Dear Editor, Chronic kidney disease (CKD) is one of the key complications occurring in 25–40% of patients with type 2 diabetes mellitus (T2DM).1 Our earlier study also showed that CKD was present in 53% of patients with T2DM recruited from a secondary care diabetes centre and primary care polyclinic...

Dear Editor, Peripheral artery disease (PAD) is characterised by the debilitating atherosclerotic occlusion of arteries in the lower extremities, with chronic limb threatening ischaemia (CLTI) representing the most advanced stage of this disease process. Left untreated, these sequelae will invariably progress to major lower extremity amputation (LEA) and premature death....

Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to 8.5% in 2014.1 DM has been shown to be a common comorbidity in heart failure (HF) patients ranging from 4.3–28%2 and when present, portends a...

Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Although deliberate hypotension during surgery may potentially cause organ ischaemia, in particular of the myocardium and cerebrum, it is widely used as an adjuvant technique in oral and maxillofacial surgery aimed at reducing blood loss and improving the surgical field. Deliberate hypotension was reported as the fourth commonest cause...

Pyogenic granulomas are common benign fibrovascular growths of the oral cavity that are non-neoplastic in nature. They may also present as skin lesions. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Tooth avulsion, frequently of the maxillary central incisors, occurs most often in children from 7 to 9 years of age, when the periodontium surrounding the immature erupting teeth is loosely structured, providing minimal resistance to extrusive forces. Falls against hard objects, including those incurred during sports activities, are one...

Ameloblastoma is a benign but locally invasive tumour that affects the jaws. Although it is commonly regarded as a homogeneous group of tumours, detailed investigations have proven its clinicopathologic diversity. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Schimmelpenning syndrome (SS) is characterised by specific skin manifestations, skeletal defects, and central nervous system abnormalities, such as mental deficiency and seizures. Happle has shown that a clinical entity known as “epidermal nevus syndrome”, formerly used as an alternative term to SS, does not exist. This article is available only...

Secondary alveolar bone grafting, which was pioneered in Europe, was reported in the German literature at the beginning of this century. However, it was not until the 1970s that secondary or delayed bone grafting became popular in the United States. This article is available only as a PDF. Please click...

The current explosion of molecular biology encompassing genetics, morphogenesis, teratogenesis and pharmacogenomics for targeted drug therapy is about to have a profound impact upon the practice of medicine in the next century. A new discipline of molecular medicine is becoming a feature of clinical practice. This article is available only...

Most of the mucocutaneous diseases are confined to the stratified squamous epithelia and thus may involve oral, genital and other mucosae and skin. Most of these conditions are acquired and have an immunological basis but there is often a hereditary predisposition. This article is available only as a PDF. Please...

Form follows function and adaptation to physiologic demands dictates skeletal form. In the oro-facial region, tooth loss leads to atrophy of the alveolar arches in all planes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Cranial bone defects can be a result of trauma, congenital defects, infection or iatrogenically induced by surgery. Even for patients with sufficient hair to cover the affected site, hair styling may not be sufficient to mask off the deficient external cranial contour. This article is available only as a PDF....

There are a variety of pathological conditions that present in the oral cavity. While clinical and radiographic examination will suggest a provisional diagnosis, histological examination is often required to confirm or exclude a suspected diagnosis. This article is available only as a PDF. Please click on “Download PDF” on top...

Multiple segment osteotomy (MSO) orthognathic surgery serves to combine total or segmental maxillary and mandibular correction of dentofacial deformities with concurrent diastematic procedures to provide immediate repositioning of dental-osseous elements. In addition, splitting the palate may often be necessary to correct a functionally poor relationship of the maxilla to...

Craniofacial development is a complex multidimensional process that depends in large part on growth in the cranial base at several growth centres posteriorly and a suture anteriorly. Coordinated development of these sites produces the normal shape of the skull. This article is available only as a PDF. Please click on...

Cleft palate morphology and palatal dimensional changes due to growth and treatment have been analysed by numerous quantitative techniques. Many of these methods, however, produce two-dimensional measurements of the three-dimensional cleft palate deformity. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Distraction osteogenesis is rapidly becoming a mainstream treatment modality for the early management of the patient with mandibular hypoplasia. Following early clinical experience with external distracters, intraoral buried internal distracters have been developed that offer specific advantages over the external device. This article is available only as a PDF. Please...

Apart from the nasal bone, the mandible is the most commonly fractured bone in the face. It is also the 10th most often broken bone in the body. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Diabetes mellitus affects some 9% of Singaporeans. Studies had shown that virtually all insulin dependent diabetes mellitus (Type 1) and 85% of non-insulin dependent diabetes mellitus (Type 2) patients would develop retinopathy after 20 years of disease. This article is available only as a PDF. Please click on “Download PDF”...

A 57-year-old woman was admitted to our hospital for perforated left tubo-ovarian abscess and found to have newly diagnosed diabetes with an admission blood glucose of 23 mM and glycated haemoglobin value of 12% (reference range 4.6% to 6.4%). She denied past symptoms of thirst, polyuria or polydipsia. This article...

The mandible is a unique bone in the human skeleton and occupies a prominent position in the craniofacial region. Traumatic injury to the face, especially in the lower third, may result in fractures of the mandible. This article is available only as a PDF. Please click on “Download PDF” on...

The spectrum of pulmonary aspergillosis includes saprophytic colonisation, hypersensitivity syndromes and invasive lung disease. There has been a tendency to classify these syndromes as separate entities but clinical overlap occurs. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The “gold standard” for the diagnosis of diabetes mellitus has all along been the oral glucose tolerance test (OGTT). As diabetes mellitus defines a group of individuals at high risk for macrovascular and microvascular disease, it is essential that the diagnosis be made promptly. This article is available only as...

Traditional medicine includes the knowledge and practices that rely exclusively on practical experience and observations handed down from generations to generations, either verbally or in writing. Traditional systems of medicine in India are culturally acceptable and usually inexpensive. This article is available only as a PDF. Please click on “Download...

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

In the last decades, the exponential growth in the sophistication of the medical/dental knowledge and technologies has made the current dental curriculum more cramped and inevitably compartmentalised. This paradigm shift has caused, globally and regionally, a great demand on dental schools to produce dentists who can differentiate the quality...

Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma or with symptoms caused by excess of counterregulatory hormones like catecholamines, such as palpitations, sweating and tremulousness. It is most commonly seen in patients with...

Unlike in Caucasians, primary malignant melanoma is an uncommon skin malignancy in Singapore. There have been little published data on cutaneous melanoma in Southeast Asia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Patients with rheumatic disease are often immunocompromised as a result of either their disease or treatment. They may become ill either from a flare of their autoimmune disease or from complications of treatment, at times requiring intensive care. This article is available only as a PDF. Please click on “Download...

Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to 12% and about 0.7% are reported to have central nervous system infection e.g. epidural abscess or meningitis. This article is available only as a PDF. Please...

Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on glycaemic control to one addressing global cardiovascular risk factors in a particular individual, glycaemic control remains one of the key challenges that the physician faces...

Cleidocranial dysplasia is an autosomal dominant skeletal disorder characterized by short stature, brachycephaly, delayed closure of the fontanelles and sutures, Wormian bones, midface hypoplasia, unerupted teeth, supernumerary permanent teeth, aplasia or hypoplasia of the clavicles, and other skeletal anomalies, such as hypoplastic iliac wings and brachydactyly. This article is available...

A 19-year-old Indian male with a past history of “Ludwig’s angina” was seen at the Accident and Emergency Department of National University Hospital complaining of an acute swelling at the floor of the mouth for 2 days. The patient was seen the day before in an outpatient clinic and...

The floor of the mouth takes form as early as in the fourth week of gestation with the downward growth and subsequent degeneration of the ectoderm surrounding the peripheral of the tongue, forming the lingual sulcus separating the tongue and the floor of the mouth. The anterior boundary is...

Ameloblastoma is a true neoplasm of enamel organ type tissue which does not undergo differentiation to the point of enamel organ. This type of tumour occurs mostly in the mandible and grows slowly with variable clinical and histological characteristics, but it is histologically benign. This article is available only as...

Six patients with unusual presentations of head and neck disease were presented for diagnosis by discussants at the conference. Images were accompanied by brief details and the differential diagnosis was explored by the discussants. This article is available only as a PDF. Please click on “Download PDF” on top to...

The Internet is a global network of networks that connect computers all over the world, so that anyone from any point in the network can communicate with others on the network through a service provider. The Transmission Control Protocol/Internet Protocol (TCP/IP) and the World Wide Web (www) technology have...

Bisphosphonates are commonly prescribed for the treatment (and prevention) of postmenopausal and corticosteroid induced osteoporosis, Paget’s disease, hypercalcemia associated with malignancy and osteolysis (and bone pain) associated with metastatic bone disease (e.g. in metastatic breast and prostate cancers). This article is available only as a PDF. Please click on “Download...

Recurrent aphthous stomatitis (RAS) is a common condition of the oral mucosa of unknown aetiology. Several predisposing factors have been suggested including haematinic deficiencies, reactions to foodstuffs and local trauma. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Human immunodeficiency virus (HIV) infection is a major global health problem. It is estimated that the number of people living with HIV infection in India, by the end of 2002, is 4 to 5 million. This article is available only as a PDF. Please click on “Download PDF” on top...

Betel quid/areca nut use has been common in South and Southeast Asia and the Asia Pacific region for a long time and is common among migrated communities in Africa, Europe and North America. Because of its ancient history, its use is socially acceptable among all sections of society, including...

The primary function of the immune system of the mouth is to protect the teeth, jaws, gingivae and the rest of the oral mucosa against infection. The oral immune system is part of an extensive and specialised compartmentalised mucosa-associated lymphoid tissue (MALT). This article is available only as a PDF....

The practice of Dentistry in Singapore has advanced rapidly, with the development and recognition of several specialty practices, coupled with the support of established specialty training programmes abroad as well as locally. In this respect, the Academy of Medicine, Singapore (AMS) had led and played a pivotal role in...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Diabetes mellitus (DM) is a common and growing healthcare problem in Singapore with a prevalence of 9% in 1998. Since the 1990s, the Ministry of Health, Singapore has identified DM as a priority condition for disease control. This article is available only as a PDF. Please click on “Download PDF”...

Deformity refers to distortion of any part of the body. The term dentofacial is related to the dental arches and their effects on facial contours. Dentofacial deformity has been described as a deformity that affects primarily the jaws and dentition, although the mid and lower faces are also affected. This...

Cataract surgery is one of the most successful surgical procedures performed. However, postoperative endophthalmitis, defined as severe inflammation involving both the anterior and posterior segments of the eye secondary to an infectious agent, is an uncommon but devastating complication. This article is available only as a PDF. Please click on...

The epidemic of type II diabetes mellitus is now recognised worldwide. In India, it has been estimated that the population with type II diabetes would increase by 150% in 2025. As the population with type II diabetes increases, so does the prevalence of diabetic retinopathy and other microvascular complications. This...

The significance of methicillin-resistant Staphylococcus aureus (MRSA) is indisputable. Its successful establishment and maintenance as the most important endemic healthcare associated infection (HCAI) results from its reservoir in up to 20% of inpatients and 16% of healthcare workers plus its ability to survive on surfaces for over 12 days. This...

During the growth and development of a person, the facial structures are primarily dependent on the genetic makeup and secondarily on the environmental factors. If the facial structures grow abnormally or disproportionately, a dentofacial deformity occurs. This article is available only as a PDF. Please click on “Download PDF” on...

The mandibular advancement device (MAD) consists of upper and lower splints attached to the teeth and postures the mandible forward. The rationale for use of the MAD is that the forward movement of the mandible moves the tongue forward since the tongue is attached to the genial tubercles of...

Recently, the impact of periodontal disease on adverse pregnancy outcome has received much attention. Pre-term low birth weight (PLBW) is a problem encountered in most world communities at varying levels of prevalence. The problems of PLBWs have considerable repercussions in terms of medical financial resources, mortality and increased susceptibility...

Total knee arthroplasty (TKA) for patients with knee arthritis that is unresponsive to conservative treatment is being increasingly performed all over the world. It is a safe procedure with a low risk of perioperative death. Improvements in surgical techniques, as well as the identification and treatment of comorbidities, have...

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

The idea of having an Academy of Medicine in Singapore was first proposed by some 20 medical specialists on 19 July 1957 and was named then as “Academy of Physicians & Surgeons”. It was officially formed by 34 founding members (comprising Dental Surgeons, Physicians and Surgeons) and was renamed...

Vancomycin-resistant enterococci (VRE) have emerged as one of the most challenging nosocomial threats in the past decade globally.1,2 Although antibiotic exposure may facilitate VRE transmission by providing selective advantage for VRE and increasing the concentration of VRE in the stools, antibiotic use in association with de novo development of...

The incidence and prevalence of diabetes mellitus (DM) worldwide is increasing, due almost exclusively to an increase in non-insulin-dependent (type 2) DM, which represents more than 90% of all cases of diabetes.1 Presently, there is a global pandemic of type 2 DM and its clinical sequelae. The World Health...

Diabetes Mellitus (DM) is a serious chronic illness that imposes significant morbidity and mortality and has a major impact on the quality of life of the individuals suffering from this illness. Singapore, a multi-ethnic country in Southeast Asia, with Chinese, Malay and Indian as the three main ethnic groups,...

Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have more severe infections, a different spectrum of bacteriology and a worse outcome. In our experience, of all patients with upper limb infections, those with end-stage...

Osteomas are benign, slow-growing tumours of the bone which may be classified as solitary or multiple. Multiple osteomas are mainly associated with Gardner’s syndrome while solitary osteomas can be further classified as peripheral, central or extra skeletal depending on the origin. This article is available only as a PDF. Please...

Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the more diffuse and accelerated form of atherosclerosis and endothelial dysfunction which lead to diffuse coronary lesions, small vessel disease, multi-vessel involvement, larger plaque burden as...

Transrectal ultrasound guided prostate biopsy (TRPB) is one of the modalities in the diagnosis of prostate cancer. Its use has increased with the widespread use of serum prostate-specific antigen (PSA). It is generally a safe procedure with acceptable complication rates.1 However, when infective complications occur, it is potentially fatal.2...

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study (FHS) cohort and was designed to predict 10-year risk of hard coronary events, including mortality due to coronary heart disease and non-fatal myocardial infarction (MI)...

Metabolic syndrome describes a constellation of interrelated metabolic risk factors, in which components coexist more frequently in a given individual than could be expected by chance alone. These risk factors include hypertension, hyperglycaemia, dyslipidaemia and obesity. The underlying pathophysiology is as yet unclear, but has been closely linked to...

Type 2 diabetes mellitus is a major chronic disease globally. With increasing life expectancy, long-term complications of diabetes mellitus leading to significant morbidity and mortality have great impact on each patient’s health. Health-related quality of life refers to a person’s self-perceived functioning and well-being, and is increasingly used to...

The development of new-onset diabetes after transplantation (NODAT) is a serious metabolic complication of kidney transplantation that predisposes patients to graft dysfunction, cardiovascular disease and death. Although NODAT has been recognised for many years, the true incidence has been difficult to establish due to inconsistencies in the definition of...

The prevalence of diabetes mellitus (henceforth referred to as diabetes) has increased significantly in the last decade and it is reaching epidemic levels worldwide due to ageing population, urbanisation, obesity and sedentary lifestyles. In Singapore, the National Health Survey 2004 revealed that 8.2% of the population aged 18 to...

Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000 man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...

Coronavirus disease 2019 (COVID-19) is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported to the World Health Organization (WHO) as pneumonia of unknown aetiology in the Chinese city of Wuhan on 31 December 2019. Since then, COVID-19 has spread across the globe and...

Stroke is a major cause of death and disability globally, with 6.55 million deaths (95% uncertainty interval 6.00–7.02 million), 101 million prevalent cases (95% UI 93.2–111 million) and 143 million disability adjusted life years lost (DALYs) (95% UI 133–153 million) in 2019. The impact is even higher in...

A 70-year-old man with poorly controlled type 2 diabetes mellitus (DM), hypertension, hypercholesterolemia and alcohol dependence presented intoxicated, with occipital scalp lacerations after a fall. A brain computerised tomography (CT) revealed occipital skull fracture with bilateral subarachnoid haemorrhages, subdural haemorrhages and parenchymal contusions. He was admitted for close observation...

Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million by 2025, driven in part by marked economic and epidemiologic transition in recent decades.1 In China, the prevalence of diabetes rose from 1% in 1980...

The process of delivery of health care is complex and includes aspects which concern the clinician, the patient and the treatment process itself. Training imparts skill and knowledge to the clinician. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...