Editorial
Journey towards a smoke-free nation
“A journey of a thousand miles begins with a single step.” Singapore’s journey towards a smoke-free society started early in the 1970s when legislations were introduced to restrict smoking in certain public spaces and ban tobacco advertising.1 The National Smoking Control Programme was launched in 1986 with important objectives...
Original Article
Factors influencing smoking cessation: Insights from Singapore’s nationwide health and lifestyle survey
The global prevalence of smoking has declined over the years. According to authors utilising data from the Global Burden of Disease, Injuries, and Risk Factors Study, from 1990 to 2020, the number of male smokers fell by 27.2%, whereas female smokers fell by 37.9%.1 Moreover, the decline in smoking...
Letter to the Editor
Automated Cobb angle measurement in scoliosis radiographs: A deep learning approach for screening
Dear Editor,
Adolescent idiopathic scoliosis is the most common paediatric spinal deformity, impacting 1 in 300 children.1 In Singapore and other countries, national screening programmes have been established to detect scoliosis early, with the aim of using bracing to prevent progression to moderate or severe scoliosis, which may require surgical...
Letter to the Editor
Facing death alone: An exploration of terminally ill individuals living alone in palliative care
Dear Editor,
Home palliative care clinicians provide end-of-life care for patients from diverse social and economic backgrounds. They include patients who live alone—a single-person household.1 Auon et al. found that 7–12% of patients under palliative care lived alone for more than a year.3 Demographic trends increasingly highlight this group to...
Original Article
Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore
Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...
Letter to the Editor
Evolving landscape of sports injuries and recommendations on injury preventions: A retrospective analysis in Singapore
Dear Editor,
Sports have become increasingly integral to the daily lives of Singaporeans. According to the National Sport and Exercise Participation Survey, the percentage of Singaporeans exercising weekly rose from 54% in 2015 to 73% in 2023.1 While this surge in sports activities brings numerous health benefits, it also results...
Editorial
How close are we from achieving demographic diversity in clinical trials? Insights from Singapore
Clinical trials are essential for assessing the efficacy and safety of new therapies. Because different patient subgroups may respond variably to treatments, it is important to emphasise diversity among participants. This approach ensures that the trial population accurately reflects the patients who will use the medication in real-world settings...
Editorial
The alcohol flushing syndrome: A risk factor for cancer
Globally, alcohol consumption is responsible for an estimated 3 million deaths annually and contributes to over 740,000 new cancer cases each year.1 Acetaldehyde, a byproduct of alcohol metabolism, has been designated as first-class carcinogens by the International Agency for Research on Cancer.2 In East Asian countries such as China,...
Original Article
Screen time and social-emotional skills in preschoolers with developmental, behavioural or emotional issues in Singapore
Preschool children, particularly those with developmental, behavioural or emotional (DBE) issues, are highly vulnerable to the negative effects of excessive screen viewing time (SVT) on their social and emotional development.1,2 Singapore, an island nation with a declining birth rate,3 places significant emphasis on human potential, particularly the social and...
Editorial
Evaluating the effectiveness of cervical cancer screening and prevention in Singapore
Cervical cancer is the fourth most common cancer in women globally, with approximately 660,000 new cases and 350,000 deaths reported in 2022.1 In Singapore, it ranks as the 11th most common cancer among women and the 5th most frequent cancer among young women aged 15–44 years, with 309 new...
Letter to the Editor
Seroprevalence of cytomegalovirus over the last 2 decades (2001–2020): A retrospective data analysis from a single laboratory in Singapore
Dear Editor,
Cytomegalovirus (CMV) is ubiquitous and infects human of all ages, where it remains latent after primary infection and can reactivate upon various triggers.1 Reactivated CMV may cause complications and end organ damages in immunocompromised hosts, leading to increased morbidity and mortality.2 In addition, the presence of actively replicating...
Editorial
Illicit drug consumption in Singapore: Where are we in the fight against drugs?
Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be a growing problem worldwide. In 2021, 1 in 17 people aged 15–64 in the world had used a drug in the past 12 months. Notwithstanding...
Letter to the Editor
HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?
Dear Editor,
Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles ...
Commentary
Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...
Commentary
Value the patient as a person: Answering the call for a person-centred model of care
There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....
Letter to the Editor
Treatment outcomes of micropulse cyclophototherapy in uveitic glaucoma
Dear Editor,
We present a case series, describing the utility of micropulse cyclophototherapy in the treatment of uveitic glaucoma.
Prevalence of glaucoma in patients suffering from uveitis was estimated to be 7.6% at 12 months after acute uveitis, and 11.1% at 5 years with chronic uveitis.1,2 Uveitic glaucoma is usually associated...
Commentary
Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground
In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....
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...
Editorial
Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening
In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a...
Letter to the Editor
Evaluation on the adoption of eHealth App for electronic health record sharing system in Hong Kong
Dear Editor,
In Hong Kong, the eHealth App was launched in January 2021, as part of Stage Two development of the Electronic Health Record Sharing System. It provides the healthcare recipients, that is, those who have registered in the system, a series of functions to manage their health, such as...
Letter to the Editor
Managing and preventing severe hand injuries among sugarcane juicer operators
Dear Editor,
Of all hand injuries encountered at an emergency department, 54% are sustained in the workplace,1 in part contributed by occupational injuries among food and beverage operators that caused a loss of 16,197 man-hours in 2021 alone.2 Commonplace in Singapore and in parts of South and Southeast Asia is...
Editorial
Impact of pre-existing depression on severe COVID-19 outcomes
The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the lives of billions of individuals around the world.1 Public healthcare around the work have mainly focused on the clinical manifestations and treatment of the deadly...
Commentary
Leveraging ChatGPT to aid patient education on coronary angiogram
Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of healthcare communication comprised the use of chatbots, which is limited by a predetermined set of queries and matched answers.2 However, natural-language AI models prompt a...
Letter to the Editor
Preferences for oral anticoagulant medications for managing atrial fibrillation
Dear Editor,
Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against the elevated risks of serious bleeding events.3 Warfarin and direct oral anticoagulants (DOACs) are the available oral anticoagulants for this indication. We developed a discrete choice experiment (DCE) survey4...
Original Article
Evaluation of a return to work coordination programme for injured workers in a public hospital in Singapore
Workers who have sustained an injury at work often face difficulties returning to work, according to a study showing that over 40% of injured workers in Singapore experienced increased lethargy at work and that about 40% had difficulties in performing work at pre-injury standards.1 One in 4 workers also felt...
Editorial
Proactive steps to population health: Starting early, starting right
The global burden of non-communicable diseases is rising, with continued projected increases in the prevalence of metabolic syndrome (MetS) in the future. This epidemic, albeit of a metabolic nature, poses broad socioeconomic and healthcare burdens worldwide. Population health improvement and optimisation of healthcare are important to addressing these burdens....
Original Article
Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore
The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe symptoms of COVID-19, losing loved ones to the disease, financial insecurity, and social isolation. Furthermore, children and youths experienced disruption to their usual routine such...
Commentary
Artificial intelligence innovation in healthcare: Relevance of reporting guidelines for clinical translation from bench to bedside
Artificial intelligence (AI) and digital innovation have revolutionised many sectors and industries, prominently including healthcare during the coronavirus disease 2019 (COVID-19) pandemic.1 For example, deep learning, which is a subset of the state-of-the-art machine learning techniques, has shown robust performance in image recognition, speech recognition and natural language processing.2...
Original Article
Benefits of leisure-related physical activity and association between sedentary time and risk for hypertension and type 2 diabetes
Diabetes mellitus and hypertension are serious public health issues. Approximately 451 million individuals worldwide aged 18–99 years were living with diabetes in 2017, and this number is expected to increase to 693 million by 2045.1 More than 90% of all diabetes cases were type 2 diabetes mellitus (T2DM).2 For...
Editorial
Promoting physical activity for population health
The chronic disease burden has risen globally. In Singapore, between 2007 and 2021, the crude prevalence of hyperlipidaemia (8.2–13.9%), hypertension (12.7–15.7%) and diabetes (4.9–6.9%) has increased.1 Based on the Global Burden of Disease Study (2019), lack of physical activity and other modifiable risk factors contribute 35% of the disability-adjusted...
Review Article
Through the eyes into the brain, using artificial intelligence
Neurological dysfunction is a leading cause of disability, affecting more than 276 million people worldwide.1 Over the last decades, the prevalence of neurological dysfunction has increased, particularly in the ageing population which is commonly affected by dementia, stroke and brain tumours.1,2 The increasing number of patients suffering from neurological...
Original Article
Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma
Endometriosis is a chronic inflammatory gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus.1 Debilitating chronic pelvic pain, dysmenorrhoea, and subfertility in women of reproductive age are commonly associated with endometriosis. The disease is estimated to affect about 1 in every 10 women of reproductive age,...
Original Article
Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore
Approximately 422 million people worldwide have diabetes and 1.6 million deaths are attributed to diabetes each year,1 contributing to high economic costs worldwide. Diabetes education and awareness of the disease contribute significantly to minimising complications and reducing morbidity and mortality.2 In addition, there is also a strong impetus to...
Editorial
The eye as a window to the brain
Over the last 20 years, it has become evident that the age-old expression, “the eye is the window into the soul”, might in fact hold more truth than previously thought. We are currently able to distinguish a variety of systemic diseases by funduscopic inspection. Following the dawn of high-resolution...
Editorial
Diabetes: Know thy foe
During the COVID-19 pandemic in 2022, Singapore’s Minister for Health Ong Ye Kung mentioned, “After the COVID-19 pandemic has passed, we need to tackle a far more challenging pandemic—which is longer-term chronic illness, and diabetes is a major one.”1
Truly, in the past decade, there has been an invisible global...
Letter to the Editor
Clinical outcome of bacterial endogenous endophthalmitis in 15 patients
Dear Editor,
Endophthalmitis refers to the inflammation of the ocular cavities and their immediate adjacent structures without extension beyond the sclera, usually secondary to infection. Endogenous endophthalmitis (EE) results from haematogenous spread of microorganisms in patients with bacteraemia or fungaemia into the eye and represents 2–15% of endophthalmitis cases.1-3...
Review Article
Combating a resurgence of poliomyelitis through public health surveillance and vaccination
Singapore was certified poliomyelitis (polio)-free by the World Health Organization (WHO) on 29 October 2000, together with 36 other countries in the Western Pacific Region.1 Prior to certification, there were multiple outbreaks in 1958, 1960 and 1963 with 415, 196 and 74 paralytic polio cases, respectively.2-4 The nationwide immunisation...
Original Article
Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients
The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with solid and haematological malignancies to SARS-CoV-2 infections.1,2 Global efforts to combat SARS-CoV-2 led to the unprecedented rapid development of multiple vaccines, with reported efficacies of...
Editorial
Early COVID-19 booster is beneficial in cancer patients
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in Wuhan, China, on 31 December 20191 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare systems around the world, and rendered...
Editorial
Vaccination and surveillance: Two basic tools for a final poliomyelitis eradication
Over the past 3 decades, the Global Polio Eradication Initiative (GPEI) has strived to achieve a poliomyelitis (polio)-free world. Wild poliovirus (WPV) types 2 and 3 were eradicated in 2015 and 2019, respectively. The World Health Organization (WHO) South-East Asia Region was declared free of poliovirus in 2014, and...
Commentary
Meeting today’s healthcare needs: Medicine at the interface
The demographic of Singapore has undergone dramatic changes. Historically, younger patients with communicable diseases predominated; however, patients are now older with chronic multimorbidity and functional impairment. This demographic shift challenges existing health and social care systems in Singapore, which must pivot to meet the changing need. The consequences of...
Letter to the Editor
A strategy to make COVID-19 vaccination more accessible to the elderly
Dear Editor,
Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services.
While the...
Original Article
Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore
The Patient-Centred Medical Home (PCMH) is a model of chronic care that replaces episodic primary care, with the delivery of primary care to patients, families and communities. It is guided by the principles of first-contact accessibility, comprehensiveness and whole-person orientation, integration and care coordination, sustained clinician-patient relationships, and quality...
Editorial
From Astana to Singapore: Primary Health Care is key to the long-term success of Singapore’s health system
The Ministry of Health, Singapore (MOH) has launched a wide-ranging and ambitious initiative for a life-course approach to drive the population’s health.1 This approach aims at ensuring the sustainability of the healthcare system. Crucially, it also embodies core principles of the health systems orientation that have long been advocated...
Editorial
Frequent attenders to multiple emergency departments in Singapore
The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its negative effects include adverse impact on patient safety, medical errors and staff burnout. In addition, high volume of patients waiting to be seen (ED input)...
Original Article
Treating acutely ill patients at home: Data from Singapore
Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations age, and hospitals are expensive to build and run.1 There is increasing recognition of the risk of hospitalisation from potent nosocomial infections2,3 (exacerbated by the...
Letter to the Editor
Attitude towards screening for congenital cytomegalovirus infection in newborns in Singapore
Dear Editor,
Cytomegalovirus (CMV) infection is the most common congenital infection.1 A systematic review that included 77 studies from 36 countries reported that the overall prevalence of CMV was 0.67% in their newborn population.1 Among newborns with CMV, it was estimated that 15–20% will suffer from potentially deleterious effects including...
Commentary
COVID-19 vaccination acceptance of healthcare workers in Singapore
The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end April 2022.1 With the introduction of vaccines that are effective in reducing severe COVID-19 illnesses and deaths, Singapore had since pivoted from a COVID-19 elimination...
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
Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore
Polycystic ovary syndrome (PCOS) is a common endocrine disorder estimated to affect 4–21% of women, depending on the diagnostic criteria used.1 Clinical manifestations of the syndrome are varied, and multiple parameters are needed for its diagnosis.2,3 This complicates the diagnosis of PCOS and may cause patient dissatisfaction arising from delayed...
Original Article
A Randomized Trial of the Use of Print Material and Personal Contact to Improve Mammography Uptake Among Screening Non-attenders in Singapore
Breast cancer is the most common cancer among females in Singapore. Although lower than incidence rates in North America and the United Kingdom the incidence of breast cancer here has doubled from 20 to 38.8 per 100,000 women per year over the past 2 decades, and the disease is...
Original Article
Glaucoma Pattern Amongst the Elderly Chinese in Singapore
Glaucoma is a major cause of world blindness in developing and developed nations. The WHO Global data on blindness show that over half of the blind due to glaucoma reside in Asia, the majority being Chinese.
This article is available only as a PDF. Please click on “Download PDF” on...
Others
Frontal Sinus Mucoceles Causing Proptosis—Two Case Reports
Frontal mucoceles are collections of inspissated mucus which occur when there is obstruction to the outflow of the frontal sinuses. The obstruction may be due to congenital anomalies, infection, trauma, allergy, neoplasms or surgical procedures in the nose.
This article is available only as a PDF. Please click on “Download...
Others
A Case Series of Ocular Disease as the Primary Manifestation in Sarcoidosis
Sarcoidosis is an idiopathic, systemic, non-caseating, granulomatous disease with protean clinical manifestations. Although the first description of sarcoidosis was attributed to Hutchinson, its ocular features received little attention until 1936 when Heerfordt’s syndrome of uveitis, salivary gland enlargement and cranial nerve palsies was recognised as a sign of sarcoidosis.
This...
Review Article
Trends in the Pattern of Blindness and Major Ocular Diseases in Singapore and Asia
Singapore’s population has grown rapidly since 1965, the year in which it gained independence. The total population enumerated at its first census in 1970 was 2 074 507, compared to 3 103 500 in 1997.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
Serum Selenium in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3% Others) is dominated by non-communicable diseases. There have been increasing trends, though with recent declines, for coronary heart disease (CHD) and cerebrovascular disease, with cancer...
Original Article
Serum Ferritin and Iron Status in the General Population of Singapore, 1993 to 1995
Iron, a dietary constituent, is an essential element. Body iron stores can be measured by haemoglobin, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Epidemiological Surveillance of Melioidosis in Singapore
Melioidosis was first described in 1911 among vagrants and morphine addicts brought into the mortuary in Rangoon, Burma. However, the disease received little attention until the Vietnam War when French and US military personnel were affected by it.
This article is available only as a PDF. Please click on “Download...
Others
A Case of Accelerated Development of Proliferative Diabetic Retinopathy in a Woman with Type 2 Diabetes Mellitus after Pregnancy
Diabetic retinopathy is the leading cause of blindness in persons between the age of 24 and 64 years both in the US and the UK. Peak fertility and childbearing years correspond to the first half of this period.
This article is available only as a PDF. Please click on “Download...
Others
Trilateral Retinoblastoma—A Case Report
Retinoblastoma is the third most common tumour in childhood. It is inherited genetically.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Population-based Mammographic Screening in Singapore: What are Participants’ Views?
Breast cancer is the most common cancer among women in Singapore and has been increasing in incidence since 1968. This rise is particularly marked among younger women, suggesting that the increase will take place at an even faster rate in future.
This article is available only as a PDF. Please...
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...
Review Article
Diabetic Retinopathy
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”...
Original Article
Cross-Sectional Study of Near-work and Myopia in Kindergarten Children in Singapore
Myopia is the commonest eye disease worldwide, and is especially prevalent in certain Asian countries such as Taiwan, Japan and Hong Kong. Physiologic myopia is thought to be a multifactorial disease with both genetic and environmental factors.
This article is available only as a PDF. Please click on “Download PDF”...
Original Article
The Correction of Oriental Lower Lid Involutional Entropion Using the Combined Procedure
Involutional entropion is a frequent cause of ocular irritation in the local elderly patients. The inturning of the lid margin and the eyelashes result in corneal epithelial damage that may predispose to vision-threatening infection and irreversible corneal scarring.
This article is available only as a PDF. Please click on “Download...
Others
Myopia: Gene-environment Interaction
Myopia affects up to 70% of adults in Singapore, Taiwan, Hong Kong and Japan. The prevalence rates in these Asian countries are higher than those among Caucasians and Blacks in the United States and Europe.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Cardiovascular Disease: Genes and Public Health
The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is assumed that the identification of mutations that confer susceptibility will provide the basis for new means of detection, prevention and treatment.
This article is available only...
Review Article
Causes and Management of Descemet’s Membrane Detachment Associated with Cataract Surgery—Not Always a Benign Problem
It is well known that stripping of Descemet’s membrane (DM) occurs not infrequently during cataract surgery. In 1928, Samuels described frequent DM detachments of small dimensions during cataract extraction of minor consequence.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Original Article
Body Mass Index Profile in Hong Kong Chinese Adults
Obesity is considered a chronic disease and not just a social stigma due to the associated morbidity and early mortality. Obesity has now become an epidemic with increasing prevalence in most parts of the world.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
6th Yahya Cohen Lecture: Visual Experience During Cataract Surgery
What a patient can see during his or her surgery can be a cause of anxiety for the patient. It may cause additional stress to what for most patients is already a traumatic event.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Review Article
Evidence-based Health Promotion: Applying it in Practice
There has been a growing interest in health promotion among health professionals and policy makers in Singapore. This is partly in response to the rising trend of chronic diseases and the finding that many of these diseases are lifestyle related and amenable to change.
This article is available only as...
Others
Age-related Macular Degeneration: What’s New
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed western world, accounting for approximately 50% of all cases of registered blindness. The prevalence of AMD seems to be increasing at a rate not commensurate with the increasing age of the population, although this observation...
Others
Visual Rehabilitation with New-Age Rigid Gas-Permeable Scleral Contact Lenses—A Case Series
Advanced primary corneal ectasia presents a difficult problem in terms of visual rehabilitation. Soft contact lenses do not address the astigmatic aberrations in these conditions and conventional rigid gas-permeable (RGP) corneal contact lenses though useful in less severe disease, are poorly tolerated by those with progressively worsening keratoconus and...
Others
Is Healthcare Competition Healthy?
There are many problems which all Health Ministers worry about. But we can generally boil them down to one common problem: “money no enough”.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Primary Meningococcal Arthritis and Endogenous Endophthalmitis: A Case Report
Primary meningococcal arthritis (PMA) and endogenous meningococcal endophthalmitis are both uncommon presentations of meningococcal infection that should be considered in the differential diagnosis of reactive arthritis and acute dermatitis-arthritis syndrome. We describe a case of PMA and meningococcal endophthalmitis occurring together.
This article is available only as a PDF. Please...
Others
Public Disclosure of Healthcare Performance Information and Its Application to the Singapore Context
It has been said that apart from the prevention of diseases, the best chance of improving health is through improving the quality of care delivered to patients.1 The public disclosure of healthcare performance information is a phenomenon that has come to the fore in the United States (US) and...
Others
Gyrate Atrophy of the Choroid: Two Cases
Gyrate atrophy of the choroid (GA) is a rare choroidal dystrophy. It is an autosomal recessive disorder that results in progressive deterioration in peripheral and night vision.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Letter to the Editor
Patterns and predictors of sound levels in hospital rooms
Dear Editor,
Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also linked excessive sound levels with sleep disturbances and cardiovascular morbidity.2 While there have been data published regarding noise levels in the intensive care unit (ICU),3...
Others
The Role of Public Health and Occupational Physicians in the New Millennium
I want to thank the Chapter and organisers for honouring me with this kind invitation to speak to you. This millennium is only 4 years old, and yet I cannot see beyond the next decade, with things moving so rapidly.
This article is available only as a PDF. Please click...
Others
Initial Experience of Macular Translocation in Singapore – One-year Results
Choroidal neovascularisation (CNV) is a devastating complication of macular degeneration and a major cause of irreversible vision loss in many developed countries. The most common cause of CNV is age-related macular degeneration but it may also occur secondary to a variety of other aetiologies such as pathological myopia, ocular...
Original Article
A Study on SARS Awareness and Health-seeking Behaviour – Findings from a Sampled Population Attending National Healthcare Group Polyclinics
There was a worldwide outbreak of Severe Acute Respiratory Syndrome (SARS) caused by the novel coronavirus between November 2002 and July 2003. Singapore was one of the hot spots, in addition to China, Taiwan, Hong Kong, Toronto and Vietnam.
This article is available only as a PDF. Please click on...
Review Article
Ocular Surface Stem Cells and Disease: Current Concepts and Clinical Applications
The ocular surface is a complex biological continuum responsible for the maintenance of corneal clarity, elaboration of a stable tear film for clear vision, as well as protection of the eye against microbial and mechanical insults. The ocular surface epithelium comprises corneal, limbal and conjunctival epithelia, of which the...
Letter to the Editor
Re: Evidence for an “epidemic” of myopia
In the Annals January 2004 theme issue on Myopia, Park and Congdon have disputed the reality of the increases in prevalence of myopia in East Asia for several reasons. In particular, they criticise the 2 best documented sets of cohort data, from Taiwan and Singapore, on methodological grounds.
This article...
Original Article
Contact Lens Microbial Keratitis and Prior Topical Steroid Use: A Disaster in the Making?
Topical steroid use in cornea ulcers is still a very contentious issue in ophthalmology. A recent review by Wilhelmus found that the use of topical steroids before the diagnosis of bacterial keratitis significantly predisposed eyes with preexisting corneal disease to ulcerative keratitis.
This article is available only as a PDF....
Original Article
Integrated Hydroxyapatite Implant and Non-integrated Implants in Enucleated Asian Patients
Much has been published on the complications of integrated and non-integrated implants. Most studies on integrated implants pertain to experience with the hydroxyapatite implant, with the coralline (such as the Bio-Eye) {Integrated Orbital Implants, Inc., San Diego, California, USA} type dominating its cancellous bone counterpart (the Molteno M-sphere) {IOP,...
Review Article
The Correction of Myopia Evaluation Trial: Lessons from the Study Design
“A properly planned and executed clinical trial is a powerful technique for assessing the effectiveness of an intervention”. While each new clinical trial involves unique issues relevant to a particular condition or disease, overarching common guidelines for all studies provide the framework for obtaining meaningful results.
This article is available...
Original Article
Myopia Progression Among Preschool Chinese Children in Hong Kong
Myopia occurs when the image of distant objects, focused by the cornea and lens, falls in front of the retina. It is the commonest eye problem worldwide. Its prevalence varies in different parts of the world – myopia occurs in 25% of the adult population in the United States,...
Review Article
The Epidemiology of Myopia in Hong Kong
Myopia is a refractive condition in which the image of a distant object is formed anterior to the retina of the unaccommodated (relaxed) eye. It occurs when the refractive power of the eye is too great compared to the length of the eyeball and this may occur because the...
Original Article
Prevalence of Myopia in Taiwanese Schoolchildren: 1983 to 2000
Today in Taiwan, with increasing level of educational and living standard, the prevalence and severity of myopia appear to be on an upward trend. This is true elsewhere also, especially in Asia. In Asia, there is currently a high prevalence of myopia, especially among the Chinese and Japanese.
This article...
Review Article
Evidence for an “Epidemic” of Myopia
A number of authors have recently proposed that myopia is increasing at an “epidemic” rate, particularly in East Asia, and especially among populations of Chinese descent. It has been reported that the prevalence of myopia among some populations in this area has reached 90%.
This article is available only as...
Review Article
Using Natural STOP Growth Signals to Prevent Excessive Axial Elongation and the Development of Myopia
Myopia in humans results from an imbalance between the refractive power of the cornea and lens and the axial length of the eye, such that the image of an object at infinity falls in front of the retina, with the lens at rest. Accommodation, therefore, cannot focus the blurred...
Review Article
Ocular Shape and Myopia
Myopia develops from a mismatch of the eye’s anatomical axial length and its focal length, as determined by the combined optical powers of the cornea and lens. For higher degrees of myopia and myopic progression, this mismatch develops primarily as a consequence of disproportionate ocular growth, chiefly of the...
Others
Is it Possible to Slow the Progression of Myopia?
The rates of myopia, including high myopia , have been reported to be rising to epidemic proportions in Asia and solutions to this huge public health problem are urgently needed. Many researchers agree that myopia is not determined solely by genes and that environment may play a huge role.
This...
Original Article
Accommodative Stimulus Response Curve of Emmetropes and Myopes
There is a strong association between myopia and near work, and it has been reported that the rapid rise in the prevalence of myopia in Singaporean children may be related to an increase in near work demands such as reading. Although the mechanism by which near work affects myopia...
Original Article
Electrophysiological Findings in Persons With Nyctalopia
Nyctalopia is a subjective sensation of poor vision under dark conditions. It may be clinically associated with retinal diseases affecting the rod photoreceptors or post-receptoral pathways.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Neisseria meningitidis Keratitis in Adults: A Case Series
Neisseria meningitidis has been reported as a causative organism for conjunctivitis and endogenous endophthalmitis, more commonly in neonates and young children. A search of the literature on Medline revealed very few reports on infective keratitis caused by N. meningitidis.
This article is available only as a PDF. Please click on...
Others
Visual Recovery Following Emergent Orbital Decompression in Traumatic Retrobulbar Haemorrhage
Acute retrobulbar haemorrhage is a potentially sight threatening condition that can occur spontaneously or following retrobulbar injections and trauma to the orbit. Visual loss results from central retinal artery occlusion or optic neuropathy from direct compression or from compression of optic nerve venous drainage.
This article is available only as...
Review Article
Macular Carotenoids and Age-related Maculopathy
The macula lutea is an anatomic region of the posterior retina that measures approximately 5.5 mm in diameter, and is exquisitely specialised for sharp central vision. Lutein (L) is a carotenoid, which, along with its stereo isomer zeaxanthin (Z), is concentrated at the macula lutea, to give it its...
Others
Book Review
Ophthalmologists today depend heavily on various investigative modalities such as fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) for an accurate diagnosis and optimal management of macular disorders. This book is a quick reference guide for common macular disorders encountered in an ophthalmic practice and...
Others
Recombinant Tissue Plasminogen Activator (r-TPA) in Fibrin Dissolution due to Postoperative Endophthalmitis
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...
Original Article
Orbital Metastatic Tumour as Initial Manifestation of Asymptomatic Gastric Adenocarcinoma
Metastatic orbital tumour from gastric cancer is rare. In a Japanese survey of metastatic orbital tumours seen over 95 years, gastric metastases accounted for only 8.6% (11 patients) of cases. A series of orbital tumours from 1976 to 1999 by Rootman et al reported only 2 cases of metastasis...
Original Article
Eye Injuries in Singapore – Don’t Risk It. Do More. A Prospective Study
The issue of ophthalmic trauma is a major cause for concern. An estimated 55 million eye injuries occur each year worldwide, leaving 1.6 million patients blind from their injuries.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Retrospective Review of Eyes with Neovascular Age-related Macular Degeneration Treated with Photodynamic Therapy with Verteporfin and Intravitreal Triamcinolone
Among the variety of paradigms implicated in the pathogenesis of choroidal neovascularisation (CNV), an inflammatory component has been a recent focus of interest. The findings that complement factor H (CFH) polymorphisms are associated with an increased risk in the development of age-related macular degeneration (AMD) and that the histopathology...
Original Article
Rates of Posterior Capsule Rupture During Cataract Surgery Among Different Races in Singapore
Posterior capsule rupture (PCR) is a potentially serious intraoperative complication of cataract surgery. The anecdotal experience of some surgeons suggests that differences in the anatomy of the eyelids, bony orbit, nasal bridge and other facial features, as well as the globe itself among different races may influence such factors...
Others
Surgically-induced Corneal Changes Following Macular Translocation with Punctate Retinotomies and Chorioscleral Infolding (Limited Macular Translocation)
Changes in corneal curvatures and astigmatism after retinal surgery are well documented. Although some of these changes are mild and transient, some have reported clinically significant irregular and asymmetric corneal changes.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Review Article
Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation
Paediatric cataract has a low incidence compared with adult cataract. The estimated incidence is about 1 to 6/ 10,000 births.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Efficacy of Measuring Visual Performance of LASIK Patients under Photopic and Mesopic Conditions
LASIK is routinely carried out to correct the refractive errors of myopic patients. A high percentage of patients have good high-contrast visual acuity after undergoing LASIK surgery, with the majority of them having unaided vision that meets the minimum recommended criteria for driving.
This article is available only as a...
Original Article
Role of Ultrasound Biomicroscopy (UBM) in the Detection and Localisation of Anterior Segment Foreign Bodies
The presence of an intraocular foreign body (IOFB) is a common complication of ocular trauma. For surgical planning, the localisation of IOFBs has to be accurate. Posterior segment foreign bodies are detected by clinical examination and imaging techniques such as computed tomography (CT) and low-frequency (5 MHz to 10...
Original Article
Diabetic Retinopathy in Type II Diabetics Detected by Targeted Screening Versus Newly Diagnosed in General Practice
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...
Editorial
Environmental Planning and Urban Health
Environmental exposures to the adverse effects from climate change are expected to increase for many urban populations in the United States during the next 50 years, potentially due to increased summertime heat stress, increased ambient ozone concentrations, and other pathways such as increased vector- and water-borne disease. Vulnerable elderly...
Commentary
Ethical Issues in Ophthalmology and Vision Research
The importance of ethics in research was highlighted in the USA when a healthy volunteer subject, 24-year-old Ellen Roche, died in a Johns Hopkins asthma study in 2002. Investigations showed that there had been serious deficiencies in the ethical review and research work was suspended in Johns Hopkins until...
Others
Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids
Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE atrophy that may represent sequelae of previous episodes. CSCR can arise secondary to chronic treatment with steroids.
This article is available only as a PDF. Please...
Original Article
A Novel Locus for X-linked Retinitis Pigmentosa
Retinitis pigmentosa (RP) is characterised by initial night blindness followed by progressive loss of visual fields and eventually, loss of central vision. RP is the most prevalent group of inherited retinopathies, affecting approximately 1 in 3500 individuals.
This article is available only as a PDF. Please click on “Download PDF”...
Original Article
Utility and Validity of the Self-administered SF-36: Findings From an Older Population
The shift towards broader health perspectives and the emphasis on patient preferences have led to the development of many health questionnaires and their inclusion as primary and secondary outcome measures in clinical trials. Measurements of health-related quality of life (HRQOL), a multidimensional concept encompassing physical, emotional and social aspects...
Others
The Role of Optical Coherence Tomography (OCT) in the Diagnosis and Management of Retinal Angiomatous Proliferation (RAP) in Patients with Age-related Macular Degeneration
Retinal angiomatous proliferation (RAP), initially described as deep retinal vascular anomalous complex in 1992 by Hartnett et al, has been recently defined as a new, distinct form of exudative age-related macular degeneration (AMD). In choroidal neovascularisation (CNV), the choroidal new vessels may proliferate through the retinal pigment epithelium (RPE),...
Original Article
Axial Length: A Risk Factor for Cataractogenesis
There are several known risk factors for cataract formation, including older age, lower educational status, smoking, ultraviolet light exposure, trauma, dehydration, diabetes, uveitis and glaucoma. Epidemiological research has been confounded by co-existing risk factors that are difficult to measure.
This article is available only as a PDF. Please click on...
Original Article
Clinical Features of Autosomal Dominant Retinitis Pigmentosa Associated with a Rhodopsin Mutation
Retinitis pigmentosa (RP) is the most prevalent group of inherited retinopathies. This spectrum of diseases affects approximately 1 in 4800 individuals.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
A Novel Mutation of the VMD2 Gene in a Chinese Family with Best Vitelliform Macular Dystrophy
Best vitelliform macular dystrophy is an autosomal dominant disorder characterised by an egg yolk-like appearance of the macula. The vitelliform “egg yolk” lesions result from abnormal accumulation of lipofuscin in the retinal pigment epithelium (RPE).
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
Characterisation of Human Tear Proteins Using High-resolution Mass Spectrometry
Over the last few years, with advances in mass spectrometry, there has been increasing interest in exploring the proteome of body fluids such as plasma, urine, cerebrospinal fluid (CSF) and saliva. An important objective is to search for potential biomarkers for the diagnosing and monitoring the progression of disease.
This...
Original Article
Scanning Laser Polarimetry in Pulmonary Tuberculosis Patients on Chemotherapy
Pulmonary tuberculosis is a worldwide disease. In Hong Kong, there are about 7000 new cases of pulmonary tuberculosis each year and the prevalence remains high at about 110/100,000. The male elderly (>60 years) are at the greatest risk.
This article is available only as a PDF. Please click on “Download...
Letter to the Editor
Time to Raise Awareness of Blindness as Another Smoking-related Condition
Singapore currently has a comprehensive range of tobacco control policies and programmes. It started implementing legislative measures against cigarette smoking in the early 1970s, and since then has been regularly reviewing and revising its laws and their enforcement.
This article is available only as a PDF. Please click on “Download...
Review Article
SARS Revisited: Managing “Outbreaks” With “Communications”
In the short span of 3 years since SARS first appeared on the Asian landscape, terms like “risk communications” and “outbreak communications” have assumed greater import and found common usage in the lexicon of governance by public health systems in our part of the world.
This article is available only...
Review Article
SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity above National Sovereignty
The majority of the world’s information about infectious disease outbreaks no longer comes from voluntary reporting by countries, the willingness of which is influenced by fears of severe decreases in travel, tourism and trade as a result of aggressive protective measures undertaken by other countries. It now comes from...
Review Article
SARS in Singapore – Key Lessons from an Epidemic
The 2003 severe acute respiratory syndrome (SARS) outbreak represented the most severe communicable disease challenge to the public health system and the government and people of Singapore. The SARS outbreak in Singapore began on 1 March 2003 and the last case of the outbreak was isolated on 11 May...
Letter to the Editor
“Galaxy in My Eye”: An Artist’s View of Cataract Surgery from Behind the Crystalline Lens
Cataract surgery is the most commonly performed elective surgery in many countries. As a result of advances in surgical and anaesthetic techniques, most cataract surgeries are currently performed under local anaesthesia.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Commentary
Methodologies for Interventional Myopia Studies
Past studies on intervention in myopia progression have given conflicting results. For example, in the past, studies on (PMMA) hard contact lenses took researchers in the past on a roller-coaster ride.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Others
Ethambutol-associated Optic Neuropathy
Tuberculosis (TB) has been present since ancient times. Around 460 BC, Hippocrates identified phthisis, which is the Greek term for consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor and long relentless wasting) as the most widespread disease of the times, which...
Others
Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis
Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes and non-caseating epithelioid granulomas in affected organs.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Others
Retrobulbar Alcohol Injection for Orbital Pain Relief Under Difficult Circumstances: A Case Report
The management of pain in the orbital region, whether ocular or orbital in origin, is complex and lies at the margins of several subspecialty interests. Because of this, and because of its rarity, it has received little attention in the literature.
This article is available only as a PDF. Please...
Original Article
Rising Trends of STIs and HIV Infection in Singapore – A Review of Epidemiology Over the last 10 Years (1994 to 2003)
A review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1977 to 1996 showed a declining number of all STIs notified in Singapore from 22,427 in 1978 to 5570 in 1996, with the 20-to-29 years age group consistently accounting for the highest proportion of...
Others
Book Review
In Retinal Vascular Disorders, Dr Mohan and co-authors cover common and important retinal vascular disorders in a series of short chapters which are written by one or more of the authors. The text is organised logically, with clear headings and subdivisions, and is generally well-written and quite readable.
This article...
Others
Vision 2020 and Prevention of Blindness: Is it Relevant or Achievable in the Modern Era?
This review article considers the universal definition of blindness, the causes of world/global blindness, and ongoing international efforts in blindness prevention. The prospects for Vision 2020 – 20/20 or 6/6 visual acuity for all by year 2020 – worldwide, and for Singapore in particular, and whether it is relevant...
Original Article
Enhancement of the Mechanical and Biological Properties of a Biomembrane for Tissue Engineering the Ocular Surface
The most recent treatment for severe ocular surface disease is the transplantation of cultivated corneal and conjunctival epithelial stem cells, which makes use of human amniotic membrane (HAM) as a substrate and cell carrier. Although the results are quite promising, this new procedure is still facing some challenges.
This article...
Others
Mycobacterium-related Ocular Inflammatory Disease: Diagnosis and Management
Tuberculosis (TB) is an ancient disease that has been detected in 3000-year-old Egyptian mummies. Robert Koch’s discovery of the tubercle bacillus as the aetiologic agent of this disease in 1882 led to the acceptance of “Koch’s postulates,” which remain the gold standard for linking a pathogen to a disease.
This...
Others
Photodynamic Therapy for Choroidal Neovascularisation Secondary to Inflammatory Chorioretinal Disease
Photodynamic therapy using verteporfin (Visudyne, Novartis Ophthalmics) has been proven safe and effective for the treatment of predominantly classic, age-related macular degeneration (AMD)-related subfoveal choroidal neovascularisation (CNV), pathologic myopia-related CNV, and subgroups of AMD-related occult CNV. Visual results following verteporfin treatment of subfoveal, non-AMD related CNV have been variable....
Original Article
Variables Determining Perceived Global Health Ranks: Findings from a Population-based Study
In 1982, Mossey and Shapiro first demonstrated that global self-rating of health was a better predictor of 7-year survival than medical records or self-reports of medical conditions in participants of the Manitoba Longitudinal Study. Since then, many population-based longitudinal studies have confirmed that global self-rated health remains an independent...
Original Article
Multivariate Analysis of Childhood Microbial Keratitis in South India
Corneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and treat, as they are unwilling and sometimes unable to cooperate during active management.
This article is available only as a PDF. Please click on “Download PDF”...
Original Article
Can the Sequential Use of Conventional Silicone Oil and Heavy Oil be a Strategy for the Management of Proliferative Vitreoretinopathy?
Advances in vitreoretinal surgery have greatly increased the anatomical re-attachment rate in cases with proliferative vitreoretinopathy (PVR). The availability of perfluoro-carbon liquids, indirect viewing systems for surgery, illumination systems allowing bimanual dissection, the use of dyes and the use of retinotomies have all contributed to achieving a complete re-attachment...
Original Article
Surgical Outcomes of 25-Gauge Transconjunctival Vitrectomy Combined With Cataract Surgery for Vitreoretinal Diseases
The recent development of 25-gauge instrumentation for vitreous surgery has promoted a great interest in the transconjuctival sutureless vitrectomy system. Similar to the trend towards minimally invasive surgical intervention in the case of current cataract surgery, smaller incisions with self-sealing wounds in vitrectomy might decrease surgical trauma and operating...
Review Article
New Concepts in the Management of Optic Nerve Sheath Meningiomas
Optic nerve sheath meningiomas (ONSMs) account for one-third of primary optic nerve tumours, are the second most common optic nerve tumours after gliomas, and are the most common tumours of the optic nerve sheath. Although ONSMs are said to comprise 1% to 2% of all meningiomas, their reported incidence...
Review Article
Ophthalmic Regional Block
Patient comfort, safety and low complication rates are the essentials of local anaesthesia. The anaesthetic requirements for ophthalmic surgery are dictated by the nature of the proposed surgery, the surgeon’s preference and the patient’s wishes.
This article is available only as a PDF. Please click on “Download PDF” on top...
Review Article
Hyperbaric Oxygen Therapy for Radiation-induced Optic Neuropathy
Radiation optic neuropathy (RON) is an infrequent but usually devastating consequence of radiation to the optic pathways. It is almost exclusively an iatrogenic phenomenon, occurring in patients who have undergone radiation therapy for tumours and other lesions in sites near the visual apparatus, such as the choroid, orbit, paranasal...
Review Article
The Natural History of Occult Choroidal Neovascularisation Associated With Age-related Macular Degeneration. A Systematic Review
Choroidal neovascularisation (CNV) is a leading cause of blindness in the western world. It causes 90% of the visual loss in age-related macular degeneration (AMD).
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Retinal Prostheses for the Blind
Each year, thousands of people are afflicted with photoreceptor degenerative diseases that reduce vision to bare light perception or complete blindness. Retinitis pigmentosa (RP) is the leading cause of inherited blindness with 1.5 million people worldwide affected and an incidence of 1/3500 live births.
This article is available only as...
Editorial
Age-related Macular Degeneration: An Emerging Challenge for Eye Care and Public Health Professionals in the Asia Pacific Region
Age-related macular degeneration (AMD) is a severe ocular disease characterised by progressive deterioration of the macula, the most sensitive central back portion of the retina. Choroidal neovascularisation (wet AMD) leading to haemorrhage and scar formation beneath the central retina accounts for most cases of legal blindness from AMD (80%...
Others
Public Healthcare – Welfare, Market Share or Laissez-faire? – A Sentosa Carlsberg Skytower View
Recently, two doctor-administrators commented to me separately, “Singapore probably has the best public healthcare system in the world.” While I understand the basis for their view, the accolade of world’s best healthcare system, according to the World Health Organization’s ranking, actually goes to France.
This article is available only as...
Others
Intravitreal Triamcinolone Acetonide for the Treatment of Diffuse Diabetic Macular Oedema – A Case Report
Focal and grid laser photocoagulation are the primary surgical treatments for diabetic macular oedema. However, laser treatment of eyes with diffuse macular oedema has been disappointing.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Bruch’s Membrane Abnormalities in Dome-shaped and Mushroom-shaped Choroidal Melanomas
Uveal melanoma is the most common primary intraocular malignancy and is diagnosed chiefly in the fifth to seventh decades of life. The choroid is the most common site for its development, and choroidal melanomas grow as dome-shaped or mushroom-shaped tumours.
This article is available only as a PDF. Please click...
Original Article
Human Limbal Progenitor Cell Characteristics are Maintained in Tissue Culture
The surface of the eye is covered by 3 distinct forms of non-keratinising stratified squamous epithelium – transparent corneal epithelium overlying the corneal surface, conjunctival epithelium covering the sclera, and a junctional intervening zone of limbal epithelium overlying the limbal region which lies between the corneal and sclera. To...
Original Article
Angiographic Characteristics of Acute Central Serous Chorioretinopathy in an Asian Population
Acute central serous chorioretinopathy (CSCR) is a condition of unknown origin characterised by a serous detachment of the macula. It afflicts young healthy adults, mostly men, between the ages of 20 and 50 years.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Original Article
A Nationwide Survey on the Knowledge and Attitudes of Malaysian Optometry Students on Patients’ Visual Experiences During Cataract Surgery
Cataract is one of the most common causes of visual impairment in the elderly and its surgery is the most common major ophthalmic surgery, with over 8 million performed globally every year. The majority of cataract surgeries are performed under regional (retrobulbar, peribulbar or sub-Tenon’s) or topical anaesthesia.
This article...
Editorial
Towards 2020 Vision in Singapore
With the increasing demands of contemporary life, higher levels of visual performance are expected. In modern societies such as Singapore, many more adults will join the workforce and perform complex tasks that require perfect visual function.
This article is available only as a PDF. Please click on “Download PDF” on...
Others
Disaster Relief and Initial Response to the Earthquake and Tsunami in Meulaboh, Indonesia
A massive earthquake and tsunami hit the South Asian region on 26 December 2004, killing more than 200,000 people and displacing countless more.1 The epicentre of the earthquake was near the coast of Aceh in Sumatra, Indonesia. 2 The subsequent tsunami, one of the deadliest in history, affected more...
Commentary
Graduate Public Health Education – Singapore’s Contribution to Strengthening Capacity in the Region and Beyond
The effectiveness with which the world tackles its most pressing public health problems depends crucially on the calibre of its public health workforce. Institutions of higher learning play a critical leadership role in this regard, both to build capacity at the national, regional and global levels, and to ensure...
Others
Fungal Pan-sinusitis with Severe Visual Loss in Uncontrolled Diabetes
Fungi are known opportunistic organisms, which potentially invade and infect a host with depressed immunity. Fungal pan-sinusitis complicated with orbital apex syndrome or cavernous sinus syndrome has been described in immunosuppressed patients.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
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
Opening Our Eyes to Guide Dogs for the Blind in Singapore
The concept of the modern guide dog first began in Germany after World War I in an effort to support veterans blinded in combat. In 1927, Dorothy Eustis, having gained inspiration from her visit to a guide dog school in Potsdam, Germany, introduced guide dogs into the United States...
Original Article
Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme
Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM) worldwide, with 8.2% of Singapore adults between the ages of 18 and 69 having diabetes and there is little data on the prevalence of diabetic...
Review Article
The Emerging Challenge of Age-related Eye Diseases in Singapore
Singapore has one of the fastest ageing populations in the world today. The current elderly population, defined as persons 65 years or older, comprises 7% of Singapore’s total population and is expected to multiply almost threefold to 19% by the year 2030.1 Although the current figure stands at 7%,...
Letter to the Editor
Progressive Hemi-facial Atrophy and Keratoconus
Progressive hemifacial atrophy (Parry-Romberg syndrome, PHA) is characterised by slowly progressive atrophy, usually involving one side of the face, and may be associated with ocular manifestations which include enophthalmos, restrictive strabismus and hypotony. We report a case of keratoconus seen in a patient with PHA after obtaining approval from...
Others
Effects on the Contralateral Eye After Intravitreal Bevacizumab and Ranibizumab Injections: A Case Report
Vascular endothelial growth factor (VEGF) is recognised as an important mediator in the pathogenesis of age-related macular degeneration (AMD) and retinal neovascularisation. Anti-VEGF therapies such as pegaptanib (Macugen, EyeTech/OSI Pharmaceuticals) and ranibizumab (Lucentis, Genentech) are Food and Drug Administration (FDA)-approved in the US for the treatment of neovascular AMD.
This...
Commentary
Risk Communications: In Search of a Pandemic
The first decade of the new millennium has seen a string of disasters worldwide – earthquakes, tsunamis, floods, typhoons and acts of terrorism – bringing in its wake, scenes of utter devastation and death. Predictably, these disasters have been accompanied by public outrage, directed more often than not at...
Review Article
Prevention and Control of Avian Influenza in Singapore
Avian influenza (AI) or “bird flu” is a highly infectious disease of birds. AI viruses are negative single-stranded enveloped RNA viruses that belong to the influenza A genus of the Orthomyxoviridae family.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Review Article
Preparing for an Influenza Pandemic in Singapore
The last influenza pandemics occurred in 1957 and 1968. Few remember the pandemic in 1968 in Singapore as it was relatively mild.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Avian Influenza and Pandemic Influenza Preparedness in Hong Kong
In 1997, Hong Kong became reputed by identifying the first instance of human infection with avian influenza H5N1. A total of 18 cases occurred that year resulted in 6 deaths. The outbreak was completely terminated after the culling of over 1.5 million chickens.
This article is available only as a...
Review Article
Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia
Since July 2005 to December 2007, Indonesia has reported the highest number of influenza A (H5N1) human cases in the world, i.e., 116 cases with an extremely high fatality proportion of 81% . Those patients were reported from 12 out of 33 provinces (Fig. 1).
This article is available only...
Review Article
A Global Perspective on Avian Influenza
The world is confronted by many important public health challenges, some of which constitute potentially devastating global threats. Prime among these is the threat of a influenza pandemic.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Twentieth Century Influenza Pandemics in Singapore
Tropical countries such as Singapore, although without well-defined influenza seasons, are also affected by influenza epidemics and pandemics. Twenty per cent of Singapore’s population is clinically infected by seasonal influenza annually, and excess mortality over the past decade was about 14.8 per 100,000 person-years – comparable to temperate United...
Original Article
A Cross-sectional Study of Primary-care Physicians in Singapore on Their Concerns and Preparedness for an Avian Influenza Outbreak
Outbreaks of avian influenza (AI) caused by the H5N1 subtype in several Asian countries have raised concern all over the world. AI is endemic in several parts of Asia. To date, there have been more than 200 human cases of AI virus infection, mainly as a result of poultry-to-human...
Editorial
Singapore and the Tobacco Pandemic
The World Health Organization, in its 2008 Report on the Global Tobacco Epidemic, has framed the problem in almost apocalyptic terms, in stating that tobacco smoking is now the number one preventable cause of death globally. Smoking will kill up to 1 in 2 smokers and is a major...
Review Article
Current Understanding of the Treatment and Outcome of Acute Primary Angle Closure Glaucoma: An Asian Perspective
Primary angle-closure glaucoma (PACG) is a major cause of irreversible blindness in Asia and many parts of the world. It is a particularly serious problem in East Asia, where it represents the major form of glaucoma.
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care
The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the threat of an avian influenza (AI) pandemic is imminent. Healthcare institutions are expected to be key players during a pandemic, with healthcare workers (HCWs) at...
Original Article
Public Perceptions of Healthcare in Singapore
Healthcare is increasingly dominating the policy agenda in developed countries. In the United States, healthcare has been ranked only behind the war in Iraq as the issue the American public would “most like the president and Congress to act on next year”, while 19% of Canadians deemed healthcare the...
Letter to the Editor
Acute Concomitant Esotropia during Heroin Detoxification
Although acute concomitant esotropia following heroin detoxification or withdrawal has been described in a few case reports in Europe and Australia, it has not been reported elsewhere. Given the high prevalence of heroin use, however, this phenomenon may have been overlooked.
This article is available only as a PDF. Please...
Others
Intraocular Avastin (Bevacizumab) for Neovascularisation of the Iris and Neovascular Glaucoma
Neovascularisation of the iris is associated with many ischaemia retinal disorders and elevated levels of the vascular endothelial growth factor is found in patients with neovascular glaucoma. Inhibition of the vascular endothelial growth factor has been shown to prevent retinal ischaemia-associated neovascularisation of the iris.
This article is available only...
Original Article
Public Misperceptions About Transmission of Hepatitis B Virus in Singapore
Chronic hepatitis B (CHB) is an important global health problem, with more than 350 million individuals affected worldwide. CHB is particularly important in Asia, as 4% to 10% of the total population are affected, and approximately 75% of patients with CHB worldwide reside in Asia.1,2 During the course of...
Others
A History of the Chapter of Public Health and Occupational Physicians
The history of the Chapter of Public Health and Occupational Physicians began with the founding of the Academy of Medicine in 1957. It was the first professional corporate body of medical and dental specialists in Singapore.
This article is available only as a PDF. Please click on "Download PDF" to...
Original Article
Lack of Awareness amongst Community Patients with Diabetes and Diabetic Retinopathy: The Singapore Malay Eye Study
Diabetes is a major public health problem, and diabetic retinopathy is the leading cause of blindness in working-aged people.1 Previous studies have documented poor attainment of guidelines of glycosylated haemoglobin (HbA1c) and blood pressure control2 and eye care utilisation3-6 in the prevention of diabetic retinopathy. Studies have also documented...
Letter to the Editor
Cysticercosis of the Levator Palpebrae Superioris
Cysticercosis cellulosae, the larval form of the pork
tapeworm Taenia solium, causes cysticercosis, in which
humans serve as the intermediate hosts in the parasite
life cycle. Cysticercosis is endemic in developing regions
such as South America, India and China.
This article is available only as a PDF. Please click on “Download PDF” on top...
Clinical Update
The Evolving Role of the Community Pharmacist in Chronic Disease Management – A Literature Review
Pharmacy has matured as a clinical profession and is presently well positioned to transform itself from a product and task oriented (dispensing) to a patient oriented profession (provision of care, advice and counselling). Every day, millions of people across the world visit community pharmacies for their healthcare needs for...
Original Article
Pathological Video-Gaming among Singaporean Youth
Video-gaming and internet use are a part of the lives of children and adolescents today. Among countries that are highly wired with high speed internet access, Singapore had the second highest broadband penetration rate in 2008 next to South Korea in the world, with 88% of households having broadband...
Original Article
Trends in Importation of Communicable Diseases into Singapore
Singapore is a city-state in Southeast Asia, with a total population in 2007 of 4,839,400, of which 3,642,700 (75.3%) are Singaporean residents. The remaining 25% constitute of immigrant workers on work permit, foreigners on employment pass, and student pass holders.
This article is available only as a PDF. Please click...
Original Article
Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden
Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from 13.7 million people in 2005 to 64.6 million people in 2050.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
Multi-disease Health Screening in an Urban Low-income Setting: A Community-based Study
With the burden of chronic disease rising amongst rapidly urbanising Asian populations, active participation in health screening would allow for early detection and management of disease. However, participation in health screening can vary greatly within populations and is influenced significantly by sociodemographic and attitudinal factors.
This article is available only...
Original Article
The Pedagogical Value of a Student-run Community-based Experiential Learning Project: The Yong Loo Lin School of Medicine Public Health Screening
Experiential learning brings medical students out of the comfort zone of learning in their classrooms to acquire and apply knowledge and skills in an immediate and relevant setting. By linking theory and practice, experiential education differs from the traditional education in that it actively engages students in experiences that...
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.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics
In recent decades, medical advances and economic pressures have shifted medical student training from hospital inpatient to ambulatory settings such as hospital outpatient and primary care clinics. Most studies have found that patients are agreeable to seeing medical students and value the opportunity to interact with them.
This article is...
Original Article
Peripheral Arterial Disease in Community-based Patients with Diabetes in Singapore: Results from a Primary Healthcare Study
Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In addition, PAD is a manifestation of systemic atherosclerosis and is associated with increased risk of death and ischaemic events.
This article is available only as a...
Original Article
Intraretinal Segmentation on Fourier Domain Optical Coherence Tomography
Optical coherence tomography (OCT) has become an indispensable tool in the management of retinal and optic nerve diseases as well as in clinical trials. In late 1996, the earliest commercially available OCT had an axial resolution of approximately 17 μm.
This article is available only as a PDF. Please click...
Letter to the Editor
Intravitreal Bevacizumab for the Treatment of Myopic Choroidal Neovascularisation in an Asian Population
Myopic choroidal neovascularisation (mCNV) is one of the most common causes of permanent central visual loss in patients with high myopia, and its natural history results in the development of chorioretinal atrophy around the regressed mCNV, causing further progressive central visual loss.
This article is available only as a PDF....
Original Article
Knowledge, Attitudes and Practices of the Advance Medical Directive in a Residential Estate in Singapore
The Advance Medical Directive (AMD) Act was passed in Parliament in May 1996. The AMD is a legal document that an individual can sign in advance to inform his or her attending doctor that he or she does not want any extraordinary life-sustaining treatment to be used to prolong...
Original Article
Attitudes of Patients, Visitors and Healthcare Workers at a Tertiary Hospital Towards Influenza A (H1N1) Response Measures
Following the announcement by the World Health Organization (WHO) that outbreaks of a novel influenza virus had occurred in Mexico and several parts of the United States of America,1 the Emergency Preparedness Teams of the Singapore General Hospital and its sister institutions on the Outram Campus were activated. Measures...
Review Article
Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?
In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence suggests the presence of interactions between the immune system, the central nervous system (CNS) and the endocrine system, where these systems can be influenced by...
Original Article
Trends in Long-term Cancer Survival in Singapore: 1968-2002
With increasing health awareness and the greater extent of healthcare provision over the years, the life expectancy of Singaporeans has increased from 75.3 in 1990 to 78.4 in 2001. This suggests that cancer patients are surviving longer than before, due to an increasing number of delayed cancer deaths. Hence,...
Others
Knowledge and Practice of Household Mosquito Breeding Control Measures between a Dengue Hotspot and Non-Hotspot in Singapore
Dengue is the most common mosquito-borne viral disease in the world and its severity is reflected by a 30-fold increase over the last 50 years. Today, 2.5 billion people over 100 endemic countries remain susceptible to this disease with an estimated annual incidence of 50 million leading to 22,000...
Others
Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report
The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to the development of several intravitreal anti-angiogenic therapeutics. Ranibizumab (Lucentis, Genentech, San Francisco, USA) and pegaptanib (Macugen, OSI/Eyetech Pharmaceuticals, New York, USA) have been FDA-approved for...
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.
This article is available only as a PDF. Please click...
Letter to the Editor
Atypical Presentation of Central Retinal Artery Occlusion
Central retinal artery occlusion (CRAO) typically presents with a retinal “cherry red spot”. In CRAO, infarction of the retinal nerve fibre layer renders the retina opaque. The fovea, where this layer is absent, retains its normal orange red colour due to perfusion from the underlying choroidal vessels, resulting in...
Editorial
Sleep, Public Health and Wellness: The Elephant in the Room
The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of city dwellers can implement
to reduce their risk of accidents, coronary artery disease, diabetes, cancer and all-cause mortality while improving their cognitive performance. Unlike costly supplements...
Letter to the Editor
Bilateral Polychromatic Crystalline Keratopathy as the Initial Manifestation of IgG-Lambda Multiple Myeloma
Dear Editor,
Multiple myeloma is a subgroup of plasma cell dyscrasias with neoplastic proliferation of plasma cells or their precursors. Crystalline keratopathy is a well-recognised but rare ocular manifestation of multiple myeloma. We present a rare case of IgG-lambda multiple myeloma that manifested as polychromatic crystals in the cornea—a presentation...
Original Article
Healthcare cost of patients with multiple chronic diseases in Singapore public primary care setting
The rising occurrence of individuals suffering from multiple chronic diseases, namely multimorbidity, is of public health concern globally.1 The current prevalence of multimorbidity in Singapore ranges from 26 to 89% by various studies depending on the definition used and the population studied.2-5 With Singapore’s fast ageing population, where 1...
Editorial
Prevention and management of multimorbidity to ensure healthcare sustainability
Singapore has a healthcare system that is distinguished by its ability to achieve top health outcomes at very low healthcare expenditures.1 Yet one of the Ministry of Health’s (MOH) foremost policy concerns is the sustainability of the healthcare system in the face of a rapidly ageing society. With an...
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...
Commentary
Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?
Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values.
—Louis D Brandeis
As a small island state with finite resources, Singapore’s healthcare philosophy is governed by pragmatism, rationing and cost-effectiveness (see Appendix 1 for definition) with an unrelenting emphasis...
Original Article
A Review of Back Injury Cases Notified to the Ministry of Manpower from 2011 to 2012
Work-related low back disorders consist of both low back pain (LBP) and low back injuries. They are a significant and increasing problem all over the world. Studies estimate that between 60% and 90% of people will suffer from low back disorders at some point in their life. Among the...
Letter to the Editor
Re: An Alternative Diagnosis: Bartonella Neuroretinitis
I would like to thank the authors for the reply to our case report. The differential diagnosis of Bartonella neuroretinitis in this patient was considered, but it would definitely not be on the top of my list due to the following reasons.
This article is available only as a PDF....
Letter to the Editor
An Alternative Diagnosis: Bartonella Neuroretinitis
We refer to the letter ‘Lyme Neuroretinitis in Singapore: A Diagnostic Dilemma’ published in the April 2012 Vol. 41 No. 4 issue of the Annals, Academy of Medicine. We propose a differential diagnosis of Bartonella neuroretinitis for the case reported.
This article is available only as a PDF. Please click...
Original Article
How do English-speaking Cancer Patients Conceptualise Personhood?
Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral and legal status of an individual, is central to the protection of rights and privileges and is pivotal to the maintenance of the distinctiveness of...
Editorial
Too Much Medicine: Time to Stop Indiscriminate Cancer Screening
Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in Singapore today is as a result of cancer. It is therefore unsurprising that cancer screening has become an integral part of health screening in primary...
Letter to the Editor
27-Gauge Vitrectomy for Primary Rhegmatogenous Retinal Detachment: Is it Feasible?
Pars plana vitrectomy (PPV) using the 27-gauge transconjunctival approach is the last frontier of small gauge vitrectomy. Only 1 paper has been published so far describing the use of 27-gauge vitrectomy in a limited number of cases, including epiretinal membranes, idiopathic macular holes, diabetic vitreous haemorrhages, a vitreous biopsy...
Editorial
MERS-CoV: Where Are We Now?
Prior to 2002, coronaviruses were known mainly for causing mild human upper respiratory tract infections (URTIs) and enteric and respiratory infections in many animals. However, their full pathogenic potential was only realised when an outbreak of severe pneumonia with a high fatality rate occurred in southern China, and they...
Original Article
An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit
Over the past 30 years, different versions of severity of illness scoring systems and prognostic models have been developed for prediction of patient outcomes in critical care. These physiological-based systems and models allow patients to be stratified according to their severity of illness and provide prediction of in-hospital mortality....
Editorial
A Decade of Progress in the Understanding, Prevention and Treatment of Age-related Macular Degeneration in Singapore
The year 2014 had marked the 10th anniversary of the nationwide Age-related Macular Degeneration (AMD) Awareness Week in Singapore.1 This public health campaign, organised annually since 2005, aims to generate awareness and understanding of AMD by promoting the importance of education, early detection, and knowledge of treatment and rehabilitation...
Original Article
Anaerobic Bacteraemia Revisited: Species and Susceptibilities
Over the last 2 decades, the importance of anaerobic bacteraemia has undergone various shifts in opinion. Early studies in the 1970s reported that anaerobes accounted for 2% to 20% of bacteraemia. However, by the mid 1980s, multiple centres reported declining rates of anaerobic bacteraemia, and several authors suggested that...
Original Article
Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study
Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the readmissions considered preventable,3 early identification of the underlying risk factors can offer better management and discharge planning.4 Some risk factors of readmissions related to patient...
Editorial
Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions
Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue to increase given Singapore’s ageing population and growing chronic disease and multimorbidity burden, impacting care quality and patient/provider experience.2,4 While majority of admissions are clinically...
Letter to the Editor
Health professions education in pandemics and epidemics: A proposed framework for educators
The COVID-19 pandemic has disrupted healthcare systems and health professions education (HPE). There are few frameworks to help educators manage HPE before, during and after pandemics and epidemics. We developed a crisis management framework which
draws from diverse theories to emphasise preparedness, leadership, stakeholder perceptions and organisational learning to provide...
Letter to the Editor
The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown
Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties in the care of patients with communicable diseases like COVID-19. PPE is also worn by ancillary staff such as security personnel, porters, medical transport crew...
Commentary
Merits of a harmonised system to classify drug-related problems in Singapore
A drug-related problem (DRP) is commonly defined as an event or circumstance involving drug treatment that actually or potentially interferes with the optimal outcome of a patient’s medical care. It broadly includes events related to errors, adverse effects or adherence issues. DRPs are associated with increased healthcare costs and...
Original Article
Factors influencing protective behaviours during haze episodes in Singapore: A population-based study
Southeast Asia suffers from recurrent episodic air pollution from biomass smoke known as haze, which is mainly caused by human activities such as the extensive use of fire to clear land for agriculture,1 or to settle disputes over land rights.2 It is a major public health problem affecting an...
Editorial
Seasonal haze: Knowledge gaps and risk perception behaviours
The seasonal haze in Southeast Asia has been a recurrent concern whenever we enter the southwest monsoon season (June–September). This phenomenon, caused by agricultural fires, has vast effects on multiple countries in the region.
This article is available only as a PDF. Please click on "Download PDF" to view the...
Original Article
Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study
Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work pass issued to semiskilled workers, comprise 26.0% of Singapore’s entire labour force. Two other work passes held by FWs, “S pass” and “employment pass”, are...
Original Article
Accuracy of self-reported height, weight and BMI in a multiethnic Asian population
Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight has been directly linked to a number of debilitating diseases, including diabetes, heart disease and cancer, and has gained increased popularity as a measure of...
Original Article
Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry
Ophthalmic cancers are commonly encountered in clinical practice and are an important cause of morbidity and mortality. Globally, the incidence of ophthalmic cancers have been increasing in the past 2 to 3 decades.3-6 Data on recent incidence of primary ophthalmic cancers, comprising intraocular and extraocular cancers, have not been...
Letter to the Editor
Seeing through the eyes of patients with age-related macular degeneration
Age-related macular degeneration (AMD) is a severe ocular disease characterised by progressive deterioration of the macula, the most sensitive central part of the retina. It is the most common cause of irreversible vision loss among individuals aged ≥60 years in developed countries, and accounts for about 6% of all...
Original Article
Vulnerability to rumours during the COVID-19 pandemic in Singapore
The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found to be elevated among healthcare workers and the general population. Others have reported a higher incidence of stress-related symptoms or post-traumatic stress disorder. These findings...
Original Article
Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore
In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community transmission began early in the outbreak, the government started emphasising the role that individuals had to play by adopting health-preventive behaviours.
This article is available only...
Editorial
The Novel Coronavirus (SARS-CoV-2) Pandemic
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and was reported to the World Health Organization (WHO) on 31 December 2019. An outbreak of unknown aetiology was suspected because many early cases were linked...
Original Article
Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children
Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...
Review Article
Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre
As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...
Review Article
Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months
Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...
Original Article
Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore
Primary care in Singapore is set to face challenges in managing a rapidly ageing population. The expected population of older adults aged 65 years and above will be close to 1.5 million by 2030, corresponding to 2.7 working adults per older adult in 2030.2 Between 2019 and 2050, Singapore...
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...
Letter to the Editor
Neuro-Behçet’s disease presenting as isolated intracranial hypertension
Behçet’s disease (BD) is a chronic multisystem inflammatory disease with a classic triad of painful oral ulcers, genital ulcers and uveitis. Neurological manifestations, though uncommon, can affect both central and peripheral nervous system; producing parenchymal, non-parenchymal and mixed forms of the disease. Ophthalmic findings include ocular inflammation and other...
Review Article
Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review
The World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern on 30 January 2020. To control the outbreak, many countries have implemented nationwide lockdowns and social distancing measures, which have brought challenges to accessibility of healthcare services and continuation of long-term medical care,...
Original Article
Excimer Laser Phototherapeutic Keratectomy for Recurrent Corneal Erosions
Recurrent cornea1 erosion (RCE) syndrome is a commonly encountered clinical condition which may be difficult to treat. Hansen first described it in 1872.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks
Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good operating conditions, with the facial nerve block preventing blepharospasm and providing lid akinesia.
This article is available only as a PDF. Please click on “Download PDF”...