A 77-year-old Chinese woman with a past medical history of Sjogren’s syndrome, nodular goitre and right-sided neck lymphadenopathy, presented to the gynaecological service for...

Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care,...

Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is...

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....

Cervical cancer is a preventable disease that affects nearly half a million women worldwide. The Papanicolaou smear has been used for screening for over...

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians.This article is...

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians.This article is...

A 53-year-old Caucasian woman, a receptionist in a general practice, was referred to the gynaecology outpatient clinic with an 18-month history of heavy, irregular...

Urogenital fistulas are a known but uncommon complication of gynaecological surgery, especially those involving a malignant process. Its incidence does not exceed 2%.This article...

To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer.This article...

Gestational trophoblastic diseases (GTD) encompass a spectrum of interrelated conditions: Hydatidiform mole (HM) Invasive mole (IM) Choriocarcinoma (CC) Placental site trophoblastic tumour (PSTT)This article is available only as...

Fallopian tube cancer is the least common of gynaecological malignancies. It was first described by Renaud in 1847.This article is available only as a...

Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although...

Topoisomerases are essential nuclear enzymes with a multiplicity of cellular functions involving DNA replication, RNA transcription, mitosis, and chromosome condensation. Two classes have been...

Ovarian cancer is the most common gynaecological malignancy with over 5000 new cases diagnosed every year in the UK and 22 000 in the...

Accurate staging is of utmost importance in determining the prognosis of carcinoma of the cervix. Demographic features such as race and socio-economic status have...

Carcinoma of the cervix is still a relatively common gynaecological malignancy. However, despite being potentially preventable it still claims the lives of many women...

It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the...

One of the most remarkable advances in the management of gynaecological cancers is in malignant ovarian germ cell tumours. Before the early 70s, some...

Platinum resistance, either de novo or acquired, is a major obstacle in the treatment of advanced ovarian cancer. Platinum-resistance has been classified into the...

Ovarian carcinoma ranks fourth among causes of death in women and is the leading cause of death from gynaecological malignancies in Western countries. In...

Endometrial carcinoma comprises a morphologically heterogeneous group of tumours. Several authors during the 1960s and 1970s described an unusual variant of endometrial cancer containing...

Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control...

Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at...

Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma...

Wertheim radical hysterectomy has today become an accepted method of management of stage IB and early stage IIA cervical carcinoma, particularly in young patients...

It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness...

Cancer of the cervix is the fourth most common cancer in females in Singapore after breast, colorectal and lung cancers. It forms 7.8% of...

Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all...

Postmenopausal osteoporosis is the most common cause of osteoporosis. It is heralded by the cessation of oestrogen production by the ovaries resulting in at...

Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy....

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...

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...

Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill...

Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously...

Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique...

Diabetic retinopathy is the leading cause of blindness in persons between the age of 24 and 64 years both in the US and the...

Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric...

The relationship between lipid disorders and arthritis is manifold. Hyperlipidaemia may manifest clinically in the musculoskeletal system. In 1968, Khachadurian studied 14 families of...

In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance...

Cervical intraepithelial neoplasia (CIN) is a neoplastic disorder in which infection with sub-types of the human papillomavirus appears to play an important aetiological ro1e....

The most common chromosomal abnormalities in newborns are trisomy 21, trisomy 18, trisomy 13, and monosomy X, with incidences of 1/800, 1/8,000, 1/20,000, and...

Parainfluenza viruses are relatively large RNA paramyxoviruses. Four serologic types cause disease in humans.This article is available only as a PDF. Please click on...

T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T...

Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been...

From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had...

Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are...

In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of...

The first pregnancy resulting from the thaw and transfer of cryopreserved pre-embryos was reported in 1983 by Trounson and his team, in Melbourne, Australia....

Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to...

Increase in the plasma lipid fractions in normal pregnancy have been described but irregularity of sampling, difference in materials studied (whole blood, serum, and...

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship...

Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few...

A 55-year-old Chinese lady had a left mastectomy in April 1995 for an invasive lobular carcinoma of the breast. Axillary lymph node metastases were...

Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine...

Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but...

Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of...

The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is...

Three to four per cent of men have severe defects in sperm production that result in infertility. Most of these men are healthy and...

Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia,...

Association and agreement between two factors are very different concepts, although the methods used to describe them appear similar. For example, the association between...

Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay,...

Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It...

Nipple discharge is a common disturbing symptom for many women and often leads to a surgical referral. It accounts for 3% to 5% of...

Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations,...

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...

The incidence of mortality is higher among psychiatric patients than among the general population and the cause of which may be the psychiatric disorder...

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...

Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which...

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...

Since the onset of the acquired immunodeficiency syndrome (AIDS) epidemic in the mid-1980s, the number of HIV-infected cases has risen sharply throughout the world....

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...

Pregnancy is associated with physiological changes in various organ systems and complications arising from the interaction between these changes and disease processes may be...

Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely...

Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of...

When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think...

Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the...

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...

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...

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,...

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...

The nail-patella syndrome (NPS) is a rare autosomal dominant disorder defined by the association of nail dysplasia, bone abnormalities and, frequently, renal disease. We...

Rheumatic heart disease comprises acute rheumatic fever following group A beta-haemolytic streptococcal infection of the tonsillopharynx, and its long-term sequelae of heart valve fibrosis...

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...

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...

Pre-eclampsia is a major cause of adverse obstetric outcome. It remains one of the leading causes of maternal mortality1 and continues to contribute significantly...

Venous thromboembolism (VTE) refers specifically to 2 related entities: deep vein thrombosis (DVT) and pulmonary embolism. The management of arterial thrombo-embolism, in particular that...

Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The...

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

Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more...

Successful renal transplantation significantly improves the sexual and reproductive functions of women with end-stage renal disease and offers the best hope for those who...

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....

Idiopathic thrombocytopaenic purpura (ITP) is the most common autoimmune haematological disorder in pregnancy. The pathophysiology of the disease is peripheral destruction of platelets mediated...

It is said that, worldwide, over half a million maternal deaths occur annually. This might well be a conservative estimate, given the difficulties inherent...

Nowhere is the fate of two individuals more closely intertwined than that of the mother and her fetus. Pregnancy is a unique state where...

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...

Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous...

With the rapid advances in the field of neonatal intensive care, the focus of interest has been on the very-low-birthweight (VLBW) infant in recent...

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

Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into...

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

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

Genuine stress incontinence (GSI) is the most common cause of female urinary incontinence. When conservative treatment fails, surgery is indicated. Open Burch colposuspension is...

Endometrial cancer is the most common female genital malignancy in industralised countries today. Despite the overall favourable prognosis in this neoplasia, survival is associated...

Important prognostic factors in stage 1B cervical carcinoma include primary tumour diameter, nodal metastases, depth of stromal invasion, lymph-vascular invasion, microscopic parametrial extension and...

Epithelial ovarian cancer is the leading cause of death in patients with gynaecological malignancies in Singapore and developed countries, the main reason being the...

Arteriovenous malformations (AVMs) of the uterus are rare but potentially life-threatening lesions. The common presentation is vaginal bleeding and, if not diagnosed correctly, can...

Since Little’s article of 1862, it was popularly believed that brain damage in the majority of cases of cerebral palsy occurs during labour and...

Although the presence of fetal echogenic bowel (EB) has been largely regarded as benign, it has been viewed as a soft marker for various...

Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta.This article is available only...

Small amounts (<0.1 mL) of fetal blood are commonly found in maternal circulation. Massive fetomaternal haemorrhage (FMH) involves fetal blood loss into the maternal...

Umbilical cord prolapse is an uncommon intrapartum event with a reported incidence of 1 in 160 to 714 deliveries. Predisposing factors include fetal malpresentation,...

The National Health Service (NHS) was established in the United Kingdom (UK) in 1948, against a post-war background of poverty and ill health. The...

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...

The science and art of providing quality health care to women has made tremendous strides in recent years. In the subspecialties of Obstetrics and...

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...

A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for...

The introduction of a new diagnostic test into a clinical arena goes through a number of stages. The first stage is technical development.This article...

In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm...

The enterovirus family causes a wide array of illnesses, some easily recognised clinically and others diagnosed as non-specific viral illnesses. This large family of...

One of the major challenges in neonatal-perinatal medicine in the new century is the optimal management of the mother and infant when delivery is...

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...

With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great...

Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of...

Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome...

Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore....

Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is...

Increasing rates of caesarean deliveries have received widespread attention in recent years and has increased widespread discussion in the public domain. The ideal caesarean...

Obstetric cholestasis (OC) is a pregnancy-specific liver disorder. It is also known by other names, such as pruritus gravidarum, recurrent intrahepatic cholestasis of pregnancy...

Technology in sonography has advanced tremendously in recent years, contributing to improvements in clinical applications for prenatal diagnosis and fetal therapy. These include transvaginal...

Birth weight remains one of the most important measures we have of the health status of a population, being a strong predictor of both...

One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This...

Glucose-6-phosphate dehydrogenase (G6PD) deficiency occurs in 2.5% of Singapore’s population, and affected newborns are at risk for severe neonatal hyperbilirubinaemia and kernicterus. In the...

Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1)...

The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major...

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

Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in...

Since the acquired immunodeficiency syndrome (AIDS) was first diagnosed in Singapore in 1985, its incidence rose from 15 cases in 1988 to 226 in...

Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually...

Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration....

In 1984, the Royal Children’s Hospital (RCH) in Melbourne, Australia opened a new ward specifically for adolescent inpatients. This initiative was the result of...

The nature of paediatric practice is changing worldwide. In developing countries, infant mortality from infectious diseases continues to fall with improved immunisation, medical care...

Increased sensitivity to biological change can make adolescents particularly vulnerable to non-organic symptomatic disorders. A variety of pains, headaches, dizziness and fatigue may remain...

Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many...

The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to...

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent...

Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and...

Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms...

The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or...

The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in...

Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such...

In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field...

Dear Editor,Labour analgesia provided through the central neuraxial approach is offered for parturients who are in their active stage of labour, usually after 2–4cm...

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...

The diagnosis of preterm labour poses a problem. Preterm labour accounts for about 50% of preterm births; however, most data reveal that only about...

Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an...

Has it done any good to pregnancy outcome as promised?This article is available only as a PDF. Please click on “Download PDF” on top...

Optimal chromosome preparation is a function of many factors. These include cell density culture initiation, optimal time for harvest, concentration and exposure duration to...

Although no significant survival difference exists between primary surgery and radiotherapy (RT) for the treatment of FIGO stage Ib cervical cancer, radical surgery is...

Uterine leiomyomas are the most common gynaecological tumour. Typical appearances of leiomyomas are easily recognised on imaging.This article is available only as a PDF....

Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include...

The diagnostic work-up of abnormal liver function tests (LFT) in pregnancy is challenging, as the conditions peculiar to pregnancy have to be considered in...

Twin studies are regarded as one of the better ways to study the effects and significance of gene, environment and interactions of both. The...

Paediatric Medicine (CD) is a rare form of congenital short-limbed dwarfism, classically characterised by campomelia (bowing of the long bones of the lower extremities)...

Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase...

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

Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first...

Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital...

Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories...

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...

Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an...

Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles...

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have...

Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the...

This handbook is written by 3 obstetricians and gynaecologists based at the KK Women’s & Children’s Hospital, Singapore. It is an excellent book that...

The incidence of non-immune hydrops (NIH) has been reported to be 1/10001 and is associated with high perinatal morbidity and mortality at all gestational...

Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8...

Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an...

Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this...

In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it...

Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection...

Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20%...

Hypoxic-ischaemic encephalopathy (HIE) is an important cause of death and later neurological disability in full-term neonates worldwide. Perinatal asphyxia causes about 19% of the...

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Lemierre’s syndrome (LS) is a condition which follows an oropharyngeal infection, often in an otherwise healthy young adult. This usually progresses to septic thrombophlebitis...

Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected...

Atrial isomerism is a disorder of lateralisation characterised by symmetric development of normally asymmetric cardiac atria and organ systems. The synonyms for these defects...

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate...

I think a lot these days about doctors giving advice. Nobody taught me, back in medical school, how to give advice.This article is available...

Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are...

Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the...

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

Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in...

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...

Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of...

Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most...

Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway occlusion during sleep that are associated with daytime behavioural changes and abnormalities...

Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in...

Retinopathy of prematurity (ROP) is characterised by abnormal vascular development of retina in premature infants.1 Recent advances in neonatal care have improved the survival...

Chylous ascites is an unusual phenomenon where there is accumulation of chyle in the peritoneal cavity. It is especially rare following treatment of gynaecological...

Pseudoxanthoma elasticum (PXE) is an inherited multisystem disorder of the elastic tissue leading to skin disease as well as ocular and cardiovascular complications. Although...

Holoproscencephaly (HPE) is an uncommon congenital developmental defect of the forebrain structures to divide into separate hemispheres and ventricles during embryogenesis. The prevalence rate...

Singapore’s national immunisation programme for the 6 traditional Expanded Programme on Immunisation (EPI) vaccines (i.e. BCG, diphtheria, tetanus, pertussis, polio and measles) and hepatitis...

A 10-year-girl from Bangladesh presented with a moderately severe anaemia (lowest recorded haemoglobin level of 5.6 g/dL) and a mild jaundice (latest serum bilirubin,...

A white female with an uncomplicated history of birth delivery and a familial history of diabetes mellitus presented to the orthopaedic clinic at the...

Laparoscopy was first used for the evaluation of acute abdominal pain in pregnancy by gynaecologists in 1980. The most commonly reported laparoscopic procedure during...

Laparoscopic sterilisation is a common method of permanent contraception. The Filshie clip system is a safe and effective method of female sterilisation.This article is...

In the post-war days of the 1950s, Singapore children were faced with problems of malnutrition and infectious diseases. There was poverty, overcrowded housing and...

Abnormalities of the external ear are described in many syndromes and genetic conditions. Melnick et al reported an incidence of 1 in 90 births...

Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations,...

Menopause is a life change described by biological alterations occurring in the context of important social changes. There is an increasing appreciation for the...

Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from...

Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications...

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...

Endometriosis commonly affects women during their reproductive years and may involve any organ. Although rare, endometriosis has been reported in postmenopausal women and is...

Cardiovascular disease is a major cause of morbidity among postmenopausal women. Up to the age of 50 years, the prevalence of coronary artery disease...

A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth,...

Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis...

Parainfluenza type 3 virus (PIV-3) is an important nosocomial pathogen. It closely mimics respiratory syncytial virus (RSV) in its clinical presentations, and in infants....

We present a case of a 10-year-old child who sustained a traumatic fracture-dislocation of his proximal radius and subsequently underwent surgical removal of the...

A 5-year-old, previously healthy French Caucasian boy was seen at a Paediatric Emergency Department for a skin rash over his left forearm.This article is...

Human milk is the ideal food which provides the complete nutritional requirements for infants during the first 6 months of life. The lipids accumulated...

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...

A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the...

Causes of neonatal cholestasis (NC) are long and diverse but the responses of newborn liver, either physiological or anatomical, are limited. This is because...

Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can...

Smooth Muscle Tumours of Undetermined Malignant Potential or STUMPs are interesting tumours from both the standpoint of histological diagnosis and classification as well as...

Bannayan-Riley-Ruvalcaba syndrome (BRRS) classically presents with macrocephaly, subcutaneous and visceral lipomata, haemangiomata, hamartomatous intestinal polyps and pigmented macules involving the genitalia. This autosomal dominant...

An 8-year-old boy presented with uncontrolled seizures. He was born as the second child to non-consanguineous parents. He had significant perinatal asphyxia in the...

Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the...

Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of...

Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise...

Influenza A H1N1 (2009) is a new viral strain containing gene segments from human, swine and avian lineages. Soon after reports of human cases...

We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the...

I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than...

The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to...

Acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) make up the bulk of childhood leukaemia cases. With risk stratified therapy being one of...

Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is...

The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health...

What do you see in the image? a) Deviated posterior nasal septum b) Nasopharyngeal tumour c) Rhinolith with mucous plug d) Bilateral choanal atresia e) Nasal pyriform aperture stenosisThis...

Brain tumours in pregnancy are rare with an incidence of 15 per 100,000 and previous reports have shown variable outcomes. We present a case...

Studies of monozygotic and dizygotic twins represent an important approach in estimating the relative contributions of genes and environment to the development of various...

Health-related quality of life (HRQOL) has been progressively acknowledged as an essential health outcome measure in clinical trials and health services research and evaluation....

Intermittent auscultation (IA), cardiotocography (CTG), amniotic fluid colour and fetal scalp capillary blood gas analysis are currently accepted standards for intrapartum fetal monitoring. According...

Different contraceptive options are available today; however, tubal sterilisation is still one of the most prevailing contraceptive alternatives. Locally, many prefer mechanically occluding the...

The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist...

Singapore was listed consistently among the top 3 countries in the world with the lowest infant mortality rate. In particular, Asia had seen its...

Neonatologists were caught looking the other way in the early part of the millennium. While they were keenly following the progress of extreme preterms...

The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The...

It is very likely that in 10 years time, invasive prenatal diagnostic tests like amniocentesis and chorionic villus sampling (CVS) will join the club...

Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either...

Over the past decade, the non-invasive prenatal test (NIPT) has increasingly been used as a method for prenatal screening for trisomy 21 (T21) and...

Obesity during pregnancy is associated with increased risk of adverse health outcomes such as gestational diabetes mellitus (GDM), hypertension and preeclampsia. Unlike the well-known...

Uterine rupture is a catastrophic life-threatening complication of pregnancy with associated high maternal and neonatal morbidity and mortality. The incidence of uterine rupture varies...

Uterine rupture is arguably one of the most dreaded acute obstetric complications in obstetrics. Synonymous with significant maternal and perinatal morbidity and mortality risks,...

Cervical cancer is the most common gynaecological cancer in many countries in Southeast Asia, with a cumulative age-standardised incidence rate (ASRI) of 17.2 per...

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases...

Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports...