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...

The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix....

Gynaecomastia is not a commonly recognised feature among the myriad symptoms and signs associated with hyperthyroidism. A review of the literature disclosed only eight...

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...

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...

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...

Osteoporosis is becoming an increasing public health problem in most countries. Osteoporosis literally means “porous bones” and involves skeletal fragility leading to an increased...

Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval...

Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate...

Apart from the nasal bone, the mandible is the most commonly fractured bone in the face. It is also the 10th most often broken...

Pathologic skin picking may be defined as the habitual picking of skin lesions, which when chronic and extensive, can lead to significant distress, dysfunction...

Obesity is a risk factor for cardiovascular disease. This risk is partially mediated by the correlation between obesity and other coronary artery disease risk...

Trichotillomania (TTM) is a chronic psychiatric condition characterised by uncontrollable, self-inflicted, hair pulling, resulting in noticeable hair loss. First described by Hallopeau a century...

Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients...

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...

The pancreatic islets of Langerhans were described by Paul Langerhans in 1869. They are distributed throughout the entire pancreas forming in adults approximately 1%...

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...

The term “obesity” implies an excess of adipose tissue (fat) and excess adiposity is a health risk. In most cases it develops in the...

Obesity is one of the most common health problems in Singapore with escalating prevalence, affecting about 6% of the Singapore population above 18 years...

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...

The “gold standard” for the diagnosis of diabetes mellitus has all along been the oral glucose tolerance test (OGTT). As diabetes mellitus defines a...

In 1989, the St Vincent Declaration was formulated by all European countries to address the growing problem of diabetes, with the general goals of...

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...

Breast cancer is the commonest malignancy in Singapore women, with an age-standardised rate of 46.1 per 100,000 per year and an annual increase in...

Diabetic ketoacidosis is generally believed to be the result of an acute and severe degree of insulin insufficiency, classically occurring at the presentation of...

The word obesity implies an excess of adipose tissue (fat) and not merely an excess of body weight. An increase in body weight may...

Many areas of medical research require the application of statistical techniques. Although most clinicians are taught some statistics as part of their basic medical...

Occupational asthma is the most common occupational respiratory disease in the United Kingdom and also in Singapore. Recent estimates of the proportion of adult...

The traditional statistical approach used in most areas of medical research involves what is commonly known as frequentist statistics. Bayesian methods provide an increasingly...

Helicobacter pylori is one of the commonest infections in human, affecting 30% to 50% of people worldwide. It is associated with the development of...

Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma...

There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic...

Obesity is considered a chronic disease and not just a social stigma due to the associated morbidity and early mortality. Obesity has now become...

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...

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,...

Primary hyperparathyroidism is said to have evolved from a disease of “bones, stones and groans”, to one that is largely asymptomatic with a relatively...

Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on...

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders...

Iodine is an essential component of thyroid hormone and is actively taken up by thyroid follicles. This is the physiological basis for the use...

Chronic diseases are the main causes of morbidity and mortality in developed countries. In most developed countries, the problems of a rising prevalence of...

In an article published in this journal, Chia discusses the difference between measuring association and agreement. In this paper, we extend the discussion to...

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...

Cervical cancer is one of the most common female cancers worldwide. It is ranked second only to breast cancer and in many underdeveloped countries,...

Abnormalities of thyroid function associated with pregnancy encompass both hyperthyroidism and hypothyroidism. These may have been present before the onset of pregnancy, or occurred...

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....

Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians...

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...

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...

Prior to 1997, the diagnosis of diabetes mellitus in asymptomatic individuals was based upon the 1985 World Health Organisation (WHO) diagnostic criteria in which,...

Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal...

Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A...

The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its...

Osteoporosis is a condition characterised by low bone mineral density, microarchitectural deterioration of bony tissue, and a consequent increase in fracture risk. With rapid...

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...

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 current practice and management of osteoporosis differs greatly from even the recent past. Up to 15 years ago, bone mineral density (BMD) measurements...

Osteoporosis affects predominantly elderly women; although younger women and men may also be affected. Demographically, the number and proportion of the elderly (aged 65...

Singapore has a rapidly ageing population. In 1990, only 6% of the population was above the age of 65 years but this percentage of...

Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular...

Osteoporosis twenty years ago was a very different disease from what we know of it today. At that time a diagnosis of osteoporosis was...

In the 1970s, several studies appeared to suggest that users of oral contraceptives (OCs) were at increased risk of cardiovascular events. More recently following...

Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in...

Infertility is defined as the inability to conceive after 1 to 2 years of unprotected intercourse. In general, an estimated 84% of all women...

The understanding of hormone replacement therapy (HRT) for postmenopausal women has undergone dramatic change since the publication of the results of the Women’s Health...

Without prenatal diagnosis, 1 in 50 babies are born with serious physical or mental handicap, and as many as 1 in 30 with some...

Cervical cancer affects >400,000 women a year worldwide, and represents a significant health issue for women. In the United States (US) however, screening programmes...

A chromosome abnormality contributes significantly to fetal loss during pregnancy, and perinatal morbidity and mortality. The contribution of chromosomal abnormalities to fetal loss decreases...

Caesarean sections performed without medical indication, better known as maternal request caesarean sections, have generated intense debate in recent times. While uncommon in the...

Biopsy may be performed at surgery (open biopsy) or percutaneously (closed biopsy). Percutaneous bone biopsies are usually performed under imaging guidance using a variety...

In females with cancer, cervical carcinoma is second to breast cancer in both incidence and mortality worldwide. About 465,000 new cases are diagnosed each...

Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality....

Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver...

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started...

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 the histopathological diagnosis of any lymphoma still largely hinges upon the demonstration of lymphoid architectural abnormality, the pathologist must first be cognizant of...

Diabetes mellitus (DM) is a common and growing healthcare problem in Singapore with a prevalence of 9% in 1998. Since the 1990s, the Ministry...

Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been...

The rates of myopia, including high myopia , have been reported to be rising to epidemic proportions in Asia and solutions to this huge...

Bile duct perforation (BDP) and biliary ascites in children is a rare clinical entity. The aetiopathogenesis is still elusive.This article is available only as...

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...

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...

Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating...

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Parathyroid carcinomas account for 1% to 3% of patients with primary hyperparathyroidism (PHPT).1 Patients usually present with a severe form of hyperparathyroidism at diagnosis,...

Status epilepticus (SE) describes a clinical condition characterised by an epileptic seizure or a series of seizures that lasts for at least 30 minutes...

The long lasting debate on the role of generalists and specialists in the management of diabetes is still ongoing. Nonetheless, the last 3 decades...

In the present pandemic of diabetes and obesity, 60% of the affected population will come from Asia. Between India and China, these two most...

Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a...

The management of idiopathic Parkinson’s disease is deceptively simple. Current practice, which consists of replacing dopamine on a twice or thrice daily regime may...

Osteoporosis is a condition in which an increased risk of fracture takes place due to a reduction of bone mineral content. It occurs as...

Slow coronary flow (SCF) is a well recognised clinical entity, characterised by delayed opacification of coronary arteries in the presence of normal coronary angiogram....

Right siting, defined as “patients treated in the most appropriate locations by medically competent teams at the lower possible cost”, has been on the...

Phaeochromocytomas are catecholamine producing neuroendocrine tumours that can manifest a variety of symptoms which mimic other diseases. They are also known for their “rule...

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...

Despite perforated appendicitis (PA) being a common surgical emergency in childhood, controversy still exists with regard to its management in this era of minimal...

With rapid development of therapy, the mortality from acute complications of diabetes mellitus (DM) has decreased, but mortality from chronic complications like diabetic nephropathy...

Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In...

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...

Diabetes mellitus is one of the most challenging global health problems in the 21st century. It is associated with excess mortality and significant morbidity...

Patients with type 2 diabetes mellitus are at an increased risk of developing atherosclerosis and cardiovascular diseases leading to higher morbidity and mortality. These...

Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its...

The Internet has in recent years become ubiquitous in the lives of young persons and children due to rapid information technology (IT) development, high...

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...

Rhabdomyosarcoma (RMS) constitutes nearly 4% of all children diagnosed with cancer in the ethnically diverse small island city of Singapore. It is the most...

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...

Diabetes is a chronic disease characterised by elevated levels of blood glucose. The most common type of diabetes is type 2 diabetes mellitus (T2DM)....