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Long-term survival and clinical implications of allogeneic stem cell transplantation in relapse/refractory lymphoma: A 20-year Singapore experience

Over the past few decades, a wide array of novel therapies has become available for the treatment of relapsed/refractory (R/R) lymphoma. Despite these advancements, outcomes and the durability of disease control remain poor for many patients. While autologous hematopoietic stem cell transplantation (auto-HSCT) may be appropriate for some lymphoma...

Unplanned hospitalisations among subsidised nursing home residents in Singapore: Insights from a data linkage study

Hospitalisations pose hazards and safety risks to nursing home (NH) residents who may be frail, cognitively impaired, suffering from multi-morbidities and physically dependent,1 with propensity to develop adverse outcomes such as functional, psychological or cognitive decline, iatrogenic complications, and be subjected to over-investigation.2 There is an imperative for health...

AL amyloidosis: Singapore Myeloma Study Group consensus guidelines on diagnosis, treatment and management

Amyloidosis refers to disorders characterised by the deposition of insoluble amyloid fibrils, which are pathogenic,1 resulting in organ dysfunction. Amyloidoses differ in the protein precursor undergoing aggregation and downstream target organs implicated. Consequently, clinical manifestations are varied, from localised amyloidosis in Alzheimer’s disease, to systemic amyloidosis such as immunoglobulin...

Clinical utility of PET/MRI in multiple myeloma

Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and bone lesions. A sensitive method to detect bone lesions is crucial as it could determine the decision to start treatment. In this era, the International...

Improving management of AL amyloidosis

In this issue of the Annals, Tan et al. on behalf of Singapore Myeloma Study Group presented the consensus guidelines on light chain (AL) amyloidosis.1 This is an encouraging effort as AL amyloidosis is a rare disease, with diagnostic and therapeutic challenges.  A comprehensive review examining its pathophysiology, diagnostic...

Incorporating assessment of fibrinogen gene polymorphisms and bleeding risk in patients treated with direct oral anticoagulants

Direct oral anticoagulants (DOACs) have become entrenched as the dominant anticoagulant over the last decade for patients with venous thrombosis and atrial fibrillation.1 Compared to warfarin, bleeding risk is similar or lower for patients on DOACs but clinically relevant bleeding is still a risk, especially for patients with impaired...

Case studies of fetal mosaicisms detected by non-invasive prenatal testing

Dear Editor, The American College of Medical Genetics and Genomics recommended that all pregnant women be offered non-invasive prenatal testing (NIPT) regardless of the patient’s risk profile.1 With increasing NIPT uptake, encounters with genetic conditions other than the 3 common fetal trisomies are becoming prevalent. We report 2 cases of...

Erdheim-Chester disease: Imaging spectrum of multisystemic manifestations

Dear Editor, Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis, usually affecting middle-aged to older adults. It is a multisystemic disease with protean clinical manifestations. It can involve single or multiple organs, and presentations range from asymptomatic lesions detected incidentally on imaging to severe organ dysfunction. Hence, accurate and timely...

Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation

The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and major adverse cardiac events (MACE) seen in this group of patients even after surgical aortic valve replacement (SAVR).1,2 In recent times, the role of transcatheter aortic...

Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series

Dear Editor, Thrombosis is an unexpected complication of COVID-19 initially reported in 3 patients from China.1 These patients tested positive for immunoglobulin (Ig) A anticardiolipin (ACA), IgG anti-β2-glycoprotein I antibodies (aβ2GPI) and IgA aβ2GPI, though not for the lupus anticoagulant (LAC). In a Singapore study comprising 47,527 patients, 19 (0.04%) developed...

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....

Different strokes for different folks

Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey’s observation of fibrillating auricles in open chest animal models in 1628. Willem Einthoven first documented ECG tracing of AF in 1906. Fast forward several hundred years since its first observation, AF remains a mystery from its pathogenesis and...

Barriers to breast cancer screening in Singapore: A literature review

Breast cancer is a major public health concern and a leading cause of cancer death among women worldwide, including Singapore.1 According to the 2018 Singapore Cancer Registry report, breast cancer has been consistently ranked as a leading cancer (29.3% of all cancers in Singapore) among women in Singapore for...

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...

Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore

Functional gastrointestinal (GI) disorders, such as colic, gastroesophageal reflux (GER) and constipation, are common in infants under 1 year. They are a frequent cause of concern for parents and result in a significant healthcare burden1,2 due to their negative impact on feeding behaviours, caregivers’ mental wellbeing and quality of...

Gastroesophageal reflux disease in Asian infants: Similar condition, different perceptions

Gastroesophageal reflux disease (GERD), a common problem in infancy, may lead to troublesome symptoms or complications such as oesophagitis or oesophageal stricturing in a small minority of infants.1 In the majority of cases, however, frequent regurgitations, the commonest symptoms of GERD, resolves with age spontaneously without any medical intervention.2,3...

Haemoglobin H disease and outcomes in Singapore

Dear Editor, Haemoglobin H (HbH) disease is a haemoglobinopathy affecting 3 of 4 α-globin genes on chromosome 16. It results from the deletion of 2 linked α-globin genes (α0-thalassaemia) on one chromosome and either a single α-globin gene deletion (--/-α) or non-deletional gene mutation (--/αTα) on the other chromosome.  The...

A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia

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

A Study of Idiopathic Thrombocytopenic Purpura (ITP) Patients over a Ten-year Period

Idiopathic thrombocytopenic purpura (ITP) is an immunoregulatory disorder in which antibodies damage platelets leading to their removal by cells of the reticuloendothelial system (RES). This occurs mainly in the spleen which is also the primary site of synthesis of these antiplatelet antibodies. This article is available only as a PDF....

Use of Atypical Neuroleptics in a State Mental Institute

Schizophrenia is the most severe of all mental disorders and affects about 1% of the population. The main disturbances of schizophrenia comprise positive symptoms, negative symptoms and disorganisation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore

In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has focused especially on cancer and the possible link between immunology and psychological factors. This article is available only as a PDF. Please click on “Download PDF”...

A Case Report of Adult T-Cell Leukaemia/Lymphoma (ATLL)

Our patient was a 71-year-old Chinese man who presented with a 6-year history of recurrent papular erythematous eruptions to the dermatologist. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Newer Thrombolytic Agents

First-generation fibrinolytic agents (streptokinase and urokinase) are effective thrombolytic drugs, but are not fibrin specific as they also have the property to convert circulating plasminogen to plasmin when given at therapeutic doses. Because the plasminogen in the thrombus is in equilibrium with the plasminogen pool in plasma, the plasminogen...

8th Seah Cheng Siang Memorial Lecture: New Antithrombotic Agents

The tremendous interest in finding new anti-aggregating agents stems from the preeminent role that platelets play, not only in haemostasis and thrombosis, but also in atherogenesis and, be it less definitive, in arterial spasm. Compelling data from large-scale trials have established the role of platelet inhibitors in reducing coronary...

Activated Protein C Resistance: A Study Among 60 Thromboembolic Patients in the Singapore Population

In 1993, Dahlback and colleagues described a new hereditary thrombophilia state-activated protein C resistance (AK-R). Further studies showed this to be the commonest genetic cause of thrombophilia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Pseudomembranous Tracheobronchitis Caused by Aspergillus in a Patient after Peripheral Blood Stem Cell Transplantation

Pseudomembranous tracheobronchitis caused by Aspergillus is a rare and lethal variant of invasive aspergillosis. It has been reported in a few series of immunocompromised patients. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Philadelphia Positive Acute Lymphoblastic Leukaemia (ALL): Clinico-Haematologic Characteristics, Molecular Analyses and 3-year Follow Up—A Single Institution Study

A number of specific chromosome abnormalities are associated with acute lymphoblastic leukaemia (ALL). The commonest in adults with B lineage ALL is the Philadelphia (Ph) chromosome t(9;22)(q34;q11). This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Thrombotic and Haemorrhagic Complications in Patients with Mechanical Heart Valve Prostheses Attending the Singapore General Hospital Anticoagulation Clinic

Patients with mechanical heart-valve prosthesis receive lifelong anticoagulation. The management of these patients taking oral anticoagulants is aimed at achieving and maintaining adequate levels of anticoagulation to prevent thrombotic manifestations and at the same time to keep the risk of severe haemorrhagic complications to the minimum. This article is available...

Treatment of Acute Promyelocytic Leukaemia Using a Combination of All-trans Retinoic Acid and Chemotherapy

Acute promyelocytic leukaemia (APL), or acute myeloid leukaemia (AML)-M3 under the French-American-British (FAB) classification, is characterised by the following: a distinct expansion of promyelocytes and immature myeloblasts in the bone marrow; balanced reciprocal translocation between the long arms of chromosome 15 and 17, t(15;17) which results in apposition of...

The Views of Mental Health Professionals Towards Psychotherapy—A Singapore Survey

There is a trend in Asia towards a greater application of psychotherapeutic approaches in multidisciplinary settings to emotional and behavioural disturbances. The inaugural issue of Asian Psychologist announced landmarks in the education and training of clinical psychology in two major Asian communities. This article is available only as a PDF....

The Use of Vigabatrin in Infantile Spasms in Asian Children

Infantile spasms are a form of age-dependent myoclonic epilepsy that is difficult to control. Agents such as adrenocorticotrophic hormone (ACTH) and prednisolone have been used as first-line therapy, but are associated with major side effects. This article is available only as a PDF. Please click on “Download PDF” on top...

CD4 Lymphocyte Enumeration in Patients with Human Immunodeficiency Virus Infection Using Three-Colour and Four-Colour Dual-Platform Flow Cytometry: An Inter-Laboratory Comparative Evaluation

Clinical flow cytometry provides a precise technology for the multiparameter analysis of the morphological (scatter) and immunofluorescence properties of stained leukocyte populations, as well as their percentages and absolute counts, at the single-cell level. Flow cytometry is commonly used for the identification of human lymphocyte subsets, a process referred...

Deep Vein Thrombosis is Not Rare in Asia—The Singapore General Hospital Experience

Deep vein thrombosis (DVT), pulmonary embolism (PE), the postphlebitic syndrome and recurrent venous thromboembolism (VTE) are important and often preventable causes of early morbidity or death and of long-term disability in western populations. The reported annual incidence of VTE is about 2 per 10,000 persons in Scotland. This article is...

High-dose Therapy followed by Autologous Haematopoietic Stem Cell Transplantation in Multiple Myeloma

Multiple myeloma (MM) is a disorder in which malignant plasma cells accumulate in the bone marrow and produce an immunoglobulin, usually monoclonal IgG or IgA. The incidence of MM in Singapore is 1 to 2 per 100,000 per year with a median age of 65 to 70 years at...

New Aspects of the Blood Coagulation Cascade, Anticoagulants and Vein Thrombosis in Asia

Injury to blood vessels triggers haemostasis, a process that has evolved to achieve two superficially incompatible outcomes: arresting blood loss while protecting vessel patency and blood flow to distal organs. Contributors to haemostasis include subendothelial tissues and endothelial cells, blood platelets, tissue factor, plasma clotting factors and their physiological...

Four Pregnancies in Two Patients with Essential Thrombocythaemia—A Case Report

Essential thrombocythaemia (ET) is a rare myeloproliferative disease which manifests with an elevated platelet count. It presents predominantly in the middle-aged population, occurring slightly more frequently in women than men. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Idiopathic Thrombocytopenia in Pregnancy

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which platelets are sensitised with an antiplatelet autoantibody and then destroyed by the reticuloendothelial system.1 Hence, it is also known as primary autoimmune thrombocytopenic purpura. There are two forms of ITP—acute and chronic. This article is available only as a PDF....

Thrombophilia in Pregnancy

A clear understanding of thrombophilia is becoming increasingly important in the practice of high-risk obstetrics. In addition to their role in thromboembolic disease, there is increasing evidence linking thrombophilia and adverse pregnancy outcomes such as pre-eclampsia, intrauterine growth restriction, placental abruption and recurrent pregnancy loss. This article is available only...

Management of Haematologic Malignancies in Pregnancy

Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The most commonly diagnosed malignancies during pregnancy are breast cancer, cervical carcinoma, Hodgkin’s lymphoma and melanoma. This article is available only as a PDF. Please click on...

Pregnancy in Women with Idiopathic Thrombocytopaenic Purpura

Idiopathic thrombocytopaenic purpura (ITP) is the most common autoimmune haematological disorder in pregnancy. The pathophysiology of the disease is peripheral destruction of platelets mediated by antiplatelet antibodies. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Clinical Update on Deep Vein Thrombosis in Singapore

Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It also contributes to significant morbidity in terms of post-phleblitic syndrome and chronic venous ulcers. This article is available only as a PDF. Please click on “Download...

Case Report on Recombinant Coagulation Factor VIIa in the Treatment of Three Haemophilia A Patients with Inhibitors in Singapore

Development of inhibitors against factor VIII is one of the main complications in the treatment of haemophiliacs. Inhibitors block the procoagulant effects of factor VIII and prevent the successful arrest of bleeding episodes when administered to these haemophiliacs. This article is available only as a PDF. Please click on “Download...

Evaluation on the Use of a Portable Unit Versus the Laboratory for the Monitoring of International Normalized Ratio (INR) in Orally Anticoagulated Patients

Oral anticoagulation therapy is used for a number of conditions, namely deep venous thrombosis, pulmonary embolism, mechanical heart valves, embolic stroke as well as atrial fibrillation. Patients receiving this therapy are carefully monitored in order to maintain the intensity of anticoagulation in the appropriate therapeutic range. This article is available...

Trauma-induced coagulopathy: Mechanisms and clinical management

Globally, trauma accounts for the highest number of mortalities in adolescents and young adults up to 49 years old.1 Of these deaths, a large percentage is attributable to exsanguination.2 Trauma-induced coagulopathy (TIC) occurs in 25–35% of hospitalised severe trauma patients and is associated with increased incidence of bleeding, blood...

Coagulopathy related to trauma: Is it time for a goal-directed approach?

Trauma represents a leading cause of death globally, and post-traumatic haemorrhage accounts for 40% of early mortality in spite of recent improvements in modern trauma care.1 Post-traumatic haemorrhage occurs primarily from direct injury to blood vessels, leading to exsanguination and hypovolaemic shock depending on the type and calibre of...

In vitro Biological Characteristics of Human Cord Blood-derived Megakaryocytes

Haematopoietic stem cell transplantation (HSCT) is now a well-established therapeutic modality for a broadening spectrum of medical problems. Umbilical cord blood (CB) has emerged as an alternative source of HSCT in recent years due to the lack of a human leukocyte antigen (HLA)-identical sibling donor in the majority of...

Unrelated Umbilical Cord Blood Transplantation in Children and Adults

Allogeneic haematopoietic stem cell transplantation (HSCT) is an established form of treatment for many high-risk haematological malignancies and marrow failure syndromes. The use of HSCT is still limited by the availability of human leukocyte antigen (HLA) matched donors, even though unrelated donor registries have markedly improved the chances of...

Haematopoietic Graft Engineering

Haematopoietic stem cell transplantation (HSCT) has become an established modality for the treatment of cancer and diseases of the bone marrow and immunological system. Such transplants effect their cures through 3 main avenues: namely, eradication of disease through intensive chemo/radiotherapy, replacement of defective blood-forming cells with normal haematopoietic progenitors...

Stem Cells: Current Usage and Future Potentials

In recent years, the term “haematopoeitic stem cell transplantation” has replaced “bone marrow transplantation”. It is more precise and emphasises the “haematopoeitic stem cell” as the key element. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Rare Case of Porphyria

Porphyrias are a rare and intriguing group of metabolic disorders. We report a case of congenital erythropoietic porphyria, one of the infrequent forms of porphyria. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Extensive Calcinosis Cutis in Relapsed Acute Lymphoblastic Leukaemia

Calcinosis cutis is characterised by the aberrant deposition of calcium salts in the skin. In metastatic calcinosis cutis, calcium salts are precipitated in normal tissue as a result of an underlying defect in calcium and/or phosphate metabolism. This article is available only as a PDF. Please click on “Download PDF”...

The Effectiveness of Transvaginal Anterior Colporrhaphy Reinforced with Polypropylene Mesh in the Treatment of Severe Cystoceles

Using the Baden-Walker halfway system, Grade 4 cystoceles are defined as extrusions of the bladder base beyond the vaginal introitus with patient straining maximally and represent the extremes of anterior vaginal wall prolapse (Table 1). They result from increased laxity and weakness of the urethrovesical supporting system comprising the...

Clinical Experience with Three Combination Regimens for the Treatment of High-risk Febrile Neutropenia

Cancer patients who become severely neutropenic as a result of intensive myelosuppressive chemotherapy are at high risk for developing life-threatening infections, and unless they are treated at the first sign of infection, the rate of mortality is high. Because of the defect in the inflammatory response, the classic signs...

Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children

Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share a bedroom, since the child is often unaware of what happens when he or she is asleep. This article is available only as a PDF. Please...

Concurrent Chemoradiotherapy followed by Surgery in Locally Advanced Squamous Cell Carcinoma of the Oesophagus: A Single Centre Experience

Carcinoma of the oesophagus is a relatively uncommon malignancy in Singapore and incidence rates have been declining since 1968. A total of 506 cases were diagnosed from 1993 to 1997. The age-standardised rate for the same period was 5.8 per 100,000.1 The predominant histologic type is squamous cell carcinoma,...

Clinical Characteristics of Renal Infarction in an Asian Population

Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined

Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications of osteonecrosis and chondrolysis, preventing further slips, and promoting physeal closure. This article is available only as a PDF. Please click on “Download PDF” on top...

Use of Antibiotics in a Haematology Ward – An Audit

Rising rates of antibiotic resistance prompted a review of antibiotic use policies hospitalwide. The Department of Haematology established a new set of consensus guidelines in 2002 for antibiotic use in febrile neutropenia. We were tasked by the hospital’s Pharmacy and Therapeutics Committee to audit adherence to the guidelines. This article...

Application of the McDonald MRI Criteria in Multiple Sclerosis

Since its advent in 1982, magnetic resonance imaging (MRI) has become an important component in the evaluation of multiple sclerosis (MS). MRI is a highly sensitive tool for MS, with 95% patients with clinically definite MS (CDMS) demonstrating brain abnormalities.1 However, MRI is also known to be low in...

Extracranial Non-vestibular Head and Neck Schwannomas: A Ten-year Experience

Schwannomas, also known as neurilemmomas, neuromas, or neurinomas, are uncommon nerve sheath neoplasms that may originate from any peripheral, cranial or autonomic nerve of the body with the exception of the olfactory and optic nerve. Malignant change is unusual. Some 25% to 45%1 of schwannomas are located in the...

An Unusual Cause of Lymphadenopathy and Rash

A 38-year-old Chinese man who was previously well, presented with one month of fever and a non-pruritic rash involving the face, trunk and upper limbs. There was no oral, ocular or genital involvement. He denied weight loss, night sweats, fatigue or easy bruising and there was no history of...

Bone Marrow Cytogenetics Workup: Application of Lean Management System to Determine if Additional Cell Workup is Helpful and Necessary to Analysis

Cytogenetic studies are important to the diagnosis and monitoring of various haematopoietic disorders such as myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), lymphoproliferative disease (LPD), and multiple myeloma (MM). It can also provide a prognosis to a...

A Case of Congenital Haemolytic Anaemia and Thrombocytopenia

A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to thrive since birth. This article is available only as a PDF. Please click on “Download PDF” on top to view the full 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...

Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore

Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A study analysing pooled FN data from 115 US academic medical centres between 1995 and 2000 showed that the overall in-hospital mortality was 9.5%, whereas pooled...

Socio-demographic Profile and Psychiatric Comorbidity of Subjects with Pathological Gambling

Gambling has been defined as a wager of any type of item or possession of value upon a game or event of uncertain outcome in which chance, of a variable degree, determines the outcome. The failure to resist the impulse to gamble despite disruption to personal, family and vocational...

Immunophenotypic, Cytogenetic and Clinical Features of 113 Acute Lymphoblastic Leukaemia Patients in China

Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with abnormal proliferation and accumulation of immature lymphoblasts within the bone marrow (BM), peripheral blood and lymphoid tissues, and is composed of different genetic, biological, and clinically relevant subtypes. Morphological and cytochemical methods were the main tools for diagnosis and classification...

Non-haem Iron-mediated Oxidative Stress in Haemoglobin E Beta-thalassaemia

Thalassaemia is a genetic haemoglobinopathy in which the production of normal haemoglobin is partly or completely suppressed because of a defective synthesis of 1 or more of its component globin chains. In haemoglobin (Hb) E beta-thalassaemia, an individual inherits 1 gene for Hb E from 1 parent and 1...

Thrombocytopenia and its Related Factors: A Hospital-based, Cross-sectional Study

Thrombocytopenia is a common clinical problem found in laboratory results during health examinations. Blood platelets play an essential role in haemostasis, thrombosis and coagulation of blood. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Supplementary Breast Ultrasound Screening in Asian Women with Negative But Dense Mammograms—A Pilot Study

Mammogram has been the gold standard for breast cancer screening and Magnetic Resonance Imaging (MRI) has been advocated for screening of high- risk individuals. However, there is currently no recommendation for supplementary ultrasound scan in breast cancer screening. Moreover, it is known that dense breasts, which are common in...

Male Breast Cancer in Singapore: 15 Years of Experience at a Single Tertiary Institution

Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its incidence may be on the rise, although the clinical significance of this is unknown. This rarity has precluded large randomised controlled trials, and most treatment...

Immunophenotypic, Cytogenetic and Clinical Features in Chinese Adult Acute Lymphoblastic Leukaemia (ALL) Patients

Acute lymphoblastic leukaemia (ALL) is a malignant disease resulting from the accumulation of genetic alterations of B or T lymphoid precursor cells. Immunophenotyping, cytogenetic-molecular studies, and more recently, high resolution genome-wide screening are characterising ALL as a heterogeneous disease with distinct manifestations and prognostic and therapeutic implications. Of the...

Medical management of PAD: Expand or consolidate?

In this issue of the Annals, a rapid review of adherence to evidence-based medical treatment highlights an important and underappreciated aspect of the management of patients with peripheral arterial disease (PAD). It is easy, upon meeting a patient, to prescribe appropriate medication in an outpatient setting and believe that...

Severe COVID-19 and coagulopathy: A systematic review and meta-analysis

Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications. Our understanding of the pathophysiology of the disease process is still evolving. As part of the host response to viraemia, it has been postulated that...

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...

Estimating the impact of COVID-19-induced coagulopathy

The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...

Carbamazepine-induced toxic epidermal necrolysis in a patient despite testing negative for HLA B*15:02 allele

Carbamazepine (CBZ) has been used in Singapore since 19881 as an effective drug for the treatment of conditions such as epilepsy, neuropathy, neuralgia and psychiatric conditions. However, it is a high-risk drug for Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), particularly in Asians, and in 2004, a genetic marker human leukocyte...

Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians

In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which have replaced open surgical high tie and stripping as the treatment of choice. CVI is common in the Western population and is reported to affect...

Assessing the Content Validity of the EQ-5D Questionnaire Among Asians in Singapore: A Qualitative Study

EQ-5D is a tool to measure and value health status. It is a standardised questionnaire that comprises 2 components: a Descriptive System (DS) on the first page and a hash-marked visual analogue scale (EQ-VAS) on the second page. Importantly, responses to the DS can be converted into a utility...

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...