Related Articles

Trends in fluid overload-related hospitalisations among patients with diabetes mellitus: The impact of chronic kidney disease

Diabetes mellitus (DM) is a major global health problem, contributing to significant clinical disease burden, healthcare expenditure and societal costs.1 In Singapore, DM accounts for 2.9% of disability-adjusted life years and 4.3% of years lived with disability.2,3 By 2030, it is projected to cost approximately USD 1.89 billion in...

Challenges in genetic screening for inherited endocrinopathy affecting the thyroid, parathyroid and adrenal glands in Singapore

In the current landscape of medicine, it is well known that most diseases incorporate a genetic component to some degree. Genetic testing of human diseases originated in the 1950s, and screening for genetic disorders followed a decade after.1 It is worthwhile noting that the Human Genome Project (1990–2003), which...

Polycystic ovary syndrome v.2023: Simplified diagnostic criteria for an East Asian phenotype

Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting 6–19% of women of reproductive age, depending on the reference population and definition used.1,2 The incidence of PCOS is increasing and the syndrome can be considered the single most common endocrine abnormality among women of reproductive age.3 Although its...

Enhancing the accuracy of polycystic ovary syndrome diagnosis

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder, experienced by 1 in 10 women of childbearing age. Its aetiology is multifactorial and complex, and its clinical presentation is heterogeneous with menstrual irregularities, high levels of androgens and the presence of multiple follicles or cysts in the ovaries...

Comparison of existing methods of low-density lipoprotein cholesterol estimation in patients with type 2 diabetes mellitus

Elevated low-density lipoprotein cholesterol (LDL-C) levels are a major risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). A reduction in LDL-C levels has been shown to significantly reduce the risk of incident ASCVD1 and all-cause mortality.2 LDL-C levels are hence key treatment targets in the prevention of...

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...

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...

Association between self-care and chronic kidney disease in patients with type 2 diabetes mellitus

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

Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis

Non-alcoholic fatty liver disease (NAFLD) is a growing epidemic and has become a major cause of liver-related mortality and indication for liver transplantations globally. It is estimated that nearly 25% of the world’s population and more than 60% of type 2 diabetes mellitus (T2DM) patients have NAFLD. A prior...

Safety and efficacy of combined antiplatelet and low-dose rivaroxaban in patients with chronic limb threatening ischaemia in Singapore

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

Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction

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

Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction

With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction (HFmrEF), much has yet to be fully understood with regard to patient demographic, clinical presentation, response to guideline-directed heart failure therapies, and outcome across the...

Congenital cytomegalovirus infection: Advocating for screening and education

Cytomegalovirus (CMV) infection is the leading non-genetic cause of congenital neurosensory hearing loss in children, accounting for 21% of cases of hearing loss at birth and 25% of deafness at age 4 years.1 It can also give rise to other serious sequelae such as cerebral palsy, cognitive impairment, seizures...

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...

Thyroid Storm Presenting as Jaundice and Complete Heart Block

Thyroid storm is defined as a severe and often life-threatening exacerbation of thyrotoxicosis which is usually characterised by hyperthermia, tachycardia, severe agitation and altered mental status. With the “apathetic” variant of hyperthyroidism, the classical features may not be evident. This article is available only as a PDF. Please click on...

Hyperthyroidism with Gynaecomastia as the Initial Complaint: A Case Report

Gynaecomastia is not a commonly recognised feature among the myriad symptoms and signs associated with hyperthyroidism. A review of the literature disclosed only eight reported cases of gynaecomastia as a presenting feature in thyrotoxicosis, and herein we describe an additional case. This article is available only as a PDF. Please...

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

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

A Case Series of Paget’s Disease of Bone: Diagnosing a Rather Uncommon Condition in Singapore

Sir James Paget’s description in 1877 of “a form of chronic inflammation of bones” which now bears his name was based entirely on clinical and pathological observations in patients with advanced disease. Today, more than a century later, advanced imaging techniques and biochemical tests have allowed us to identify...

A Case Report of a Patient with Bronchial Carcinoid Tumour and Late Presentation of Cushing’s Syndrome

Cushing’s syndrome is usually easy to recognise clinically. Determining the cause of non-iatrogenic Cushing’s syndrome is, on the other hand, often a diagnostic enigma. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Measurement of Obesity by Anthropometry and Bioelectric Impedance Analysis: Correlation with Fasting Lipids and Insulin Resistance in an Asian Population

Obesity is a risk factor for cardiovascular disease. This risk is partially mediated by the correlation between obesity and other coronary artery disease risk factors. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Study to Assess the Effect of Dietary Supplementation with Soluble Fibre (Minolest®) on Lipid Levels in Normal Subjects with Hypercholesterolaemia

Hypercholesterolaemia is one of the major risk factors in the development of coronary artery disease (CAD). In recent years, many non-prescription treatments have become available for cholesterol lowering. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Regulation of Insulin Secretion by Nerves and Neuropeptides

The pancreatic islets of Langerhans were described by Paul Langerhans in 1869. They are distributed throughout the entire pancreas forming in adults approximately 1% of the pancreatic mass. This article is available only as a PDF. Please click on “Download PDF” on top to view the full 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”...

Hypoglycaemia from Islet Cell Hyperplasia and Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus—A Case Report

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

Orlistat (Xenical) in the Management of Obesity

The term “obesity” implies an excess of adipose tissue (fat) and excess adiposity is a health risk. In most cases it develops in the absence of any underlying disease process. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Molecular Pathogenesis of Obesity: An Unfinished Jigsaw Puzzle

Obesity is one of the most common health problems in Singapore with escalating prevalence, affecting about 6% of the Singapore population above 18 years of age. The prevalence of obesity is 12.2% in Singapore children aged 6 to 7 years, 12.8% in children aged 11 to 12 years, and...

1990-2000: Progress in Determining High Blood Pressure Genes

Essential hypertension and its complications, coronary heart disease, stroke and renal failure are leading causes of morbidity and mortality in western societies.1 While the aetiology of essential hypertension is not known, it is recognised as being a multifactorial disease caused by both genetic and environmental factors. This article is available...

A Case Report of Aspergillus Hypersensitivity Syndrome with Obstructing Bronchial Aspergillosis

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

A Rational Alternative for the Diagnosis of Diabetes Mellitus in High Risk Individuals

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

Evaluation of a Rapid Screening Test for Microalbuminuria with a Spot Measurement of Urine Albumin-Creatinine Ratio

In 1989, the St Vincent Declaration was formulated by all European countries to address the growing problem of diabetes, with the general goals of improving health care and quality of life for the diabetic patient. One of the targets in the declaration was the need to implement effective measures...

Traditional Indian Systems of Medicine

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

Graves’ disease after COVID-19 vaccination

Dear Editor, Case 1 was a 41-year-old man with a history of primary hyperthyroidism. At the time of diagnosis, thyroglobulin antibodies were elevated although no thyrotropin receptor antibodies (TRAB) were available. The patient was treated with carbimazole for 20 months. At the time of cessation of carbimazole in May 2020,...

Severe Diabetes in Remission: A Singapore’s Perspective

Diabetic ketoacidosis is generally believed to be the result of an acute and severe degree of insulin insufficiency, classically occurring at the presentation of a newly diagnosed individual with Type 1 diabetes. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Obesity in Singapore

The word obesity implies an excess of adipose tissue (fat) and not merely an excess of body weight. An increase in body weight may be due to fat (as in an obese person) or due to lean muscles (as in Hercules or in a body builder). This article is available...

A Rare Cause of Syncope in a Patient with Diabetes Mellitus—A Case Report

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

Malignant Melanoma Seen in a Tertiary Dermatological Centre, Singapore

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

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...

Problem-based Learning (PBL) as an Approach in the Teaching of Biochemistry of the Endocrine System at the Angeles University College of Medicine

The Angeles University College of Medicine (AUCOM) was established in 1983 with a curriculum that is conventionally teacher-centred. Biochemistry is a basic science subject introduced in the first year of the medical curriculum. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Introduction of Problem-based Learning in a Traditional Medical Curriculum in Singapore—Students’ and Tutors’ Perspectives

The National University of Singapore was started in 1905. Since then, it has trained many generations of medical practitioners. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

46, XY Female—A Case Report

The phenotypic sex of an individual is usually male if that person’s genotype is 46, XY since the SRY gene on the Y chromosome, being the putative testicular determining factor (TDF) governs testicular gonadogenesis. Yet, there are distinct situations where sexual differentiation proceeds along a female phenotype despite the...

A Case Report of Primary Hyperparathyroidism with Severe Bony Involvement and Nephrolithiasis

Primary hyperparathyroidism is said to have evolved from a disease of “bones, stones and groans”, to one that is largely asymptomatic with a relatively benign course in the majority of patients. In a 1981 study, the incidence of radiologically detectable bone disease was found in 24% of patients but...

Current Therapeutic Strategies for Type 2 Diabetes Mellitus

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

Treating Thyrotoxicosis with Radioiodine

Iodine is an essential component of thyroid hormone and is actively taken up by thyroid follicles. This is the physiological basis for the use of radioiodine in the treatment of thyrotoxicosis. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

A Preliminary Evaluation of a Disease Management Programme for Patients with Diabetes Mellitus and Hypertension in a Primary Healthcare Setting

Chronic diseases are the main causes of morbidity and mortality in developed countries. In most developed countries, the problems of a rising prevalence of chronic disease and escalating costs have forced healthcare policymakers to look for ways to provide cost-effective healthcare for chronic disease patients. This article is available only...

Thyroid Diseases in Pregnancy

Abnormalities of thyroid function associated with pregnancy encompass both hyperthyroidism and hypothyroidism. These may have been present before the onset of pregnancy, or occurred only during or after pregnancy. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Gestational Diabetes Mellitus: A Call for Systematic Tracing

The prevalence of diabetes is increasing worldwide. In Singapore, the prevalence of diabetes has increased dramatically from 4.7% in 1984 to 8.6% in 1998. Diabetic complications lead to a significant number of patients with blindness, amputations and end-stage renal failure annually. This article is available only as a PDF. Please...

Statins and Bone Morphogenetic Proteins: New Pathways in Bone Formation

Osteoporosis is a major public health problem causing considerable morbidity and mortality in Asian women. It is estimated that half of the world’s hip fractures will occur in Asia in 50 years’ time. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Comparing Fasting Plasma Glucose against Two-hour Post-load Glucose Concentrations for the Diagnosis of Diabetes Mellitus and Glucose Intolerance in Singaporean Hospital Patients

Prior to 1997, the diagnosis of diabetes mellitus in asymptomatic individuals was based upon the 1985 World Health Organisation (WHO) diagnostic criteria in which, utilising the 75g oral glucose tolerance test (OGTT), diabetes was defined either by a fasting plasma glucose (FPG) concentration of >7.8 mmol/L or by a...

Clinical Update on Osteoporosis

Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...

The Bone and Joint Decade 2000-2010: For Prevention and Treatment of Musculoskeletal Disease

The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its multi-faceted, multidisciplinary approach, has been identified as one of the four clinical fields selected also for emphasis by the Bone and Joint Decade initiative. This article...

Osteoporosis—A Worldwide Problem and the Implications in Asia

Osteoporosis is a condition characterised by low bone mineral density, microarchitectural deterioration of bony tissue, and a consequent increase in fracture risk. With rapid ageing of the Asian population, osteoporosis has become one of the most prevalent and costly health problems. This article is available only as a PDF. Please...

Bone Fragility in Asian and Caucasian Men

Bone fragility in men has been receiving greater attention during the last few years. Epidemiological studies have been done in Caucasian and Asian populations. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Steroid-induced Osteoporosis

Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed. The most important effects appear to be on bone formation due to direct effects on cells of the osteoblastic lineage although indirect effects related to...

Medical Treatment of Osteoporosis—Increasing Options

The current practice and management of osteoporosis differs greatly from even the recent past. Up to 15 years ago, bone mineral density (BMD) measurements were not widely available, osteoporosis was still largely diagnosed only at the stage of fractures, the epidemiology of osteoporosis was not well studied yet and...

Osteoporosis Risk Factor Assessment and Bone Densitometry—Current Status and Future Trends

Osteoporosis affects predominantly elderly women; although younger women and men may also be affected. Demographically, the number and proportion of the elderly (aged 65 years and above) in many countries is increasing rapidly, and the problem of osteoporosis will increase concomitantly. This article is available only as a PDF. Please...

Osteoporosis in Relation to Menopause

Singapore has a rapidly ageing population. In 1990, only 6% of the population was above the age of 65 years but this percentage of elderly citizens will rise rapidly to 17% by the year 2030. As Singaporean women achieve longer life expectancy and live a greater portion of their...

An Asian Perspective to the Problem of Osteoporosis

Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Osteoporosis: A Treatable Disease

Osteoporosis twenty years ago was a very different disease from what we know of it today. At that time a diagnosis of osteoporosis was made at the point of sustaining a fracture as there was no routine method of pre-fracture diagnosis such as bone mineral density measurement. This article is...

Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital

The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and medical personnel. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Diagnosis and Management of Hypercalcaemia

Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in women and <1% in men above the age of 60 years. This article is available only as a PDF. Please click on “Download PDF” on top...

The Perils of Puberty

Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such as cytochrome P450 systems, accretion of peak bone mass, and the development of sexually dimorphic adult patterns in blood lipids, blood pressure, haemoglobin and red...

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...

Unravelling the Mystery in a Case of Persistent ACTH-independent Cushing’s Syndrome

A Malaysian Chinese male patient, CMO, first presented at the age of 22 years with a 2-week history of severe spontaneous low backache with no prior trauma or back injury. A lumbar spine X-ray showing marked osteopenia and compression fracture of the first lumbar vertebra led to findings of...

Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations

Diabetes mellitus (DM) is a common and growing global health problem. It is highly prevalent in Asian communities. Hong Kong, Pakistan, and Singapore are among the countries with the highest prevalence of diabetes in the adult population. This article is available only as a PDF. Please click on “Download PDF”...

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...

A Hyperthyroid Patient with Measurable Thyroid-stimulating Hormone Concentration – A Trap for the Unwary

Free thyroxine (FT4), total tri-iodothyronine (T3) and thyrotropin (TSH) are the commonly measured biochemical indices in the assessment of thyroid function in a patient with suspected thyrotoxicosis. These indices give sufficient information regarding the functional status of the thyroid gland under most circumstances. This article is available only as a...

Addressing Issues of Maldistribution of Health Care Workers

The movement of people from one place to another has shaped today’s political, social and economic world and continues to be a major influence on society. In 2000, almost 175 million people, or 2.9% of the world’s population, were living outside their country of birth for 1 year or...

Attitudes of First-year Medical Students in Singapore Towards Older People and Willingness to Consider a Career in Geriatric Medicine

With the exponential increase in the elderly population in Singapore, the training of young physicians of tomorrow in the care of elderly patients will need to change accordingly. A potential way to fulfill this need is to increase the number of specialists proportionately to manage elderly patients effectively. This article...

Diabetes Outcomes in Specialist and General Practitioner Settings in Singapore: Challenges of Right-Siting

The long lasting debate on the role of generalists and specialists in the management of diabetes is still ongoing. Nonetheless, the last 3 decades have seen the increasing shift of chronic disease management from specialist outpatient clinic-based to more general practice-based services. This article is available only as a PDF....

Diabetes in Asia – From Understanding to Action

In the present pandemic of diabetes and obesity, 60% of the affected population will come from Asia. Between India and China, these two most populous nations will contribute more than 100 million to the world’s population of people with diabetes, many of whom remain undiagnosed, untreated or suboptimally managed. This...

Should Singapore have a Second Medical School?

Singapore has had only one medical school since 1905. This medical school, the Medical Faculty in the National University of Singapore (NUS), currently takes in about 230 students each year and its primary task is to train physicians for the entire nation. The NUS Medical Faculty is also involved...

One Hundred Years of the Teaching of Medicine in Singapore

In 2005, the Medical Faculty of the National University of Singapore (NUS) will commemorate the 100th year of its founding. The Straits and Federal Malay States Government Medical School, as it was called, had a humble beginning, with an enrolment of only 23 students in 1905. This article is available...

The Evolution of Teaching and Learning Medical Microbiology and Infectious Diseases at NUS

The Straits and Federated Malay States Government Medical School was founded in 1905. Dr Chen Su Lan, 1 of the 7 graduates in the first class to qualify in March 1910, reminisced in 1965 on his training experiences: “Among the ‘killer’ diseases were malaria (there were 20 deaths a...

Evidence-based Medicine (EBM) for Undergraduate Medical Students

The practice of evidence-based medicine (EBM), which integrates individual clinical expertise with the best available evidence from systematic research, demands a set of skills. These skills help clinicians retrieve, appraise and apply the current best evidence. This article is available only as a PDF. Please click on “Download PDF” on...

Sleep Disorders in Children: The Singapore Perspective

Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in 1% to 3% of children. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Magnesium, Zinc, Copper, Manganese, and Selenium Levels in Postmenopausal Women with Osteoporosis. Can Magnesium Play a Key Role in Osteoporosis?

Osteoporosis is a condition in which an increased risk of fracture takes place due to a reduction of bone mineral content. It occurs as a result of an imbalance between bone formation and bone resorption. This article is available only as a PDF. Please click on “Download PDF” on top...

The Relation Between Insulin Resistance Determined by Haemostatic Modelling and Slow Coronary Flow

Slow coronary flow (SCF) is a well recognised clinical entity, characterised by delayed opacification of coronary arteries in the presence of normal coronary angiogram. Many aetiological factors, such as microvascular and endothelial dysfunction, have been implicated. This article is available only as a PDF. Please click on “Download PDF” on...

Impact of the Singapore National Asthma Program (SNAP) on Preventor-Reliever Prescription Ratio in Polyclinics

According to the World Health Organization/Global Initiative on Asthma (WHO/GINA) report on the global burden of asthma, Singapore is an intermediate-risk country for asthma prevalence, which is about 5% of the population. But has one of the highest rates of asthma deaths in the world. This article is available only...

Consequences of Right Siting of Endocrinology Patients – A Financial and Caseload Simulation

Right siting, defined as “patients treated in the most appropriate locations by medically competent teams at the lower possible cost”, has been on the national healthcare agenda for a number of years, even meriting mention and discussion in the Singapore Parliament. Internationally, the term “appropriate siting” is more commonly...

Phaeochromocytoma the Great Mimicker: A Case Report

Phaeochromocytomas are catecholamine producing neuroendocrine tumours that can manifest a variety of symptoms which mimic other diseases. They are also known for their “rule of 10” where 10% are extra-adrenal, of which 10% are extra-abdominal, 10% are malignant, 10% occurs in normotensive patients and 10% are hereditary. This article is...

Metabolic Control in Type 2 Diabetes Correlates Weakly with Patient Adherence to Oral Hypoglycaemic Treatment

Diabetes mellitus is one of the most common chronic diseases affecting Singaporeans. In 2004, 8.2% of the population was afflicted, placing a significant burden on healthcare resources and affecting the well-being of the community. This article is available only as a PDF. Please click on “Download PDF” on top to...

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

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

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...

From a “Generalist” Medical Graduate to a “Specialty” Resident: Can an Entry-level Assessment Facilitate the Transition? Assessing the Preparedness Level of New Surgical Trainees

Undergraduate medical education is considered a continuum leading into postgraduate training and ultimately medical practice.1 To this effect, it has been suggested that measures of performance of medical students and practising doctors should be aligned and the transition should be a smooth one. However, studies show a poor correlation...

A Brief History of the Chapter of Psychiatrists

The Inaugural Meeting of the Chapter of Psychiatrists and Chapter of Pathologists, Academy of Medicine, was held on 5 December 1986 at King’s Hotel.1,2 At that time the Academy already had 7 Chapters in her fold. The Chairman, Dr Lawrence Chan (then Master of the Academy of Medicine) remarked...

Diabetes and Associated Cardiovascular Risk Factors in Iran: The Isfahan Healthy Heart Programme

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

Impact of Depression on Health Related Quality of Life in Patients with Diabetes

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

Elevated Level of Carbonyl Compounds Correlates with Insulin Resistance in Type 2 Diabetes

With rapid development of therapy, the mortality from acute complications of diabetes mellitus (DM) has decreased, but mortality from chronic complications like diabetic nephropathy has increased. The incidence and prevalence of type 2 DM is increasing in developing countries. This article is available only as a PDF. Please click on...

Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure

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

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...

Foot Screening for Diabetics

Prevalence of diabetes is high in Singapore (8.2%). Five per cent to 15% of diabetics developed foot ulcers. In fact, the lifetime risk for a person with diabetes of developing a foot ulcer could be as high as 25%. This article is available only as a PDF. Please click on...

Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis

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

The Singapore National Healthcare Group Diabetes Registry – Descriptive Epidemiology of Type 2 Diabetes Mellitus

Diabetes mellitus is one of the most challenging global health problems in the 21st century. It is associated with excess mortality and significant morbidity from complications, which lead to disability, poor quality of life and an enormous health cost. This article is available only as a PDF. Please click on...

Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns

Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise in numbers of infected cases despite initial containment followed by mitigation efforts. Local incidence for acute upper respiratory infections (which was a reasonable surrogate for...

Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction

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

The Relevance of the Metabolic Syndrome

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

Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study

The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months and partial breastfeeding thereafter for at least 12 or 24 months....

Comparison of Oral Glucose Insulin Sensitivity with Other Insulin Sensitivity Surrogates from Oral Glucose Tolerance Tests in Chinese

Patients with type 2 diabetes mellitus are at an increased risk of developing atherosclerosis and cardiovascular diseases leading to higher morbidity and mortality. These complications cause serious economic burdens, not only to patients, but also to the family and society. This article is available only as a PDF. Please click...

Health-related Quality of Life is Associated with Diabetic Complications, but not with Short-term Diabetic Control in Primary Care

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

Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation

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

Geriatric Syndromes and Depressed Mood in Lower-income Singaporeans with Diabetes: Implications for Diabetes Management and Health Promotion

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

Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan

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

Fasting during Ramadan and Associated Changes in Glycaemia, Caloric Intake and Body Composition with Gender Differences in Singapore

Muslim individuals worldwide participate in obligatory abstinence from oral consumption of medications, food and liquid during the fasting month of Ramadan. Fasting during Ramadan is one of the 5 pillars of Islam. However, Islam exempts individuals whose health may be significantly affected from fasting. Despite this, up to 80%...

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

In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their individual strengths to become an integrated academic healthcare cluster. This new academic healthcare cluster has a mission to provide outstanding clinical service, discover and promote...

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...

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...

Recurrent vascular events in ischaemic stroke patients with diabetes

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

Adipsic diabetes insipidus and SGLT2 inhibitor: A perplexing conundrum

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

Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review

Diabetes is a chronic disease characterised by elevated levels of blood glucose. The most common type of diabetes is type 2 diabetes mellitus (T2DM). This usually occurs in adults and arises through insulin resistance or an insufficiency of insulin production. Diabetes is one of the priority non-communicable diseases targeted...

Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore

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