Original Article
Epidemiology of paediatric intensive care unit admissions, deaths and organ donation candidacy: A single-centre audit
With advancements in medical care, mortality rates in critically ill patients have decreased substantially.1,2 Contemporary studies from developed countries report paediatric intensive care mortality rates of 2–3%3,4 in 2014 to 2019, whereas mortality in developing countries can be as high as 50%5 as of 2024, indicating large disparities in...
Editorial
Balancing screen time: Insights and impact on preschool children
Over the past decade, the exposure of young children to screen devices at home and preschool has become increasingly common. Screen viewing time (SVT) has risen alongside the surge in ownership of screen devices such as television, smartphones, tablets and laptops worldwide.1 In many countries, screen time and digital...
Editorial
Promoting evidence-based care for children and adolescents on the autism spectrum
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has been increasing in worldwide prevalence,1 including Singapore. In this latest issue of the Annals, we share the latest Singapore Clinical Practice Guidelines (CPG) for Autism in Children and Adolescents, discussed by Wong et al.2 This is the culmination of...
Original Article
Clinical utility of PET/MRI in multiple myeloma
Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and bone lesions. A sensitive method to detect bone lesions is crucial as it could determine the decision to start treatment. In this era, the International...
Original Article
Long COVID prevalence, risk factors and impact of vaccination in the paediatric population: A survey study in Singapore
On 5 May 2023, more than 3 years since the start of the COVID-19 pandemic, the World Health Organization (WHO) declared that COVID-19 no longer constituted a public health emergency. Despite high numbers of children and younger persons (CYPs) having acute COVID-19,1 information on the quality of health and...
Commentary
Transforming radiology to support population health
The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery of health services in Singapore.1 Part of it involves a shift away from tertiary hospital-based to community-based care, to improve diagnostic imaging services in the...
Original Article
Clinical outcomes and management of contrast hypersensitivity in patients requiring repeated computed tomography imaging
Allergic and non-allergic hypersensitivity reactions to iodinated contrast media (ICM) are increasingly recognised, particularly the latter where there is greater clarity on pathomechanisms.1 There is limited evidence for the use of corticosteroids as premedication to prevent the occurrence of contrast-related reactions. At our institution, a dose of 30mg oral...
Editorial
Preventing recurrent hypersensitivity reactions to iodinated contrast media
Iodinated contrast media (ICM) is one of the most commonly used drugs in the practice of modern medicine. ICM, as the name implies, is a contrast media that contains iodine. It is frequently used in computed tomography (CT) and angiographic procedures, to highlight important anatomical structures and for the...
Letter to the Editor
Erdheim-Chester disease: Imaging spectrum of multisystemic manifestations
Dear Editor,
Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis, usually affecting middle-aged to older adults. It is a multisystemic disease with protean clinical manifestations. It can involve single or multiple organs, and presentations range from asymptomatic lesions detected incidentally on imaging to severe organ dysfunction. Hence, accurate and timely...
Letter to the Editor
Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders
Dear Editor,
Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based patient-centric care.1
We have developed and implemented a deep-learning model using bidirectional long short-term memory (Bi-LSTM) neural network to enable automated triage of unstructured free-text...
Original Article
Multisystem inflammatory syndrome in children in Singapore
While children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulting in coronavirus disease 2019 (COVID-19) have milder manifestations compared to adults,1,2 a rare multisystem inflammatory syndrome leading to multiorgan failure and shock (multisystem inflammatory syndrome in children ) has been recognised to affect children with exposure to...
Editorial
Multisystem inflammatory syndrome in children: A unique manifestation of COVID-19
During the coronavirus disease 2019 (COVID-19) pandemic, children have been relatively spared from the severe symptomatic infection affecting adults, particularly the elderly and those with comorbidities. One of the most challenging aspects of paediatric SARS-CoV-2 infection has been the discovery of a unique late manifestation of infection characterised by...
Commentary
Low-dose computerised tomography screening for lung cancer in Singapore: Practical challenges of identifying participants
INTRODUCTION
In March 2022, the European Commission on cancer screening suggested the inclusion of low-dose computerised tomography (LDCT) for lung cancer, targeted at current and former smokers.1 The aim of LDCT screening is to increase early detection, decrease diagnoses at metastatic stage of the disease and improve overall 5-year...
Images in Medicine
TB or not TB? The axillary lump question
An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule with a central keratinous plug in the right axilla (Fig. 1). The surrounding skin was pigmented, non-tender and indurated. Sonography of the nodule demonstrated an...
Letter to the Editor
Safe time interval for screening estimated glomerular filtration rate prior to gadolinium-enhanced MRI scan
Dear Editor,
Magnetic resonance imaging (MRI) contrast media are commonly used in medical imaging and are usually gadolinium-based contrast agents (GBCAs). They can be divided into 3 groups. Group I consists of compounds with linear molecular structures. Group II consists of compounds with macrocyclic molecular structures. Group III currently includes...
Commentary
The Lancet Commission on diagnostics: What it means for Singapore
Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and global disparity regarding this healthcare value chain has been one of the fundamental problems with prioritised urgency since the United Nation’s Millennium Development Goals were...
Original Article
Risk Factors for Predicting Mortality in a Paediatric Intensive Care Unit
Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care, outcome analysis including mortality risk prediction has become a challenge for the modern day intensivists. During the early 90s, the focus has shifted from the...
Original Article
Reduction in Retake Rates and Radiation Dosage Through Computed Radiography
New computed radiography imaging systems are slowly gaining a foothold in radiological departments worldwide. By computed radiography we mean a digital imaging system which exposes a photostimulable phosphor image receptor plate to obtain a latent image using existing radiographic equipment.
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Original Article
Computed Tomographic and Magnetic Resonance Imaging Findings in Paranasal Sinus Involvement in Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma (NPC) is an aggressive infiltrative neoplasm. Spread into the paranasal sinuses is often seen but the frequency is documented in only a few series.
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Others
Book Review
This book is a collection of 30 case studies, which were published in the Singapore Medical Journal from 1994 to 1997. They include interesting cases from all the major anatomical regions and organ systems.
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Original Article
Bone Mineral Density—Correlation between Quantitative Ultrasound Characteristics and Dual Energy X-ray Absorptiometry
Osteoporosis is well documented to be a significant determinant of the risk of fracture and its assessment in vivo has been based on various methods for measuring bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) has proven so far to be reasonably precise (about 1% to 2%) and accurate...
Original Article
Infections in Acute Lymphoblastic Leukaemia
Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy. Empiric antimicrobial chemotherapy is the mainstay of therapy for febrile neutropenic episodes pending the culture results.
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Original Article
Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore
In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has focused especially on cancer and the possible link between immunology and psychological factors.
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Original Article
Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery
The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have reviewed its use for inguinal and genital surgery in children.
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Original Article
A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)
Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill of these infants would meet the criteria for the use of extracorporeal membrane oxygenation (ECMO).
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Original Article
Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia
Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously studied in Singapore children; hence we report our experience with the use of adenosine for the treatment and diagnosis of supraventricular tachycardia in children over...
Original Article
Use of Central Venous Lines in Paediatrics—A Local Experience
Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique for percutaneous insertion of central venous lines. In 1973, Shaw invented a technique of cannulating peripheral veins with silastic catheters, as an alternative approach to...
Review Article
A Review of the Role of Magnetic Resonance Imaging in the Evaluation of Shoulder Impingement Syndrome and Rotator Cuff Tendon Tears
In the evaluation of chronic shoulder pain and dysfunction clinically suspected to be due to shoulder impingement syndrome and rotator cuff tendon tears, magnetic resonance imaging (MRI) has virtually replaced double contrast shoulder arthrography. MRI has the advantage of demonstrating the shoulder joint in multiple anatomical planes with excellent...
Original Article
Survey of Aerobic Bacterial Infections in Paediatric Surgical Intensive Care Unit Patients
Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric medical patients, paediatric surgical patients are a special group in their spectrum of diseases and treatment requirements.
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Original Article
Portable Chest Radiography: Comparison of High-resolution Digital Displays with Laser Printed Digital Film
In most institutions, about 10% to 25% of imaging examinations are recorded digitally (e.g. digital subtraction angiography, computed tomography, magnetic resonance imaging and ultrasound). Conventional-projection radiographic studies are still displayed in an analog fashion (on film).
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Original Article
Percutaneous Needle Aspiration in the Treatment of Hepatic Abscess: Factors Influencing Patients’ Outcome
Liver abscess traditionally has been treated by open surgical drainage, mortality rates being as high as 80% to 100% if left untreated. However, with the advent of modern non-invasive imaging techniques, percutaneous techniques performed under imaging guidance have, over the recent years, become increasingly acceptable as a suitable alternative...
Original Article
Contrast-Enhanced Magnetic Resonance Imaging of the Internal Auditory Canals and Posterior Fossa
Contrast-enhanced magnetic resonance imaging (MRI) is now the gold-standard examination for the exclusion of acoustic schwannomas or other posterior fossa tumours. We retrospectively reviewed 314 cases done over a period of 2 years and 9 months, correlating presenting symptoms with scan findings.
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Review Article
Imaging of Thoracic Manifestations of Scleroderma
Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys, and heart. The American College of Rheumatology has proposed that for the purpose of clinical trials and surveys, the diagnosis is made if the patient...
Review Article
Overview of Imaging in Rheumatologic Diseases
Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations and advances in technology in imaging and interventional radiology today enable more precise and earlier detection, assessment and treatment.
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Original Article
Magnetic Resonance Imaging of Brain Metastases: Magnetisation Transfer or Triple Dose Gadolinium?
Accurate detection of brain metastases is an important part of tumour staging. Magnetic resonance (MR) imaging is well accepted as a sensitive tool in the detection of brain metastases.
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Original Article
A Clinical Study of Seven Cases of Trichotillomania in Singapore
Trichotillomania was first described by a French dermatologist Hallopeau (1889) of a young man who pulled out his hair in tufts. The word trichotillomania is derived from the Greek thrix which means hair; tillein, to pull; and mania, madness or frenzy.
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Original Article
Radiological Placement of 211 Central Venous Catheters: Outcome and Complications
Long-term central venous access is an important part of modern medical practice, especially in the haematology and oncology units. Central venous (CV) catheters are used for the administration of anti-neoplastic agents, immunosuppressive drugs, antibiotics, blood components, hyperalimentation, for frequent blood sampling, and for acute and temporary haemodialysis prior to...
Original Article
Parainfluenza Type 3 Viral Outbreak in a Neonatal Nursery
Parainfluenza viruses are relatively large RNA paramyxoviruses. Four serologic types cause disease in humans.
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Others
T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report
T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T wave during sinus rhythm without any changes in the QRS complex, is an uncommonly recorded rhythm. We report here an unusual case of T wave...
Others
The Future of Medicine from the Standpoint of the Practising Paediatrician
From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had practised the art and science, on the basis of curing the patient when he has an illness. The doctor is sought out when the patient...
Others
Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children
Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease.
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Original Article
Bidirectional Cavopulmonary Anastomosis
Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to Fontan’s operation has been undertaken in an effort to reduce the volume load of a single ventricle as early as possible and to minimise the...
Original Article
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...
Commentary
Tissue Microangiography Using a Simplified Barium Sulphate Cadaver Injection Technique
The understanding of blood supply is the cornerstone of successful tissue transfer in reconstructive surgery. This understanding has been derived largely from cadaveric dissections, combined with injections to outline the blood supply.
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Original Article
Radionuclide Studies of Articular Cartilage in the Early Diagnosis of Arthritis in the Rabbit
Osteoarthritis is a common joint disease that involves destruction of articular cartilage. Magnetic resonance imaging (MRI) provides a sensitive imaging modality for the diagnosis of osteoarthritis.
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Others
Echocardiographic Features and Management of Neonatal Ductal Aneurysm
Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few years. It has been noted as an incidental finding in autopsy, echocardiography and angiography, but can present with symptoms of cough, dyspnoea, hoarseness of voice...
Others
Retroperitoneal Castleman’s Disease in the Perinephric Space—Imaging Appearance: A Case Report and a Review of the Literature
Castleman’s disease (CD) was first proposed by Castleman in 1954. It is usually found in the mediastinum, but other sites have been described.
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Original Article
Transaminitis in Duchenne’s Muscular Dystrophy
Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine and aspartate transaminase (AST) levels have been found in patients with muscle diseases such as Duchenne’s and Becker’s muscular dystrophy, myotonic dystrophy and the inflammatory...
Original Article
Evaluation of Technetium-99m Ciprofloxacin (Infecton) in the Imaging of Infection
Over the past 10 years we have used various radiopharmaceuticals (RPCs) for imaging of inflammation and infection. These include gallium-67 citrate and the technetium-99m labelled nanocolloids, immunoglobulin (IgG), antigranulocyte antibodies (AGAB) and HMPAO-labelled leukocytes.
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Others
Twenty-four hour, Non-invasive, Neonatal Chromosome Analysis—Application in a Case of Mixed Gonadal Dysgenesis
Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but longer if the initial 48-h culturing period proves unsuccessful.
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Others
Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies
Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of G<sub>M2</sub> gangliosides, particularly in the neuronal cells. The infantile form, similar to Tay Sach’s disease, may present in the first year of life with an...
Others
A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block
The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is the commonest of these disorders, and a leading cause of heart block in newborns.
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Others
Minimal Change Nephrotic Syndrome—A Complex Genetic Disorder
Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia.
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Others
Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months
Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay, India.
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Original Article
DNA Testing for Fragile X Syndrome in 255 Males from Special Schools in Singapore
Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It is associated with a cytogenetically visible fragile site in Xq27.3, termed FRAXA, which results from the unstable expansion of a trinucleotide (CGG)n repeat sequence in...
Original Article
Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients
Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations, or some other less specific complaints such as nausea, pallor and sweatiness.
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Original Article
Diagnosing and Prognosticating Acute Meningitis in Young Infants within 24 Hours of Admission
Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which present with a short history of symptoms and are caused by either bacteria (acute bacterial meningitis, ABM) or viruses (acute aseptic meningitis, AAM).
This article is...
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 as there are so few books of medicine written and published in Singapore.
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Review Article
Enteral Nutrition of the Very Low Birth Weight (VLBW) Infant
Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely delivered.
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Original Article
A Case Series of Six Children with Primary Pulmonary Hypertension
Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of the pressure in the pulmonary artery to above a mean of 25 mmHg at rest, or 30 mmHg during exercise.
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Others
2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore
When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think of quite a few other paediatricians more qualified and appropriate as speakers and hoped that my emphatic no would work.
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Others
Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome
Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the short arm of chromosome 20.
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Original Article
The Use of Vigabatrin in Infantile Spasms in Asian Children
Infantile spasms are a form of age-dependent myoclonic epilepsy that is difficult to control. Agents such as adrenocorticotrophic hormone (ACTH) and prednisolone have been used as first-line therapy, but are associated with major side effects.
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Others
Magnetic Resonance Arthrography of the Labral-Ligamentous Complex of the Shoulder: An Update
Shoulder instability is a frequently encountered clinical problem in young active people following injury, particularly in athletes. The labral-ligamentous complex is increasingly recognised as being an important structural component that contributes to shoulder instability.
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Original Article
Limited Magnetic Resonance Imaging (MRI) and the Occult Hip Fracture
Worldwide, in the past decade, the application of magnetic resonance imaging (MRI) has increased tremendously in the management of musculoskeletal trauma. Not least is its application as a valuable diagnostic tool in occult hip fracture evaluation.
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Review Article
Paediatric Orthopaedics in Singapore
The name “Orthopaedic Surgery” is derived from the words “orthos” (meaning straight or to straighten) and “paido” (meaning child). Thus, it is not unexpected that paediatric orthopaedics was the first discipline within Orthopaedics to develop as a subspecialty.
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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 group of tumours.
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Original Article
Two-year Outcome of Normal-birth-weight Infants Admitted to a Singapore Neonatal Intensive Care Unit
With the rapid advances in the field of neonatal intensive care, the focus of interest has been on the very-low-birthweight (VLBW) infant in recent years. The outcome of these infants has been extensively studied and widely reported. On the other hand, data on the incidence, risk prediction and outcome...
Original Article
Technetium-99m Methoxyisobutylisonitrile Imaging in the Follow-up of Differentiated Thyroid Carcinoma
Differentiated thyroid carcinoma (DTC) is not an uncommon tumour in Thailand.1 A high percentage of 10-year survival results in long-term follow-up. I-131 total-body scan (I-131 TBS) is commonly used for monitoring the disease after surgery and radioiodine ablation in most centres.
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Others
Bronchopulmonary Dysplasia and Chronic Lung Disease of Infancy: Strategies for Prevention and Management
Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal repair of lung injury in the neonatal period. Although BPD and CLD are closely related, they have differing diagnostic criteria and the spectrum of severity...
Others
Embolisation of a Renal Artery Pseudoaneurysm in a Patient with Renal Malrotation and Chronic Aortic Dissection
A 40-year-old Chinese male presented with severe right loin pain. He had a history of chronic abdominal aortic dissection of unknown aetiology. He was not hypertensive and there was no evidence of ankylosing spondylitis, Ehlers-Danlos syndrome or any connective tissue disorder.
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Original Article
Intussusception: A Three-Year Review
Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into another.
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Original Article
Single Centre Review of Radiologically-guided Percutaneous Nephrostomies: A Report of 273 Procedures
Percutaneous nephrostomy (PCN) is a well-established technique in the armamentarium of an interventional radiologist when dealing with urinary obstruction. It provides temporary relief in obstructive uropathy and stabilises the patients for subsequent definitive treatment.
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Original Article
To Establish the Normal Bone Mineral Density Reference Database for the Singapore Male
Bone mineral densitometry was developed as a means to quantify the bone mineral content of the skeleton accurately and has been used in the diagnosis of osteopenia and osteoporosis. Dual-energy X-ray absorptiometry (DXA) of the axial skeleton is one such technique2 which is based on a subtraction method.
This article...
Original Article
Percutaneous Vertebroplasty in the Management of Osteoporotic Vertebral Compression Fractures: Initial Experience
With the general increase in life expectancy in the local population, the incidence of osteoporosis is anticipated to rise as well. Even with screening modalities such as bone mineral densitometry and preventive treatment such as hormone replacement therapy, many patients are asymptomatic and are diagnosed with osteoporosis only after...
Original Article
Differentiation of Malignant Vertebral Collapse from Osteoporotic and Other Benign Causes Using Magnetic Resonance Imaging
An elderly patient presenting with backache and vertebral collapse on plain X-ray is a common clinical scenario and a diagnostic challenge. It is difficult to differentiate between benign and malignant causes for the vertebral collapse.
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Letter to the Editor
Letter to the Editor
We would like to draw the attention of your readers to the comments made in the editorial of the recent Imaging issue of your journal.
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Others
Severe Newborn Encephalopathy Unrelated to Intrapartum Hypoxic Events: 3 Case Reports
Since Little’s article of 1862, it was popularly believed that brain damage in the majority of cases of cerebral palsy occurs during labour and delivery. However, the growing evidence in literature has refuted this belief.
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Others
A Case Series of Pre-Viable Severe Twin-Twin Transfusion Syndrome
Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta.
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Others
Idiopathic Chronic Fetomaternal Haemorrhage Resulting in Hydrops – A Case Report
Small amounts (<0.1 mL) of fetal blood are commonly found in maternal circulation. Massive fetomaternal haemorrhage (FMH) involves fetal blood loss into the maternal circulation of greater than 150 mL or more than half the fetal blood volume.
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Others
Imaging-guided Bone Biopsy
Biopsy may be performed at surgery (open biopsy) or percutaneously (closed biopsy). Percutaneous bone biopsies are usually performed under imaging guidance using a variety of modalities, such as fluoroscopy1 and computed tomography (CT), and less commonly, ultrasonography (US) and magnetic resonance (MR) imaging.
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Others
Carcinoma of the Cervix: Role of MR Imaging
In females with cancer, cervical carcinoma is second to breast cancer in both incidence and mortality worldwide. About 465,000 new cases are diagnosed each year in both developing and industrialised nations, with a higher incidence in women of low socioeconomic status.
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Others
Intracerebral Schwannoma—A Rare Cause of Epilepsy
Schwannomas are extra-axial neoplasms derived from the nerve sheath of peripheral or cranial nerves. They represent approximately 8% of all intracranial tumours, arising predominantly from the vestibular nerve.
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Others
Radiographic Features of a Case of Severe Acute Respiratory Syndrome with Fatal Outcome
Severe acute respiratory syndrome (SARS) is an atypical pneumonia that was first reported in early 2003. Reports of outbreaks of cases rapidly appeared in Hong Kong, Vietnam, China and Singapore.
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Others
Clinical Applications of MR Cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP) has attracted a lot of interest from clinicians because it is a non-invasive method of obtaining a cholangiographic image without the morbidity that is associated with endoscopic retrograde cholangiopancreatography (ERCP).
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Others
Imaging of Paediatric Mediastinal Masses
A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for thoracic masses in children.
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Review Article
Clinical Positron Emission Tomography Imaging—Current Applications
Like other radionuclide techniques, positron emission tomography (PET) is based on the tracer principle – a small amount of labelled ligand is used to trace the metabolic pathway of an important chemical in the cell. PET complements anatomic imaging by its ability to map function or metabolism.
This article is...
Review Article
MR Imaging and MR Spectroscopy of Adenocarcinoma of the Prostate
Prostate cancer is usually suspected due to an abnormal digital rectal examination, elevated serum prostate specific antigen (PSA) level or both. The diagnosis of prostate cancer depends on histopathologic examination of tissue obtained from systematic sextant core needle biopsy under transrectal ultrasound guidance.
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Review Article
Imaging of Congenital Middle Ear Deafness
When a child or young adult with morphologically normal external ears and no previous history of ear discharge or trauma presents with conductive hearing deficit, a congenital middle ear anomaly should be sought. Although fenestral otosclerosis is a differential diagnosis, the early onset of symptoms and a lack of...
Review Article
MR Imaging of the Fetal Brain and Spine: A Maturing Technology
The introduction of a new diagnostic test into a clinical arena goes through a number of stages. The first stage is technical development.
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Review Article
Imaging of Acquired Immunodeficiency Syndrome (AIDS)
The pandemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global healthcare problem and HIV infection is the most common cause of death worldwide. There are now 60 million deaths recorded from the infection worldwide by the United Nations AIDS (UNAIDS) organisation, most of them in sub-Saharan...
Review Article
The Singapore National Breast Screening Programme: Principles and Implementation
In January 2002, the first population-based national mammographic breast screening programme in Asia, the Singapore National Breast Screening Programme (BreastScreen Singapore), was launched. The programme aims to achieve international standards of breast screening practice and breast cancer detection, as well as to reduce or stabilise the mortality from breast...
Original Article
Brachiocephalic-Superior Vena Cava Metallic Stenting in Malignant Superior Vena Cava Obstruction
A large majority of superior vena cava (SVC) syndrome is caused by malignancy (74% to 95%). This can either be due to direct SVC invasion or secondary to extrinsic compression.
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Original Article
Pilot Study Using Technetium-99m Pertechnetate Sequential Radionuclide-Sialography to Assess Salivary Gland Function in Nasopharyngeal Cancer Patients on Radiation Therapy
Nasopharyngeal carcinoma (NPC) is an epithelial malignancy occurring worldwide with particularly high frequencies in the Far East. The incidence is highest in Hong Kong followed by Singaporean Chinese.
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Original Article
Breath-hold Fast Recovery Fast Spin Echo versus Conventional Non-Breath-hold Fast Spin Echo T2-Weighted MR Imaging of Focal Liver Lesions
T2-weighted magnetic resonance (MR) imaging is an important sequence for characterisation of focal liver lesion. Accurate characterisation of benign lesions, such as haemangioma or cyst, is important to prevent unnecessary procedure or surgery.
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Original Article
Diffusion-weighted MR Imaging in Intracranial Infections
Diffusion-weighted magnetic resonance (MR) imaging (DWMRI) is becoming essential to the assessment of acute cerebral infarction and has also been applied to distinguish cerebral abscess from necrotic intracranial neoplasm. There have also been a few case reports on DWMRI of encephalitis.
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Original Article
Preoperative High Resolution CT and MR Imaging in Cochlear Implantation
Candidates for cochlear implantation undergo a thorough audiological and medical assessment. The audiological assessment is done to ensure that these candidates who have bilateral profound or severe hearing loss have been given adequate hearing amplification, but show no significant benefit.
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Original Article
Non-consensual Double Reading in the Singapore Breast Screening Project: Benefits and Limitations
Double reading of mammogram is not the standard practice in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). Rather, single reading of the mammogram remains the basic policy, as was recommended in the Forrest report.
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Original Article
Breast Cancer in Women Under 40 Years: Preoperative Detection by Mammography
The incidence of breast cancer peaks between the ages of 45 and 55 years. Approximately 7% of breast cancers occur below 40 years of age.
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Editorial
The Past Decade of Diagnostic Radiology in Singapore: How Much Progress Have We Really Made?
It has been 10 years since the first ever issue of Annals dedicated to “Radiology” was published in Volume 22 No. 5 September 1993. Keeping in mind the tremendous growth in the development and applications of Imaging for both Diagnosis and Intervention, this second theme issue is long overdue.
This...
Others
The Relationship Between Scoring Systems and Cytokine Levels in Neonatal Sepsis
In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm infants are usually nonspecific. Many clinical and haematological scoring systems have been developed in the early diagnosis of neonatal sepsis.
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Original Article
Clinical Characteristics of an Outbreak of Hand, Foot and Mouth Disease in Singapore
The enterovirus family causes a wide array of illnesses, some easily recognised clinically and others diagnosed as non-specific viral illnesses. This large family of viruses, composed of more than 70 serotypes, accounts for at least 10 to 15 millions of asymptomatic infection per year in the United States.
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Review Article
Perinatal Care at the Threshold of Viability—From Principles to Practice
One of the major challenges in neonatal-perinatal medicine in the new century is the optimal management of the mother and infant when delivery is imminent or at the threshold of viability. Considerable debate has arisen regarding the appropriate approach and strongly polarised viewpoints are held with and without supporting...
Original Article
Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital
The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and medical personnel.
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Review Article
Long-term Follow-up and Outcome of Extremely-low-birth-weight (ELBW) Infants
With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great degree of interest focused on the functioning of these high-risk survivors and their outcome into childhood and recently up to adolescence and early adulthood. Prospective...
Review Article
Exogenous Surfactant Therapy in Newborn Infants
Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of other neonatal respiratory disorders as well. Numerous randomised controlled trials have been conducted in neonatology to study different aspects of surfactant therapy.
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Others
The Use and Abuse of Steroids in Perinatal Medicine
Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality. Despite advances in medical technology, the prevalence of preterm birth in Singapore has increased, secondary to an increase in multiple gestations and obstetric interventions.
This article...
Review Article
Mass Newborn Screening in Singapore—Position and Projections
Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome with early intervention. The development in 1960 by the late Dr Robert Guthrie of a simple test, the GuthrieTest, that enabled the detection of phenylketonuria...
Others
Neonatology In Singapore: The Way We Were, The Way Forward
Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore. As I look at the present-day status of neonatology, it gives me a sense of achievement and accomplishment.
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Original Article
Chorioamnionitis and Outcome in Extremely Preterm Infants
Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is a major predisposing factor for preterm delivery.
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Editorial
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...
Others
Predicting Significant Hyperbilirubinaemia and Early Discharge for Glucose-6-Phosphate Dehydrogenase Deficient Newborns
Glucose-6-phosphate dehydrogenase (G6PD) deficiency occurs in 2.5% of Singapore’s population, and affected newborns are at risk for severe neonatal hyperbilirubinaemia and kernicterus. In the past four decades, neonatology units in local restructured hospitals have hospitalised all affected newborns for at least 14 days after birth because of this risk.
This...
Others
Autoimmune Liver Disease in Children
Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1) and serologically by the presence of non-organ and liver-specific autoantibodies and increased levels of immunoglobulin G (IgG), in the absence of a known aetiology. They...
Others
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...
Review Article
Colorectal Hepatic Metastases: Role of Radiofrequency Ablation
Colorectal cancer is the second most common cancer in Singapore, accounting for 15.9% of all cancers registered with the Singapore Cancer Registry in the years between 1993 and 1997. Despite recent advances in surgery, radiotherapy and chemotherapy, more than half of those afflicted will die from their cancer.
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Original Article
Computed Tomographic Appearance of Colorectal Hepatic Metastases
It is important to recognise the computed tomography (CT) appearance of hepatic metastases from colorectal primaries, as resection in a selected group may offer a 20% to 40% rate of five-year survival compared to 5% to 10% with non-surgical management.
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Review Article
Current Status in Imaging of Colorectal Liver Metastases
Colorectal cancer is a common primary that metastasizes to the liver. About 20% of patients with colorectal cancer will have detectable metastases at the time of clinical presentation, with an additional 30% developing clinical evidence of hepatic disease within 24 months.
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Others
Routine Abdominal and Pelvic Ultrasound Examinations: An Audit Comparing Radiographers and Radiologists
Since its introduction into clinical practice in the early 1970s, ultrasound (US) has become firmly established as an extremely valuable imaging modality and widely used to the extent that abdominal US is the second most commonly performed imaging study (after chest radiography). Our department has also experienced a steady...
Original Article
Clinical Utility of Selective Intra-arterial Calcium-stimulated Hepatic Venous Sampling in Regionalisation of Insulinomas—The Singapore Experience
Insulinomas are small tumours with dimensions that seldom exceed 2.0 cm in diameter. Preoperative non-invasive localisation using trans-abdominal ultrasound and conventional computed tomography (CT) detect only between 25% and 60% of insulinomas.
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Review Article
Adolescent Health Education Programmes: Theoretical Principles in Design and Delivery
Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually transmitted infections and unplanned pregnancy, accidental and intentional injury, including suicide, affect youth disproportionately and appear to be increasing.
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Review Article
Art and “the Language of Well-Being” in Adolescent Health Care
Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration. Creative activity parallels important strategies for mental and spiritual health—people who participate in well-designed creative processes report that it is powerfully restorative.
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Review Article
From Recreation to Creative Expression: The Essential Features of an Adolescent Inpatient Psychosocial Support Programme
In 1984, the Royal Children’s Hospital (RCH) in Melbourne, Australia opened a new ward specifically for adolescent inpatients. This initiative was the result of many years of observation, patient survey, discussion and debate about the possibility of allowing teenagers to stay in a children’s hospital.
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Original Article
Adolescent Admissions to a Tertiary Paediatric Hospital: A Dynamic Pattern
The nature of paediatric practice is changing worldwide. In developing countries, infant mortality from infectious diseases continues to fall with improved immunisation, medical care and pharmaceutical advances. This has resulted in a corresponding rise in the number of adolescents, who now constitute 30% of the world’s population.
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Review Article
Clinical Assessment, Management and Outcomes of a Group of Adolescents Presenting with Complex Medico-psychosocial Conditions
Increased sensitivity to biological change can make adolescents particularly vulnerable to non-organic symptomatic disorders. A variety of pains, headaches, dizziness and fatigue may remain unexplained after medical assessment.
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Original Article
Adolescent Chronic Illness: A Qualitative Study of Psychosocial Adjustment
Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many challenges including dealing with the symptoms of illness, side effects of medications, altered body image, unpredictable disease progression, depression and anxiety.
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Review Article
Strategies to Promote Better Outcomes in Young People with Chronic Illnesses
The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to public health measures, such as sanitation and immunisation, better housing and sweeping improvements in health care.
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Review Article
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.
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Review Article
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...
Review Article
Eating Disorders in Singapore: A Review
Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms of shape/weight dissatisfaction and eating abnormalities. Anorexia nervosa is characterised by significant self-induced weight loss secondary to fear of fatness, amenorrhoea (cessation of menstruation for...
Review Article
Youth Suicide and Parasuicide in Singapore
The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or herself in the knowledge, or expectation, of its fatal outcome. Parasuicide or attempted suicide is distinguished from suicide by the non-fatal outcome.
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Original Article
Five-Year Review of Adolescent Mental Health Usage in Singapore
The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in almost every area, including epidemiology, classification and treatment.
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Others
The Perils of Puberty
Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such as cytochrome P450 systems, accretion of peak bone mass, and the development of sexually dimorphic adult patterns in blood lipids, blood pressure, haemoglobin and red...
Editorial
Adolescent Health—A New Perspective in Singapore
In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field of Adolescent Health has only recently been recognised to be an important specialty which has not received due emphasis in the medical curriculum for undergraduates,...
Others
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 multiple dental caries, phenytoin-induced gingival hyperplasia and severely worn-down and eroded dentition. He is under regular follow-up by the Paediatrics Department of the National University...
Original Article
Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey
Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an area of considerable interest, and many unanswered questions surround this organism and the types of diseases it causes.
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Others
Reflections of a Septuagenarian – Radiology: Past, Present and Future
Before I commence, I would like to thank the Singapore Radiological Society and the Chapter of Radiologists of the Academy of Medicine for inviting me to speak today on the occasion of the inauguration of the FY Khoo Lectureship. I was initially hesitant.
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Others
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 the neck and frequently involves the thyroid gland.
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Original Article
Audit of Diagnostic and Interventional Craniocervical Catheter Angiographic Procedures at the Singapore General Hospital
Catheter angiography has long been considered the diagnostic standard by which the accuracy of other vascular imaging modalities are compared, given its superior contrast and spatial resolution, as well its high selectivity and ability to show the full extent of vascular disease, presence of contralateral disease, patterns of collateral...
Original Article
Breast Ultrasound in Women With Familial Risk of Breast Cancer
Mammography is the modality of choice to screen for breast cancer in asymptomatic women. However, it is known that about 10% to 12% of breast cancers are mammographically occult.
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Review Article
Coronary Artery Disease: Comprehensive Evaluation by Cardiovascular Magnetic Resonance Imaging
Coronary artery disease (CAD) is a major health problem worldwide. With advances in CAD intervention and improvements in treatment and management of CAD, there has been a dramatic increase in the survival rate of patients.
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Others
A Case of Right Loin Pain: Septic Ovarian Vein Thrombosis Due to Campylobacter fetus Bacteraemia
Septic ovarian venous thrombosis is an uncommon entity. Classically, it occurs as a postpartum complication with reported frequency of 1 in 600 to 2000 deliveries.
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Others
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 patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications.
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Original Article
Semi-Quantitative Measurements of Normal Organs With Variable Metabolic Activity on FDG PET Imaging
Positron emission tomography (PET) has a proven clinical role in oncology, cardiology and neurology that primarily uses 2-deoxy-2--fluoro-deoxyglucose (FDG). FDG is an analogue of glucose that mimics the cellular uptake and initial metabolism of glucose, which enables cells utilising excess glucose to be visualised. Increased glucose metabolism is commonly...
Review Article
Clinical Applications of Positron Emission Tomography in Cardiology: A Review
Ischaemic heart disease associated with depressed left ventricular function is a common clinical management dilemma. There is overwhelming evidence that such patients have a poor prognosis when treated medically.
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Review Article
The Role of FDG-PET in the Management of Non-small Cell Lung Carcinoma
Carcinoma of the lung is the leading cause of cancer death in both men and women and is the second most common malignancy in both men and women. In 2003, it is estimated that there will be 171,900 new cases of lung carcinoma diagnosed in the United States and...
Review Article
Clinical PET Imaging – An Asian Perspective
Positron emission tomography (PET) is distinct from other imaging modalities in its ability to probe the physiology and biochemistry of normal and abnormal tissues. It is based on the same principle of tracer kinetics used in conventional nuclear medicine.
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Review Article
PET Tracers and Radiochemistry
Positron emission tomography (PET) has become a powerful scientific and clinical tool for probing biochemical processes in the human body. This is due, in large part, to advances in instrumentation and synthetic chemistry.
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Review Article
Physical Principles and Technology of Clinical PET Imaging
The past few years have seen the transition of positron emission tomography (PET) from the research domain into mainstream clinical applications for oncology. The emergence of PET as the functional imaging modality of choice for diagnosis, staging, therapy monitoring and assessment of recurrence in cancer has led to an...
Editorial
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 such modalities as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). As far back as 1951, positron-emitting radiotracers have...
Letter to the Editor
A Fatal Turkish Case of Campomelic Dysplasia
Paediatric Medicine (CD) is a rare form of congenital short-limbed dwarfism, classically characterised by campomelia (bowing of the long bones of the lower extremities) in association with a posterior cleft palate, flattened facies and hypoplastic scapulae. It was first fully and originally described by Spranger et al and Maroteaux...
Original Article
Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore
Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase in prevalence has also been attributed to the changes in lifestyle and urbanisation in developed countries.
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Others
Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome
Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first described in 1961 and the phenotype was subsequently expanded in 1972.
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Others
Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article
Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital setting, such as nebulisers, water baths, dialysis machines and intravenous fluids.
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Original Article
Gender Disparity in Paediatric Hospital Admissions
Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories appears not to attract much attention or research interest. Gissler and colleagues, in a longitudinal follow-up of all children born in Finland in 1987, reported...
Original Article
Use of D-dimer and Lower Extremity Doppler Ultrasound Results to Obviate the Need for Computerised Tomographic Pulmonary Angiography
The diagnosis of pulmonary embolism (PE) can be a challenging problem. It depends on clinical suspicion and the interpretation of a combination of clinical and radiological presentations.
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Original Article
Image-guided Radiofrequency Ablation of Liver Malignancies: Experience at Singapore General Hospital
Radiofrequency (RF) ablation for the treatment of focal liver malignancies is a relatively new image-guided procedure that is gaining increasing acceptance in the radiologic and surgical community, particularly as an alternative treatment option for patients who have inoperable tumours. The potential benefits of minimally invasive image-guided ablation, as compared...
Original Article
Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience
Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an enzyme deficiency which led directly to the disruption of cellular metabolism. However 40 years later, it was discovered that many inherited diseases were not due...
Original Article
Does Visual Turbidity Correlate With Serum Triglyceride Levels in Babies on Total Parenteral Nutrition?
Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles endogenously produced chylomicrons.
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Original Article
Corticosteroids are not Present in a Traditional Chinese Medicine Formulation for Atopic Dermatitis in Children
Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have a history of AD.
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Original Article
Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore
Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the general public, with many of them utilising it for a whole spectrum of ailments.
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Original Article
The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004
Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8 months.
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Editorial
Building Collaboration in Cardiac Imaging
Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery disease (CAD) detection has captured the imagination of the public appears exceptional.
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Others
3rd FY Khoo Memorial Lecture – Education, Professionalism, Outsourcing and the Future of Radiology
Radiology is undergoing unprecedented changes. Not only is the technology evolving rapidly, providing images of breathtaking anatomical clarity, but functional information has also become a reality.
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Others
A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia
Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an estimated incidence of 1 in 350,000 in a newborn screening programme.
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Review Article
Singapore National Medical Image Resource Centre (SN.MIRC): A World Wide Web Resource for Radiology Education
Radiological images are critical for diagnosis, teaching and research. In radiology education, learners must be exposed to large amounts of visual information, and assimilation of these medical images is essential in the training of diagnostic skills.
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Review Article
Teleradiology in Singapore – Taking Stock and Looking Ahead
Teleradiology is the electronic transmission of radiologic images from one location to another for the purposes of interpretation and/or consultation. The current interest in teleradiology is fuelled mainly by rapid technological advances, a worldwide shortage of radiologists, and cost considerations in developed countries.
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Others
Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis
Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this entity became more frequent after the introduction of vasoactive drugs for intracavernosal injections.
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Editorial
Paediatrics to Geriatrics: The Continuum
In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it was no different up to the mid 1980s.
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Original Article
Clinical Features Associated with Nasal Staphylococcus aureus Colonisation in Chinese Children with Moderate-to-severe Atopic Dermatitis
Atopic dermatitis (AD) is a common chronic relapsing disease in children. It was estimated that about 15% of children suffer from this disease.1-3 Bacterial colonisation/ infection due to Staphylococcus aureus is considered an important factor in the pathophysiology and mechanism involved in AD exacerbation.4,5 We set out to (i)...
Others
A Case of Cystic Schwannoma of the Lesser Sac
Schwannoma or neurilemmoma (NL) is a well-defined, usually benign, tumour arising from the nerve sheath (Schwann cell). It may present as a solitary mass in any part of the body, but is more commonly seen in the head and neck, the extremities and on the trunk.
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Review Article
A Rotavirus Vaccine for Infants: The Asian Experience
Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20% of all diarrhoea-related deaths and global mortality among children less than 5 years of age is estimated at nearly half a million.
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Editorial
Therapeutic Hypothermia for Neonatal Hypoxic-Ischaemic Encephalopathy
Hypoxic-ischaemic encephalopathy (HIE) is an important cause of death and later neurological disability in full-term neonates worldwide. Perinatal asphyxia causes about 19% of the over 5 million neonatal deaths worldwide annually.
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Others
Outcome of Organic Acidurias in China
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Others
Organising Services for IMD in Thailand: Twenty Years Experience
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Others
Newborn Screening in Pakistan – Lessons from a Hospital-based Congenital Hypothyroidism Screening Programme
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Others
Newborn Screening in Bangladesh
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Others
Newborn Screening in China: Phenylketonuria, Congenital Hypothyroidism and Expanded Screening
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Others
Minimising Harm from Newborn Screening Programmes
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Others
Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?
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Others
Financing Newborn Screening Systems: US Experience
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Others
Inborn Errors of Metabolism Presenting as Neonatal Encephalopathy: Practical Tips for Clinicians
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Others
Legal Issues in Neonatal Screening
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Others
Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening
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Others
External Quality Assurance Programme for Newborn Screening of Glucose-6-Phosphate Dehydrogenase Deficiency
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Others
Glucose-6-Phosphate Dehydrogenase Deficiency: Correlation between the Genotype, Biochemistry and Phenotype
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Others
Disorders of Vitamin B12 Metabolism Presenting Through Newborn Screening
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Others
Diagnosis of Tetrahydrobiopterin (BH4) Responsive Mild Phenylketonuria in Japan over the Past 10 Years
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Others
Fatty Acid Oxidation Defects
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Others
Disorders of the Carnitine Cycle and Detection by Newborn Screening
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Others
Spectrum of Inherited Metabolic Disorders in Malaysia
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Others
Establishing a Universal Newborn Hearing Screening Programme
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Others
Current Understanding of Auditory Neuropathy
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Others
A Multidisciplinary Approach to Paediatric Hearing Loss: Programme at the Centre for Hearing Intervention and Language Development, National University Hospital, Singapore
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Others
Early Intervention For Hearing Impairment: Appropriate, Accessible and Affordable
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Others
Impact of the National Hearing Screening Programme in China
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Others
Outcome of Early Cochlear Implantation
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Others
Eliminating Iodine Deficiency: Obstacles and Their Removal
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Others
Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism
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Others
Issues on Universal Screening for Galactosemia
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Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case
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Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: Supporting Arguments
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Others
My Early Experiences in Establishing Neonatal Screening and the Reason for Regional Meetings of the International Society for Neonatal Screening
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Others
Diagnosis and Management Support for an Expanded Newborn Screening Programme
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Others
Considerations in Choosing Screening Conditions: One (US) Approach
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Others
Clinical Applications of Molecular Genetics: The Model of Congenital Adrenal Hyperplasia
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Others
Newborn Screening in Japan: Restructuring for the New Era
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Others
Improved Health and Development of Children who are Deaf and Hard of Hearing Following Early Intervention
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Others
Towards Universal Newborn Screening in Developing Countries: Obstacles and the Way Forward
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Others
Improving Child Health – Newborn Screening for All?
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Editorial
Neonatal Screening – A Global Perspective
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Original Article
Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia
Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected vision equal to or worse than 20/40, and it varies from as low as 2.72% in South Africa to as high as 15.8% in Chile.
This...
Letter to the Editor
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 medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...
Commentary
When Words Really Matter
I think a lot these days about doctors giving advice. Nobody taught me, back in medical school, how to give advice.
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Review Article
Behavioural Sleep Disorders in Children and Adolescents
Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are often overlooked by healthcare practitioners.
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Review Article
Cardiovascular Changes in Children with Snoring and Obstructive Sleep Apnoea
Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the prevalence of childhood OSA diagnosed by varying criteria was 1% to 4%.
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Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty.
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Review Article
Sleep Disorders in Children: The Singapore Perspective
Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in 1% to 3% of children.
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Review Article
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 a bedroom, since the child is often unaware of what happens when he or she is asleep.
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Review Article
The Scope of Paediatric Sleep Medicine
Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of sleep develops and matures, resulting in changing patterns of normal behaviours and of sleep disorders.
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Original Article
Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most current version of the Diagnostic and Statistical Manual of Diseases (DSM), fourth edition, has 2 lists of behavioural symptoms grouped under “inattentive” and “hyperactive-impulsive” symptoms,...
Original Article
Inflammatory Cytokines and Childhood Obstructive Sleep Apnoea
Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway occlusion during sleep that are associated with daytime behavioural changes and abnormalities in cardiovascular function. In adults, it has been shown that OSA is an independent risk factor for cardiovascular diseases.
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Original Article
Nasal Obstruction in Children with Sleep-disordered Breathing
Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in the newborn nursery. Later, during development in the first years of life, abnormal nasal breathing has important consequences for facial growth.
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Original Article
Immunogenicity, Reactogenicity and Safety of a Diphtheria-Tetanus-Acellular Pertussis-Inactivated Polio and Haemophilus Influenzae Type b Combination Vaccine in a Placebo-controlled Rotavirus Vaccine Study
Singapore’s national immunisation programme for the 6 traditional Expanded Programme on Immunisation (EPI) vaccines (i.e. BCG, diphtheria, tetanus, pertussis, polio and measles) and hepatitis B has been in place for many years and its success has been dramatic. Despite being previously endemic to Singapore in the 1950s, diphtheria has...
Images in Medicine
Transfusion-dependent Microcytic Anaemia in a 10-year-old Girl
A 10-year-girl from Bangladesh presented with a moderately severe anaemia (lowest recorded haemoglobin level of 5.6 g/dL) and a mild jaundice (latest serum bilirubin, 31 μmol/L) 3 years ago (Figs. 1 and 2). Test for haemoglobin electrophoresis on agarose gel did not reveal any abnormal bands.
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Images in Medicine
Caudal Regression Syndrome
A white female with an uncomplicated history of birth delivery and a familial history of diabetes mellitus presented to the orthopaedic clinic at the age of 16 months old with bowel dysfunction, inability to walk, one kidney, and a gibbus noted at T12. A “frog-like” appearance was noted of...
Others
3rd College of Paediatrics and Child Health Lecture – The Past, the Present and the Shape of Things to Come…
In the post-war days of the 1950s, Singapore children were faced with problems of malnutrition and infectious diseases. There was poverty, overcrowded housing and lack of hygiene, and the social conditions were apparently appalling.
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Original Article
Auricular Anthropometry of Newborns at the Singapore General Hospital
Abnormalities of the external ear are described in many syndromes and genetic conditions. Melnick et al reported an incidence of 1 in 90 births for external ear malformations and branchial sinuses and tags, with about 1 in 670 births having malformations of the pinna.
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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 the knee structures, including ligaments, menisci, bones, cartilage and periarticular soft tissues.
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Others
Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation
Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations, especially among children. The severity of the envenomation is related to haemodynamic and cardiorespiratory alterations, with cardiac failure and cardiogenic pulmonary oedema being the major...
Original Article
Screening Tools for Bacteraemia in a Selected Population of Febrile Children
Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from bacteraemia and sepsis, which is accompanied by findings of serious systemic illness.
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Original Article
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 of osteonecrosis and chondrolysis, preventing further slips, and promoting physeal closure.
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Original Article
Local Experience of Endorectal Magnetic Resonance Imaging of Prostate with Correlation to Radical Prostatectomy Specimens
Prostate cancer ranks among the top 10 cancers in Singapore. The incidence of prostate cancer has risen by 5% to 118% in most Asian countries.
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Images in Medicine
Paediatric perineal skin pit: More than skin deep?
A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth, his parents were informed that he had a “bilobed scrotum and a deep perineal skin pit” that may pose hygiene and cosmetic issues. They had...
Others
A New Method for the Removal of Safety Pins Ingested by Children
Foreign body ingestion is a relatively common problem, with an estimated incidence of 120 per 1 million population, resulting in approximately 1500 deaths each year. Toddlers form the most vulnerable group. Swallowed objects may be true foreign bodies such as coins, plastic toys, bones, pins and disc batteries.1,2 The...
Original Article
Factors Predictive of Outcome in Childhood Stroke in an Asian Population
Strokes in childhood are generally considered to be rare with an incidence of about 2.7 per 100 000 children per year.1 The aetiologies of stroke in children differ considerably from adults and multiple risk factors commonly co-exist. A large stroke registry in North America reported that a large proportion...
Letter to the Editor
Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis
Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis is rare.
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Original Article
Morbidity of Parainfluenza 3 Outbreak in Preterm Infants in a Neonatal Unit
Parainfluenza type 3 virus (PIV-3) is an important nosocomial pathogen. It closely mimics respiratory syncytial virus (RSV) in its clinical presentations, and in infants. It is the second commonest cause of pneumonia and bronchiolitis after RSV.
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Letter to the Editor
Medical Misadventure: Barium Extravasation in Colorectal Cancer
Double contrast barium enema (DCBE) is a safe and accurate diagnostic procedure for colorectal cancer. It is often the next diagnostic test after incomplete colonoscopy, with an additional diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the non-visualised portion of the colon.
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Letter to the Editor
Durian Seed Masquerading as Gallstone Ileus on Computed Tomography
Bezoars and gallstones are unusual causes of small bowel obstruction, with well-described imaging features on CT. We present a case of intestinal obstruction caused by a laminated mass in the terminal ileum that resembled a gallstone on CT, but was surgically proven to be a durian seed phytobezoar.
This article...
Letter to the Editor
An Unexpected Outcome following Radial Head Excision for Jeffrey Type II Fracture-Dislocation of the Proximal Radius in a Child
We present a case of a 10-year-old child who sustained a traumatic fracture-dislocation of his proximal radius and subsequently underwent surgical removal of the radial head. At 3 years of follow-up, he had regained full painless flexion and extension with loss of pronosupination.
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Letter to the Editor
Temporary Tattoo Associated Type IV Delayed Hypersensitivity Dermatitis in a Child – A Case Report and Call for Parental Caution in Singapore
A 5-year-old, previously healthy French Caucasian boy was seen at a Paediatric Emergency Department for a skin rash over his left forearm.
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Original Article
A Survey of Local Preclinical and Clinical Medical Students’ Attitudes towards Radiology
Radiology is not a popular specialty for undergraduate student electives or postgraduate training amongst students from a local undergraduate medical school which is based in Southeast Asia. During the last 2 years (2007 & 2008), none of our elective students came from the local undergraduate medical school. During the...
Images in Medicine
A Case of Congenital Haemolytic Anaemia and Thrombocytopenia
A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to thrive since birth.
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Images in Medicine
An Exanthem with An Annular Pattern in a 2-year-old Girl
A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the trunk and hands. The parent’s concern was the rash’s duration and association with 2 episodes of fever.
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Letter to the Editor
Primary Epithelioid Angiosarcoma of the Lung Presenting as Left-sided Shoulder Pain
Primary angiosarcoma of the lung is a rare, often difficult to diagnose disorder with non-specific respiratory manifestations. Angiosarcoma involving the lung is usually a result of metastatic disease.
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Original Article
Clinical Features Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis
Causes of neonatal cholestasis (NC) are long and diverse but the responses of newborn liver, either physiological or anatomical, are limited. This is because the ability of a developing liver of responding in the face of a variety of insults are limited.
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Original Article
Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children
Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can cause significant morbidity and mortality in children as well as adults.
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Letter to the Editor
Macronodular Tuberculosis: Imaging Resemblance of Cholangiocarcinoma
The ability of multiphasic computed tomography (CT) and magnetic resonance (MR) studies in the diagnosis of liver tumours such as hepatocellular carcinoma and cholangiocarcinoma is well established. Nevertheless, potential mimics of malignant tumours abound. Hepatic tuberculosis presenting as hepatic mass is rare and preoperative diagnosis is usually difficult without...
Letter to the Editor
Bannayan Riley Ruvalcaba Syndrome
Bannayan-Riley-Ruvalcaba syndrome (BRRS) classically presents with macrocephaly, subcutaneous and visceral lipomata, haemangiomata, hamartomatous intestinal polyps and pigmented macules involving the genitalia. This autosomal dominant disorder is linked to germline mutations of the phosphatase and tensine homologue gene (PTEN), a tumour suppressor gene which has a significant role in the...
Images in Medicine
Dyke-Davidoff-Masson Syndrome
An 8-year-old boy presented with uncontrolled seizures. He was born as the second child to non-consanguineous parents. He had significant perinatal asphyxia in the newborn period. He had developmental delay since infancy and was noticed to have right-sided tonic clonic seizures since the age of 3 years, which was...
Original Article
Central Clot Score at Computed Tomography as a Predictor of 30-day Mortality after Acute Pulmonary Embolism
Multi-detector Computed Tomography (MDCT) pulmonary angiography is currently the method of choice for the detection of acute pulmonary embolism (PE), because of its convenience, speed, sensitivity, direct clot visualisation and ability to provide alternative diagnoses that mimic PE clinically.
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Review Article
Childhood Food Allergy: A Singaporean Perspective
Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the term IgE-mediated food allergy is appropriate.
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Original Article
Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?
Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of devices has been developed for use over the years, with significant advances achieved in terms of profile and safety.
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Commentary
2009 Pandemic Influenza H1N1: Paediatric Perspectives
The pandemic H1N1 influenza virus, containing genes from avian, human and swine influenza viruses, emerged in North America, and caused illness in more than 190 countries and resulted in more than 4500 deaths worldwide. According to Taiwan Centres for Disease Control (Taiwan CDC) data, among 2,089 typed influenza isolates...
Original Article
Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns
Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise in numbers of infected cases despite initial containment followed by mitigation efforts. Local incidence for acute upper respiratory infections (which was a reasonable surrogate for...
Letter to the Editor
Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the light of some of the points raised such as frequent comorbidities that occur with ADHD as is the case of Autistic disorder and other conditions...
Letter to the Editor
Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than curing for attention deficit hyperactivity disorder (ADHD) is taking place. There are some evidence-based points that should be noted.
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Original Article
Dedicated Cytogenetics Factor is Critical for Improving Karyotyping Results for Childhood Leukaemias – Experience in the National University Hospital, Singapore 1989-2006
Acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) make up the bulk of childhood leukaemia cases. With risk stratified therapy being one of the cornerstones of the treatment of childhood leukaemia, it is important to determine the prognostic factors on which risk stratified therapy depends.
This article is available...
Original Article
Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007
Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is of public health importance because of the teratogenic effects of the virus on the developing fetus.
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Original Article
Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study
The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months and partial breastfeeding thereafter for at least 12 or 24 months....
Images in Medicine
A Missed Bilateral Choanal Atresia
What do you see in the image?
a) Deviated posterior nasal septum
b) Nasopharyngeal tumour
c) Rhinolith with mucous plug
d) Bilateral choanal atresia
e) Nasal pyriform aperture stenosis
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Original Article
Health-related Quality of Life in Children with Cancer Undergoing Treatment: A First Look at the Singapore Experience
Health-related quality of life (HRQOL) has been progressively acknowledged as an essential health outcome measure in clinical trials and health services research and evaluation. HRQOL, compared to QOL, is a more defined conceptual term which encompasses only health-related aspects of life directly amenable to healthcare services and medical products.
This...
Images in Medicine
Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?
A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron
emission tomography/computed tomography (PET/CT) for staging. Figure 1 demonstrates a whole body maximal intensity projection image while Figures 2 and 3 show cross-sectional images through the elbows...
Original Article
Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore
The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist into adulthood and increases the risk of cardiovascular metabolic diseases, giving rise to an increased healthcare burden. In Singapore, the prevalence of obesity for adults...
Original Article
Short- and Long-Term Outcomes at 2, 5 and 8 Years Old for Neonates at Borderline Viability—An 11-Year Experience
Singapore was listed consistently among the top 3 countries in the world with the lowest infant mortality rate. In particular, Asia had seen its infant mortality rate improve dramatically with time. Advances in perinatal care had however, failed to improve the survival of extremely low birth weight infants of...
Letter to the Editor
Ultrasound-Guided Thyroid Fine Needle Aspiration Biopsy—The Way Forward
I read with great interest the recent article published in the Annals of Academy of Medicine Singapore entitled, ‘Surgeon-Performed Ultrasound-Guided Fine Needle Aspiration Cytology (SP-US-FNAC) Shortens Time for Diagnosis of Thyroid Nodules, Ann Acad Med Singapore 2014;43:320-4’. Indeed, ultrasound-guided fine-needle aspiration (US-FNA) is an exceptionally valuable and simple approach...
Original Article
Relationships between Prostatic Volume and Intravesical Prostatic Protrusion on Transabdominal Ultrasound and Benign Prostatic Obstruction in Patients with Lower Urinary Tract Symptoms
Benign prostatic hyperplasia (BPH) is one of the commonest diseases of ageing men. It can be associated with bothersome lower urinary tract symptoms (LUTS) that affect quality of life and it causes structural and functional changes in the bladder. Previous clinical guidelines had emphasised on managing symptoms; however current...
Original Article
Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?
The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The Fetal Medicine Foundation, London, has refined and populated this screening test that uses a combination of maternal age, nuchal translucency (NT) thickness and biochemical markers,...
Letter to the Editor
A Follow-up Longitudinal Survey on a Cohort of Undergraduate Medical Students’ Attitudes towards Radiology
As a follow-up to an earlier study comparing the attitudes of first year undergraduate medical students following the introduction of a new radiology curriculum in 2008 with their clinical seniors who did not have an early exposure to radiology; we again surveyed this same cohort of first year students...
Letter to the Editor
Prevalence of vitamin D deficiency and insufficiency in Malaysian infants
Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either vitamin D deficient or insufficient. In a study on the state of Kelantan in Malaysia (2010–2012), 60% of pregnant women were vitamin D deficient. Maternal...
Letter to the Editor
Impact of true fetal mosaicism on prenatal screening and diagnosis
Over the past decade, the non-invasive prenatal test (NIPT) has increasingly been used as a method for prenatal screening for trisomy 21 (T21) and other aneuploidies, complementing the traditional approach of first trimester screening (FTS). FTS comprises ultrasound of the nuchal thickness and blood test to measure the levels...
Commentary
Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging
Transthyretin amyloidosis (or ATTR amyloidosis) is an under-recognised multisystemic disorder, arising from misfolding of transthyretin proteins into insoluble amyloid fibrils. As amyloid fibrils deposit into various tissues and organs, the process invariably leads to organ dysfunction. Deposition of amyloid fibrils into the heart results in cardiac amyloidosis (CA). Manifestations...
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 worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...
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 and road traffic injuries are common causes in school-going children. Majority of paediatric head injury cases are mild traumatic brain injuries, defined as a Glasgow...
Original Article
Perinatal Drug Abuse in KK Women’s and Children’s Hospital
In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance abuse in a pregnant population to be approximately 11% (range 0.4% to 27%) in a survey of 35 perinatal centres in the United States.
This article...