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Functional improvement after inpatient rehabilitation in community hospitals following acute hospital care

Early inpatient rehabilitation therapy has been known to have beneficial impact on physical function and mobility, psychological status and cognitive function of patients following an acute medical event requiring hospitalisation.1 Following an acute hospital care, those who have been identified to have potential for functional improvements are often transferred...

Abdominal Surgery in Human Immunodeficiency Virus (HIV) Infected Patients—Early Local Experience

The prevalence of human immunodeficiency virus (HIV) infection is rising at an exponential rate in Singapore. The surgical experience with this disease remains limited. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Predictors of Long-term Outcome in Severe Head Injury

Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Urinary 2/16α-hydroxyestrone Ratio: Correlation with Serum Insulin-like Growth Factor Binding Protein-3 and a Potential Biomarker of Breast Cancer Risk

Breast cancer is the most common cancer among women in Singapore with age-standardised incidence rates increasing markedly from 26.8 to 38.7 per 100 000 per year over the last decade. While many recognised risk factors exist for the development of breast cancer such as demographic factors (personal and family...

Clinical Predictors of Nephritis in Systemic Lupus Erythematosus

Lupus nephritis is a common manifestation of lupus associated with significant morbidity and mortality. The use of cytotoxic agents has resulted in improved renal outcomes but is associated with considerable morbidity, and their role in the management of lupus nephritis is not universally accepted. This article is available only as...

Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship between the risk of this disease with birth weight and gestational age had been well-documented, in particular, in infants with birth weight ≤1500 g (very...

The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report

A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral functional endoscopic sinus surgery for mild obstructive sleep apnoea and chronic sinusitis respectively. He weighed 109 kg, all his four upper incisors were missing and...

Correlation of Baseline Quantitative Plasma Human Immunodeficiency (HIV) Type 1 RNA Viral Load with Clinical Status and CD4+ T-cell Counts in Treatment-Naïve HIV-Positive Patients in Singapore

Quantitative plasma human immunodeficiency virus type 1 (HIV-1) ribonucleic acid (RNA) viral load is used clinically as a predictor of progression of HIV-1 infection to acquired immunodeficiency syndrome (AIDS) and death, and as a marker of treatment response to anti-HIV agents. Higher viral load levels have been correlated with...

Deep Vein Thrombosis after Total Knee Replacement

Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis, its incidence is quoted between 46% and 84% in various studies. This article is available only as a PDF. Please click on “Download PDF” on top...

Case Reports of Nocardiosis in Patients with Human Immunodeficiency Virus (HIV) Infection

Nocardiosis is an infection caused by a soil-borne aerobic filamentous bacterium in the genus Nocardia and the order Actinomycetales. Within the genus Nocardia, N. asteroides, N. brasiliensis and N. caviae are responsible for nearly all nocardial infections in man. This article is available only as a PDF. Please click on...

Human Immunodeficiency Virus Infection Presenting with Chronic Actinic Dermatitis: A Case Report

A 40-year-old Chinese man of skin phototype III (Table I), formerly a welder in a shipyard, presented with pruritic papules on his face, neck and arms of 3 years’ duration. He had noted sun-aggravation and had ceased working for 3 months. This article is available only as a PDF. Please...

Oral Manifestations of Human Immunodeficiency Virus (HIV)-infected Patients in Singapore

The spread of human immunodeficiency virus (HIV) disease has pursued a relentless course since it was first recognised in the early 1980s and if current trend continues, it is most likely to carry on well into the 21st century. Asia and South Asia are expected to shoulder the greatest...

Urinary Retention in Hospitalised Older Women

Voiding dysfunction is a relatively common problem in hospitalised older patients. Up to one-third of hospitalised elderly were reported to have post-void residual urine volume (PRUV) of more than 50 mL. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Abdominal Complications after Cardiac Surgery

Despite intensive therapeutic efforts, both the incidence and mortality of gastrointestinal complications after cardiac surgery employing cardiopulmonary bypass (CPB) have not decreased during the last two decades. Gastric bleeding, ischaemic bowel disease, gallbladder disease, and pancreatitis are reportedly the most common complications. This article is available only as a PDF....

A Twelve-year Review of Radical Cystectomies in Singapore General Hospital

Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of 6.9 per 100,000 per year for men and 1.7 per 100,000 per year for women in Singapore. This article is available only as a PDF. Please...

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 also contributes to significant morbidity in terms of post-phleblitic syndrome and chronic venous ulcers. This article is available only as a PDF. Please click on “Download...

Asthma in Light of Patient Documents. A Factor Analytic Study

The lack of uniform criteria for asthma handicaps the diagnosis, the systematic documentation of cases and the consistent reporting of studies addressing asthma. It restricts also the use of patient documents of asthmatics especially in detailed causal analysis, although they could give important information for research and administration. This article...

Challenges in Perinatal Medicine

One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This signaled the beginning of increased collaboration between the obstetricians and neonatologists in the management of high-risk pregnancies through multidisciplinary birth defect clinics and high-risk perinatal...

HIV/AIDS in Children

The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major public health threat with wide-ranging medical, social and economic consequences. First gaining foothold among intravenous drug users and commercial sex workers, HIV quickly spreads to...

Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent and future adult health and well being. Adolescent substance use and abuse is an example of this. This article is available only as a PDF. Please...

Sexually Transmitted Infections in Singapore Teenagers

Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and changes. The transition from childhood to adulthood includes the formation of successful intimate relationships and avoidance of the pitfalls of sexually transmitted infections (STI), including...

Guidelines on Cardiac CT in Singapore (2006)

The heart is difficult to image because of its complex wall motion and variability of the cardiac cycle. Recent advances in 16 and 64-slice computed tomography (CT) technology such as thin detector collimation and fast gantry rotation allow the heart to be scanned in a single breath-hold. This article is...

Factors Associated With Functional Decline of Hospitalised Older Persons Following Discharge From an Acute Geriatric Unit

Hospitalisation is a stressful event for the older person. The physiological changes associated with ageing, such as decreased muscle strength and aerobic activity, reduced bone density, altered appetite and tendency towards urinary incontinence, predispose older patients to complications during hospitalisation. Studies have shown that about one-third of older persons...

Multimodal Antiemetic Therapy and Emetic Risk Profiling

In the last few years, hundreds of papers exploring the issue of postoperative nausea and vomiting (PONV) have been published. It has been estimated that the overall incidence of PONV for all surgeries and patient populations is between 25% and 30%, with severe, intractable PONV estimated to occur in...

Factors Associated with Decompression and Strabismus Surgery in Thyroid Eye Disease

Thyroid eye disease (TED) is a visually and socially disabling condition. Newly diagnosed patients are often fearful of sight-threatening complications that include optic nerve compression or restrictive strabismus. Although the current literature has pointed to age (>60 years), gender (male), abnormal thyroid function (both hyper- and hypo-thyroidism), smoking and...

Healthcare Workers and HIV Health Issues

This paper aims to present a comprehensive review of issues related to HIV testing in healthcare workers (HCWs) and proposes appropriate measures in response to implications of a positive test result. It reflects an attempt to address the need to protect patients, preserve public confidence in the healthcare system...

Concomitant Coronary Artery Disease Among Asian Ischaemic Stroke Patients

Coronary artery disease (CAD) is the leading cause of mortality following ischaemic stroke. The annual risk for myocardial infarction following ischaemic stroke is approximately 2.2%. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Sociodemographic Factors Influencing the Effectiveness of Public Health Education – A Comparison of Two Studies in Singapore

Public health education is a cornerstone in the primary prevention of chronic diseases. In the United States, for example, studies have shown that cardiovascular public health education contributed to increased hypertension detection and control as well as a decline in smoking, thus contributing significantly to the major reduction in...

The Association Between Parental Socioeconomic Status (SES) and Medical Students’ Personal and Professional Development

In order to commit to their mission and placement requirement efficiently and effectively, policy-makers need to decide which types of students their training units should recruit, what type of curriculum they should design and what kinds of support mechanisms they should implement. This article is available only as a PDF....

Risk Factors for Conversion to Open Surgery in Patients With Acute Cholecystitis Undergoing Interval Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy has become a routine surgical procedure in general surgical units all over the world. Its implementation has expanded dramatically and is considered a feasible and safe approach even for acute cholecystitis.1,2 Laparoscopic management of acute cholecystitis may still be associated with increased risks of complications such as...

Cerebral Microangiopathy in Patients with Non-insulin-dependent Diabetes Mellitus

Cardiovascular complications account for the highest rate of morbidity and mortality in patients with diabetes mellitus (DM), type 1 and type 2, respectively. The Copenhagen City Heart Study, carried out in 13,105 subjects followed up prospectively for 20 years, reported that in patients with type 2 DM, the risk...

Expanding the Scope of Antiretroviral Therapy for HIV Infection

The 2010 Global Report on AIDS contains some welcome news: the number of annual AIDS-related deaths has continued to decrease from a peak of 2.1 million in 2004 to an estimated 1.8 million in 2009. This is mainly attributable to the huge expansion in access to anti-retroviral therapy (ART). This...

Prevalence of Chlamydia trachomatis in Singaporean Women Undergoing Termination of Pregnancy

Chlamydia trachomatis is the most common bacterially sexually transmitted infection (STI) in England and Wales.1 This infection if untreated can lead to pelvic inflammatory disease (PID), infertility and ectopic pregnancy.2 In fact pelvic inflammatory disease after a termination of pregnancy (TOP) is a well recognised complication and Chlamydia trachomatis...

Peripheral Arterial Disease in Community-based Patients with Diabetes in Singapore: Results from a Primary Healthcare Study

Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In addition, PAD is a manifestation of systemic atherosclerosis and is associated with increased risk of death and ischaemic events. This article is available only as a...

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). Amongst patients admitted to ICU, studies have revealed the incidence of nosocomial UTIs to range from 9% to 29%. This article is available only as a...

Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009

The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas in the United States in late April 2009. This was linked to outbreaks of influenza in Mexico, which included reports of large numbers of cases...

Rationale for Redefining Obesity in Asians

Obesity is a condition characterised by an excess of body fats. According to the World Health Organization (WHO), there were about 1.6 billion overweight adults aged 15 years and above and at least 400 million adults worldwide in 2005. Obesity poses a serious health burden as it is associated...

The Risk Factors for Ultrasound-diagnosed Non-alcoholic Fatty Liver Disease Among Adolescents

Non-alcoholic fatty liver disease (NAFLD) is increasing recognised as one of the most important causes of chronic liver disease in Western countries. It encompasses a spectrum of diseases ranging from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH). Hepatic steatosis is a common clinical and histological finding and it is...

Renal Cell Carcinoma in Young Patients is Associated with Poorer Prognosis

Recent studies show a steady rise in the incidence of renal cell carcinoma (RCC). The increase had been attributed to screen-detected renal tumours in asymptomatic patients, leading to a corresponding stage migration to smaller localised renal tumours and better disease specific survival. Interestingly, the incidence of malignant renal neoplasms...

Biomedical Strategies for Human Immunodeficiency Virus (HIV) Prevention? A New Paradigm

The first 30 years of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic will be remembered by the way individuals, communities, nations and organisations rallied to put an end the relentless spread of the infection and the death and suffering that it brought. Soon after it was described...

Presentation and Outcome Amongst Older Singaporeans Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS): Does Age Alone Drive Excess Mortality?

Singapore is a country of high income with a low level human immunodeficiency virus (HIV) epidemic, the yearly incidence of disease currently standing at 121.7 new infections per million population per year. Certain features of Singapore’s HIV epidemic are notable. Firstly, despite active screening programmes amongst high-risk populations and...

Causes of Death in Hospitalised Human Immunodeficiency Virus (HIV)-infected Patients at a National Referral Centre in Singapore: A Retrospective Review from 2008 to 2010

The advent of the highly active antiretroviral therapy (HAART) era has greatly reduced the mortality and incidence of new diagnoses of acquired immune deficiency syndrome (AIDS)-defining illnesses (ADIs) in individuals infected with human immunodeficiency virus (HIV) in many countries. This has led to a paradigm shift in the management...

Effects of Age and Gender on Left Atrial Ejection Force and Volume from Real-Time Three-Dimensional Echocardiograph

The left atrium (LA) plays the primary role in the filling of the left ventricle (LV). A number of studies have demonstrated that LA enlargement (i.e. volume increase) is a negative prognostic factor for survival in patients with a variety of cardiovascular disorders, including stroke, congestive heart failure and...

Diagnostic Value of Ultrasound-detected Calcification in Thyroid Nodules

Thyroid nodules which can be palpated are present in between 4% and 7% of the population. Solid nodules as small as 3 mm and cysts of 2 mm can be detected with high-frequency ultrasonography (US). US has been also commonly used to differentiate malignant nodules from all thyroid lesions...

Prevalence of Chronic Kidney Disease in Adults with Type 2 Diabetes Mellitus

According to the National Health Survey, the percentage of Singapore residents with diabetes mellitus (DM) aged between 18 and 69 years has risen from 8.2% in 2004 to 11.3% in 2010. DM can lead to a myriad of long-term health complications such as coronary heart disease, kidney failure and...

The Greying Pandemic: Implications of Ageing Human Immunodeficiency Virus-Positive Population in Singapore

Human immunodeficiency virus (HIV) remains a global public health issue. It is estimated that there are 37.9 million people living with HIV (PLHIV) today. With advances made in efficacy and tolerability of combination antiretroviral therapy (ART) and increased access to health services in developed and developing countries, PLHIV are...