little coverage...

Amendment of the Human Organ Transplant Act

Kidney transplants have been carried out in Singapore for more than 35 years, with the first cadaveric kidney transplant operation performed on 8 July...

Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis

Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes...

Interesting In- and Outpatient Attendances at Hogwarts Infirmary and St Mungo’s Hospital for Magical Maladies

With the return of “You Know Who” (YKW) and the rise of Death Eaters, injuries amongst both muggle and wizarding folk (MF and WF)...

The Doctor’s Multi-instrument Tool of the Future?

It is just another day in 2020, except that the eyes of the medical world are eagerly awaiting the latest invention to be revealed:...

Relationship Between Item Difficulty and Discrimination Indices in True/False-Type Multiple Choice Questions of a Para-clinical Multidisciplinary Paper

Multiple-choice questions (MCQs) are used more and more in departmental examinations or as comprehensive examinations at the end of an academic session. They may...

Re-defining Neurological Syndromes: The Genotype Meets the Phenotype

Since time immemorial, generations of medical students and physicians have always been taught that a thorough and detailed history and examination is the foundation...

Towards a Global Educational Matrix for Tomorrow’s Health Systems

Society supports medical schools expecting them to produce physicians who can improve both the health of the population as well as the health system...

Harnessing the IT Factor in Medical Education

In this digital age, we are constantly inundated with breathtaking images worthy of an Ansel Adams photograph or a Zhang Yimou film. Is it...

A Systems Approach to Teach Core Topics across Graduate Medical Education Programmes

Core curricula including Ethics, Medico-legal issues, Socioeconomics, and Quality Improvement (QI) are relevant and significant for graduate medical education programmes, regardless of specialty. A...

World Federation for Medical Education Policy on International Recognition of Medical Schools’ Programme

There is an increasing need for international quality assurance of medical education. However, there are no present mechanisms for international recognition of medical educational...

Quality Management of Medical Education at the Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Germany

In Germany, medical education is an undergraduate programme for which the students applying at the “Zentralstelle für die Vergabe von Studienplätzen” (ZVS); the final...

Supporting Learners who are Studying or Training Using a Second Language: Preventing Problems and Maximising Potential

Travel and immigration are vibrant aspects of the international medical and educational field. Patients are increasingly mobile and finding healthcare professionals in a foreign...

Development of a Tool to Evaluate Health Science Students’ Experiences of an Interprofessional Education (IPE) Programme

A shortage of healthcare professionals and resources in rural areas is well documented. These workforce shortages necessitate new models of healthcare in rural areas...

Step-2 Thai Medical Licensing Examination Result: A Follow-up Study

The Center for Evaluating and Accrediting Medical Competency of the Thai Medical Council has established the regulation that Thai medical graduates matriculated as of...

Does Team Learning Motivate Students’ Engagement in an Evidence-based Medicine Course?

Team-based learning (TBL) is a well-defined instructional strategy that has generated considerable interest within the medical education community because of its potential to promote...

A Survey of Medical Students’ Perceptions of the Quality of their Medical Education upon Graduation

Founded in 1934, Tehran University of Medical Sciences School of Medicine (TUMS-SoM) is the oldest modern medical school in Iran. It has the most...

The Learning of 7th Year Medical Students at Internal Medical – Evaluation by Logbooks

In 1945, Taihoku (Taipei) Imperial University was renamed the National Taiwan University and the Japanese teaching system was replaced with a system implemented by...

Use of Knowledge-sharing Web-based Portal in Gross and Microscopic Anatomy

The extensive use of and the rate at which medical technology is becoming an integral force in medicine has impacted on the way in...

Assessment of Psychometric Properties of a Modified PHEEM Questionnaire

In Sri Lanka, after a 5-year medical undergraduate curriculum, graduates from the medical faculties undergo a one year mandatory internship or housemanship, 6 months...

Medical Education in a Flat World

In 2005 Thomas Friedman published the international best-seller The World is Flat: A Brief History of the Twenty-First Century. He asserted that as the...

Objective Structured Clinical Evaluation Should Not Only Be a Test of Clinical Skill

The Objective Structured Clinical Examination (OSCE) was originally a test (or summative assessment) specifically of clinical skills, using standardised patients (SP), anatomical models and...

5th College of Physicians Lecture – A Physician’s Odyssey: Recollections and Reflections

Allow me to thank you Mr President and your Council for asking me to deliver the 5th College of Physicians Lecture. Your President has...

Standard Setting in Student Assessment: Is a Defensible Method Yet to Come?

To validate any “adjective”, be it for living or non-living, a criteria or standard is needed. Globalisation, mobility of doctors and the rising number...

Innovative “Case-Based Integrated Teaching” in an Undergraduate Medical Curriculum: Development and Teachers’ and Students’ Responses

In Asia, the challenges facing medical education are similar across different countries. The learning process is still problematic with large classes, and most of...

Assessment of Medical Graduates Competencies

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate...

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...

Evidence-based Medicine (EBM) for Undergraduate Medical Students

The practice of evidence-based medicine (EBM), which integrates individual clinical expertise with the best available evidence from systematic research, demands a set of skills....

Transudates in Malignancy: Still a Role for Pleural Fluid

According to Light’s criteria, an exudate is defined by at least one of the following: a total protein pleural fluid to serum ratio greater...

Functional Neuroimaging of Sleep Deprived Healthy Volunteers and Persons with Sleep Disorders: A Brief Review

Most adults have experienced sleep deprivation at some stage of their lives, be it in the context of work, illness or play. Sleep deprivation...

Treatment of Circadian Rhythm Sleep Disorders with Light

In humans, the daily pattern of consolidated sleep and wake is strongly influenced by the timing of exposure to light and darkness. In the...

Basic Science Review on Circadian Rhythm Biology and Circadian Sleep Disorders

The sleep-wake cycle, with its characteristic intervals of activity alternating with restfulness that recur with a periodicity approximating the 24-hour day-night cycle, is the...

Delayed and Extra-pontine Myelinolysis after Osmotic Dysregulation

A 58-year-old Chinese man was admitted because of increasing lethargy and confusion over 4 days. He had been taking hydrochlorthiazide for hypertension and regularly...

Limb-Shaking Transient Ischemic Attack with Distal Micro-Embolic Signals and Impaired Cerebrovascular Reactivity Using Transcranial Doppler

We present a patient with limb-shaking transient ischaemic attack (TIA) associated with extracranial carotid occlusion and suggest that the pathophysiological mechanism is hypoperfusion, as...

Neuropsychiatry – An Emerging Field

Neuropsychiatry can be described as the interface between neurology and psychiatry – the intersecting field of enquiry for both the brain and the mind....

Self-directed Learning in Health Professions Education

More than 600,000 new citations were published in MEDLINE in 2005; this raised the total number of indexed citations to more than 14 million...

Alzheimer’s Disease – Towards More Patient-centred and Meaningful Clinical Outcomes

More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in...

Translating the Family Medicine Vision into Educational Programmes in Singapore

The core of the Family Medicine (FM) vision is patient-centred care, requiring specific education and vocational training. Modern day FM began its existence as...

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...

Biomarkers of Mild Cognitive Impairment and Alzheimer’s Disease

Alzheimer’s disease (AD) is the most prevalent form of age-related dementia in the modern society. Other than symptomatic treatment with acetylcholinesterase inhibitors at its...

Validation of Transcranial Doppler with CT Angiography in Cerebral Ischaemia: A Preliminary Pilot Study in Singapore

Transcranial Doppler (TCD) is routinely performed to assess the blood flow in patients with cerebral ischaemia and provides important real-time information about cerebral haemodynamics....

Superior Sagittal Sinus Thrombosis: Subtle Signs on Neuroimaging

Cerebral venous thrombosis (CVT) is an infrequent but potentially deadly disease. The mortality rate of CVT is 10% to 20%, and surviving patients may...

Erysipelothrix rhuseopathiae Septicaemia with Prolonged Hypotension: A Case Report

Erysipelothrix sp. is a gram-positive, non-spore forming bacterium that was first isolated by Robert Koch. It has the unusual ability to infect a large...

Embryonic Stem Cells and Parkinson’s Disease: Cell Transplantation to Cell Therapy

Although levodopa is currently a well-endorsed form of treatment for Parkinson’s Disease (PD), the search for a safe, long-term and dyskinesia-free treatment remains an...

The Hospitalist Movement – A Complex Adaptive Response to The Hospitalist Movement – A Complex Adaptive Response to Fragmentation of Care in Hospitals

Healthcare systems are complex adaptive systems. They are capable of self organisation through interacting agents that adapt to changes to the internal and external...

Medication Use in the Transition from Hospital to Home

Hospital discharge can be a complex and challenging time for physicians and patients alike. Patients are being discharged sooner, often in the process of...

Family Medicine Education in Singapore: A Long-standing Collaboration between Specialists and Family Physicians

In the US, Canada and Australia, the postgraduate training of family physicians (FPs) involves the attachment of family medicine (FM) trainees to specialist departments,...

Bridging the Gap Between Primary and Specialist Care – An Integrative Model for Stroke

Cerebrovascular disease (CVD) is Singapore’s fourth leading cause of death, comprising 9% of all deaths, a crude death rate of 40.4/100,000, an age- and...

Bridging the Gap between Primary and Specialist Care: Formidable Challenges Ahead

The strong guiding hand and deep pockets of the state have brought about the growth of hospitals and national specialist centres while leaving the...

Malignant Syndrome of Two Parkinson Patients due to Withdrawal of Drugs

Neuroleptic malignant syndrome (NMS) is characterised by the impairment of consciousness, high fever, rigidity and autonomic instability. Although originally described in patients taking neuroleptic...

Clinical Skills in Final-year Medical Students: The Relationship between Self-reported Confidence and Direct Observation by Faculty or Residents

In clinical medical education, instructors train students in their medical knowledge and clinical skills. Medical educators also aspire to develop students’ self-confidence in medical...

Multimodal Therapeutic Approach in Acute Ischaemic Stroke with Real-time Neurovascular Monitoring

Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for acute ischaemic stroke (IS) within the therapeutic time-window according...

Chewing-induced Facial Dystonia

Dystonia is a movement disorder characterised by sustained muscle contractions, repetitive twisting movements, and abnormal postures of the trunk, neck, face, or arms and...

Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later

Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom...

Alzheimer’s disease–The Inexorable Epidemic

Alzheimer's disease (AD) is the most common form of dementia which refers collectively to syndromes of progressive deterioration of memory along with other cognitive...

Unusual Cause for Unilateral Headache: A Quadrigeminal Cistern Arachnoid Cyst

Young adults are frequently presented with headaches due to various causes. Atypical facial pain, renamed as persistent idiopathic facial pain (PIFP) is a poorly...

Evaluation of Intensive Care Unit-acquired Urinary Tract Infections in Singapore

Urinary tract infection (UTI) is one of the most common types of nosocomial infections encountered in the inpatient settings including intensive care unit (ICU)....

Medical Professionalism in the Internet Age

Medical professionalism encompasses the conduct and practices of physicians, both as individuals and as a collective organisation. Professionalism enhances the trust and confidence of...

Developing the “NUS Tummy Dummy”, A Low-Cost Simulator to Teach Medical Students to Perform the Abdominal Examination

Simulators may be used to provide adequate exposure to learning experiences that allow clinical skills to develop, that is, allow medical students and trainees...

Genome-wide Association Studies: Promises and Pitfalls

Genetic testing is an important means to confirm the diagnosis of an inheritable disease. For this to be feasible, genes that are associated with...

Epilepsy: Looking Beyond Seizures

World Epilepsy Day falls on 26 March 2013. As we observe this important date in Singapore, it is perhaps instructive to take a step...

Sleep, Public Health and Wellness: The Elephant in the Room

The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of...

Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?

Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values. —Louis D Brandeis As a...

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...

Single-level Anterior Corpectomy with Fusion versus 2-level Anterior Cervical Decompression with Fusion: A Prospective Controlled Study with 2-year Follow-up Using Cages for Fusion

Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive...

Academic Medicine Education Institute (AM∙EI): Transforming the Educational Culture of Health Professionals

In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their...

Diagnosing Bacteraemia Early in Older Adults

Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop...

Chorea precipitated by phototherapy as initial presentation of systemic lupus erythematosus

Dear Editor, Chorea is a well-recognised albeit rare neuropsychiatric manifestation of systemic lupus erythematosus (SLE). We describe here a case of a 67-year-old woman presenting...

Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study

Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the...

Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions

Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue...

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...

Rare homozygous PRKN exon 8 and 9 deletion in Malay familial early-onset Parkinson’s disease

Little is known about the genetics of Parkinson’s disease (PD) in Southeast Asian populations.1 We extended knowledge of the Southeast Asian monogenic PD landscape...

Neuro-Behçet’s disease presenting as isolated intracranial hypertension

Behçet’s disease (BD) is a chronic multisystem inflammatory disease with a classic triad of painful oral ulcers, genital ulcers and uveitis. Neurological manifestations, though...

Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury

The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range...

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...

Recurrent vascular events in ischaemic stroke patients with diabetes

Stroke is a major cause of death and disability globally, with 6.55 million deaths (95% uncertainty interval 6.00–7.02 million), 101 million prevalent cases...

The Singapore Cerebral Palsy Registry: An important new resource for cerebral palsy research

Cerebral palsy (CP) is a common, lifelong disorder of movement and posture resulting from an insult or maldevelopment of the developing brain. The movement...