Editorial
Evolving therapies for atopic dermatitis: Bridging guidelines and practice
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterised by dysregulated type 2 immune responses, skin barrier dysfunction and intense pruritus (itching). The disease burden of AD is substantial, affecting at least 171 million individuals worldwide in 2019, representing 2.23% of the global population.1 Among skin diseases,...
Review Article
Updated consensus guidelines for management of moderate-to-severe atopic dermatitis in Singapore: Integrating biologics, Janus kinase inhibitors and conventional therapies
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterised by dry skin, localised red scaly patches, intense itching and skin pain.1-4 Although its onset most commonly occurs before the age of 5, AD can develop during later childhood, adolescence or adulthood.1-3 Recurrence can also follow extended periods of...
Editorial
Can a Bayesian approach clarify if corticosteroids are beneficial for severe community-acquired pneumonia?
Despite advances in the antimicrobial treatment of sepsis and organ support in the intensive care unit (ICU), community-acquired pneumonia (CAP) remains a leading cause of mortality and disability-adjusted life years lost globally.1 Severe CAP, where CAP becomes complicated by acute hypoxaemic respiratory failure or shock, is also the most...
Review Article
Corticosteroids in critically ill patients with community-acquired pneumonia: A systematic review and Bayesian meta-analysis
Community-acquired pneumonia (CAP) is a common cause of hospital mortality. Each year, in the US alone, more than 1.5 million pneumonia patients are hospitalised, and 1 in 3 of them die within 1 year.1 Mortality is the highest among patients requiring organ support in the intensive care unit (ICU)....
Images in Medicine
Cause of vaginal spotting in an older woman
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 per-vaginal spotting. On clinical examination, she was noted to have a cervical polyp. A polypectomy was performed and the specimen was sent for histological examination.
The...
Commentary
Congenital cytomegalovirus infection: Advocating for screening and education
Cytomegalovirus (CMV) infection is the leading non-genetic cause of congenital neurosensory hearing loss in children, accounting for 21% of cases of hearing loss at birth and 25% of deafness at age 4 years.1 It can also give rise to other serious sequelae such as cerebral palsy, cognitive impairment, seizures...
Original Article
Risk Factors for Predicting Mortality in a Paediatric Intensive Care Unit
Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care, outcome analysis including mortality risk prediction has become a challenge for the modern day intensivists. During the early 90s, the focus has shifted from the...
Commentary
Experience with a Nine-step Policy Dealing with Requests for Medically Inappropriate Interventions for Cancer
Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is available. Physicians then face the difficult task of informing patients that, although palliation is always possible, cure is not.
This article is available only as a...
Commentary
Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia
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. The impact of the programme depends both on the detection of women with cervical intraepithelial neoplasia (CIN) and upon their being treated effectively.
This article is...
Commentary
The Polarprobe—Emerging Technology for Cervical Cancer Screening
Cervical cancer is a preventable disease that affects nearly half a million women worldwide. The Papanicolaou smear has been used for screening for over fifty years and the test has the advantage of fast and relatively easy sample collection.
This article is available only as a PDF. Please click on...
Others
Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case
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 available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case
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 available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Pelvic Spleen Masquerading as an Ovarian Neoplasm
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 menses and a pelvic mass on an abdominal ultrasound arranged by her General Practitioner (GP). She was otherwise asymptomatic.
This article is available only as a...
Others
Repair of Complex Ureterovaginal and Vesicovaginal Fistulas with Ileal Cystoplasty and Ureteric Reimplantation into an Antireflux Ileal Nipple Valve—A Case Report
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 is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
A Case Report—Delayed Vesicocutaneous Fistula After Radiation Therapy for Advanced Vulvar Cancer
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 is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Optimal Treatment in Gestational Trophoblastic Disease
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 a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Fallopian Tube Carcinoma—A Review
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 PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Current Management of Early Vulvar Cancer
Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although patient and physician delay remains common, an increasing number of patients are being diagnosed with early stage disease.
This article is available only as a PDF....
Review Article
Topoisomerase-I Inhibitors in Gynaecologic Tumours
Topoisomerases are essential nuclear enzymes with a multiplicity of cellular functions involving DNA replication, RNA transcription, mitosis, and chromosome condensation. Two classes have been identified: the class I topoisomerases, named “I” because they induce single-strand breaks and reunions of the DNA double helix, and the class II topoisomerases, named...
Review Article
Screening for Ovarian Cancer
Ovarian cancer is the most common gynaecological malignancy with over 5000 new cases diagnosed every year in the UK and 22 000 in the United States. Four thousand women die each year of ovarian cancer in England and Wales, and 13 000 die in the USA.
This article is available...
Review Article
Biomarkers in Carcinoma of the Cervix: Emphasis on Tissue-related Factors and Their Potential Prognostic Factors
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 been demonstrated as not having significant influence.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Review Article
The Management Dilemma of the Mildly Abnormal Smear: Fact or Fiction?
Carcinoma of the cervix is still a relatively common gynaecological malignancy. However, despite being potentially preventable it still claims the lives of many women even in those countries where organised screening programmes exist.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Review Article
Adenocarcinoma of the Cervix
It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the incidence of squamous carcinoma of the cervix but indeed in the last 10 to 15 years has halved the mortality rate from this disease. In...
Original Article
Malignant Ovarian Germ Cell Tumours: Experience in the National University Hospital of Singapore
One of the most remarkable advances in the management of gynaecological cancers is in malignant ovarian germ cell tumours. Before the early 70s, some of the malignant ovarian germ cell tumours had a notoriously bad reputation in terms of aggressiveness and poor prognosis.
This article is available only as a...
Original Article
A Phase II Study of Combined CPT-11 and Mitomycin-C in Platinum Refractory Clear Cell and Mucinous Ovarian Carcinoma
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 following three categories; (1) primarily (intrinsically) platinum-resistant disease: tumours showing no change (NC) or progressive disease (PD) while on initial platinum-based chemotherapy; (2) secondarily platinum-resistant...
Original Article
Single Agent Paclitaxel in Resistant and Relapsed Epithelial Ovarian Cancer After First-line Platinum-based Chemotherapy—Experience in an Asian Population
Ovarian carcinoma ranks fourth among causes of death in women and is the leading cause of death from gynaecological malignancies in Western countries. In Singapore, the incidence of this cancer has been rising for the last 25 years.
This article is available only as a PDF. Please click on “Download...
Original Article
Uterine Papillary Serous Carcinoma—The KK Hospital Experience
Endometrial carcinoma comprises a morphologically heterogeneous group of tumours. Several authors during the 1960s and 1970s described an unusual variant of endometrial cancer containing psammoma bodies.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Radiotherapy as Local Adjuvant Treatment for Endometrial Carcinoma—A Review of 45 Patients
Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control as well as to achieve excellent survival rates. Over the years, however, the specific role and relative benefit of postoperative radiotherapy for this particular cancer...
Original Article
Outcome of Obstructive Uropathy After Pelvic Irradiation in Patients with Carcinoma of the Uterine Cervix
Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at high risk for local recurrence after radical hysterectomy.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Original Article
The Surgical Management of Colorectal Complications from Irradiation for Carcinoma of the Cervix
Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma of the cervix, because radiotherapy is the principle mode of treatment for this fourth most common malignancy in women in Singapore (after carcinoma of the...
Original Article
Adjuvant Chemotherapy in “High Risk” Patients after Wertheim Hysterectomy—10-year Survivals
Wertheim radical hysterectomy has today become an accepted method of management of stage IB and early stage IIA cervical carcinoma, particularly in young patients in whom preservation of ovarian and coital function cannot be achieved if they were subjected to radiotherapy instead. However, a group of patients undergoing radical...
Original Article
A Review of Patients with High-risk Carcinoma of the Cervix Treated with Combined Surgery and Postoperative Radiotherapy
It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness with either radical hysterectomy or radical radiotherapy. However a proportion of patients treated with surgery may be classified as having a significant risk of relapse...
Original Article
Outcome of Early Cervical Carcinoma Treated by Wertheim Hysterectomy with Selective Postoperative Radiotherapy
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 all cancers in females for the period 1988 to 1992.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Editorial
Gynaecologic Oncology—The Next Lap
Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all age groups: rhabdomyosarcoma in young girls, germ cell tumours in teenage girls and young women, cervical cancer in the middle age women, and epithelial ovarian...
Original Article
Urinary Deoxypyridinoline is a Useful Biochemical Bone Marker for the Management of Postmenopausal Osteoporosis
Postmenopausal osteoporosis is the most common cause of osteoporosis. It is heralded by the cessation of oestrogen production by the ovaries resulting in at least 10% to 15% bone loss over the next 10 to 15 years from menopause.
This article is available only as a PDF. Please click on...
Original Article
Infections in Acute Lymphoblastic Leukaemia
Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy. Empiric antimicrobial chemotherapy is the mainstay of therapy for febrile neutropenic episodes pending the culture results.
This article is available only as a PDF. Please click...
Original 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”...
Original Article
Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery
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 reviewed its use for inguinal and genital surgery in children.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Original Article
A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)
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 of these infants would meet the criteria for the use of extracorporeal membrane oxygenation (ECMO).
This article is available only as a PDF. Please click on...
Original Article
Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia
Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously studied in Singapore children; hence we report our experience with the use of adenosine for the treatment and diagnosis of supraventricular tachycardia in children over...
Original Article
Use of Central Venous Lines in Paediatrics—A Local Experience
Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique for percutaneous insertion of central venous lines. In 1973, Shaw invented a technique of cannulating peripheral veins with silastic catheters, as an alternative approach to...
Others
A Case of Accelerated Development of Proliferative Diabetic Retinopathy in a Woman with Type 2 Diabetes Mellitus after Pregnancy
Diabetic retinopathy is the leading cause of blindness in persons between the age of 24 and 64 years both in the US and the UK. Peak fertility and childbearing years correspond to the first half of this period.
This article is available only as a PDF. Please click on “Download...
Original Article
Survey of Aerobic Bacterial Infections in Paediatric Surgical Intensive Care Unit Patients
Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric medical patients, paediatric surgical patients are a special group in their spectrum of diseases and treatment requirements.
This article is available only as a PDF. Please...
Review Article
Lipid Disorders and Rheumatic Diseases
The relationship between lipid disorders and arthritis is manifold. Hyperlipidaemia may manifest clinically in the musculoskeletal system. In 1968, Khachadurian studied 14 families of whom 18 homozygotes of Type II hyperlipidaemia were identified. Ten of these patients experienced a migratory polyarthritis resembling rheumatic fever.
This article is available only as...
Original Article
Rapid One-day Fluorescence In Situ Hybridisation in Prenatal Diagnosis Using Uncultured Amniocytes and Chorionic Villi
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 1/10,000, respectively. Conventional cytogenetic approaches traditionally employ foetal cells from amniotic fluid (AF) or chorionic villus (CV) grown in vitro and metaphase banding for chromosome...
Original Article
Parainfluenza Type 3 Viral Outbreak in a Neonatal Nursery
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 “Download PDF” on top to view the full article.
Others
T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report
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 wave during sinus rhythm without any changes in the QRS complex, is an uncommonly recorded rhythm. We report here an unusual case of T wave...
Original Article
A Preliminary Study of the Immunohistochemical Detection of a Novel Tumour Marker, 22-1-1 Antigen, in Gynaecological Cancer Specimens
Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been useful in diagnosis and treatment of certain cancers (as tumour markers) and many such antibodies have now been described.
This article is available only as a...
Others
The Future of Medicine from the Standpoint of the Practising Paediatrician
From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had practised the art and science, on the basis of curing the patient when he has an illness. The doctor is sought out when the patient...
Others
Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children
Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease.
This article is available only as...
Review Article
Prognostic Factors in Endometrial Carcinoma
In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of 72 per 100,000 women. In Singapore it is the third most common female genital tract cancer after cancer of the cervix and ovary.
This article is...
Original Article
Factors Affecting Success in an Embryo Cryopreservation Programme
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. This technological breakthrough in infertility treatment has been successfully repeated since then and cryopreservation of excess embryos now forms an integral part of any assisted...
Original Article
Bidirectional Cavopulmonary Anastomosis
Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to Fontan’s operation has been undertaken in an effort to reduce the volume load of a single ventricle as early as possible and to minimise the...
Original Article
Hyperlipidaemia during Normal Pregnancy, Parturition and Lactation
Increase in the plasma lipid fractions in normal pregnancy have been described but irregularity of sampling, difference in materials studied (whole blood, serum, and plasma) and the variations in the method of reporting precluded any comparison of results. In Western populations normal pregnancy leads to an increase in cholesterol...
Original Article
Retinopathy of Prematurity in Very Low Birth Weight Infants
Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship between the risk of this disease with birth weight and gestational age had been well-documented, in particular, in infants with birth weight ≤1500 g (very...
Others
Echocardiographic Features and Management of Neonatal Ductal Aneurysm
Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few years. It has been noted as an incidental finding in autopsy, echocardiography and angiography, but can present with symptoms of cough, dyspnoea, hoarseness of voice...
Others
An Unusual Tumour Metastasis to the Cervix
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 present.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Transaminitis in Duchenne’s Muscular Dystrophy
Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine and aspartate transaminase (AST) levels have been found in patients with muscle diseases such as Duchenne’s and Becker’s muscular dystrophy, myotonic dystrophy and the inflammatory...
Others
Twenty-four hour, Non-invasive, Neonatal Chromosome Analysis—Application in a Case of Mixed Gonadal Dysgenesis
Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but longer if the initial 48-h culturing period proves unsuccessful.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Others
Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies
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 G<sub>M2</sub> gangliosides, particularly in the neuronal cells. The infantile form, similar to Tay Sach’s disease, may present in the first year of life with an...
Others
A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block
The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is the commonest of these disorders, and a leading cause of heart block in newborns.
This article is available only as a PDF. Please click on “Download...
Others
Genetics of Male Infertility: Role of Androgen Receptor Mutations and Y-Microdeletions
Three to four per cent of men have severe defects in sperm production that result in infertility. Most of these men are healthy and the causes of depressed spermatogenesis are rarely identified with certainty.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Others
Minimal Change Nephrotic Syndrome—A Complex Genetic Disorder
Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Association or Agreement
Association and agreement between two factors are very different concepts, although the methods used to describe them appear similar. For example, the association between levels of aflatoxin serum albumin adducts and dietary aflatoxin intake can be demonstrated in a bivariate scattergram; the agreement between two methods of measuring aflatoxin...
Others
Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months
Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay, India.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
DNA Testing for Fragile X Syndrome in 255 Males from Special Schools in Singapore
Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It is associated with a cytogenetically visible fragile site in Xq27.3, termed FRAXA, which results from the unstable expansion of a trinucleotide (CGG)n repeat sequence in...
Original Article
Microdochectomy for Single-duct Nipple Discharge
Nipple discharge is a common disturbing symptom for many women and often leads to a surgical referral. It accounts for 3% to 5% of all breast symptoms.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients
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, or some other less specific complaints such as nausea, pallor and sweatiness.
This article is available only as a PDF. Please click on “Download PDF” on...
Others
Pathology of Ductal Carcinoma In situ of the Breast: A Heterogeneous Entity in Need of Greater Understanding
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 incidence of 3.68%. It comprises 22.8% of all local female cancers, with an annual mortality of 13.7 per 100,000 per year.
This article is available only...
Review Article
Cardiac Effects of Psychotropic Drugs
The incidence of mortality is higher among psychiatric patients than among the general population and the cause of which may be the psychiatric disorder itself or other related factors like life-style and medications. Reports of sudden deaths among patients taking psychotropic drugs have raised concerns that some of the...
Others
The Need for Collaboration Between Clinicians and Statisticians: Some Experience and Examples
Many areas of medical research require the application of statistical techniques. Although most clinicians are taught some statistics as part of their basic medical training, the important role of statistics in medical research has led to many pharmaceutical companies, hospitals and medical research institutions employing full time statisticians to...
Others
Clinical Update on Occupational Asthma
Occupational asthma is the most common occupational respiratory disease in the United Kingdom and also in Singapore. Recent estimates of the proportion of adult asthmatics where the cause could be occupational range from 4% to 9%.
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
Diagnosing and Prognosticating Acute Meningitis in Young Infants within 24 Hours of Admission
Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which present with a short history of symptoms and are caused by either bacteria (acute bacterial meningitis, ABM) or viruses (acute aseptic meningitis, AAM).
This article is...
Others
Introduction to Bayesian Methods for Medical Research
The traditional statistical approach used in most areas of medical research involves what is commonly known as frequentist statistics. Bayesian methods provide an increasingly popular alternative to frequentist approaches.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Clinical Update on Helicobacter pylori
Helicobacter pylori is one of the commonest infections in human, affecting 30% to 50% of people worldwide. It is associated with the development of peptic ulcer, chronic gastritis and gastric cancer and may play a role in a small subset of patients with non-ulcer dyspepsia.
This article is available only...
Original Article
Prevention of Human Immunodeficiency Virus (HIV) Transmission from Mother to Child—A Cohort Study in Singapore
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. Globally, 5.8 million new HIV infections have been diagnosed in 1998 with 1.2 million being diagnosed in Southeast Asia.
This article is available only as a...
Others
Book Review
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 as there are so few books of medicine written and published in Singapore.
This article is available only as a PDF. Please click on “Download PDF”...
Original Article
Obstetric Admissions to the Intensive Therapy Unit of a Tertiary Care Institution
Pregnancy is associated with physiological changes in various organ systems and complications arising from the interaction between these changes and disease processes may be severe enough to require admission to the intensive therapy unit (ITU) for management. The purpose of this study was to review all obstetric patients admitted...
Review Article
Enteral Nutrition of the Very Low Birth Weight (VLBW) Infant
Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely delivered.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
A Case Series of Six Children with Primary Pulmonary Hypertension
Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of the pressure in the pulmonary artery to above a mean of 25 mmHg at rest, or 30 mmHg during exercise.
This article is available only as...
Others
2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore
When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think of quite a few other paediatricians more qualified and appropriate as speakers and hoped that my emphatic no would work.
This article is available only as...
Others
Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome
Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the short arm of chromosome 20.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
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...
Others
Current Therapeutic Strategies for Type 2 Diabetes Mellitus
Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on glycaemic control to one addressing global cardiovascular risk factors in a particular individual, glycaemic control remains one of the key challenges that the physician faces...
Others
Update in the Management of Stroke
Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders has been rising dramatically over the last few years, exceeding 10,400 in 2001.
This article is available only as a PDF. Please click on “Download PDF”...
Others
Agreement or Prediction: Asking and Answering the Right Question
In an article published in this journal, Chia discusses the difference between measuring association and agreement. In this paper, we extend the discussion to the difference, in terms of the concepts as well as the practical usage, between analysing agreement and prediction.
This article is available only as a PDF....
Others
Age-related Macular Degeneration: What’s New
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed western world, accounting for approximately 50% of all cases of registered blindness. The prevalence of AMD seems to be increasing at a rate not commensurate with the increasing age of the population, although this observation...
Others
Management of Premalignant Lesions of the Cervix
Cervical cancer is one of the most common female cancers worldwide. It is ranked second only to breast cancer and in many underdeveloped countries, it is the most common female cancer.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Others
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.
Others
The Course of Pregnancy in a Patient with Nail-Patella Syndrome
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 report the course of pregnancy in a patient with such a condition.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
Rheumatic Heart Diseases in Pregnancy
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 causing chronic valvular lesions. Severe myocardial and pericardial involvements are much less common.
This article is available only as a PDF. Please click on “Download PDF”...
Review 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....
Review Article
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...
Review Article
Current Understanding of Pre-eclampsia
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 to perinatal morbidity and mortality.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Management of Thromboembolic Disease in Pregnancy
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 of women with artificial heart valves, is beyond the scope of this paper.
This article is available only as a PDF. Please click on “Download PDF”...
Review Article
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...
Review Article
Thyroid Diseases in Pregnancy
Abnormalities of thyroid function associated with pregnancy encompass both hyperthyroidism and hypothyroidism. These may have been present before the onset of pregnancy, or occurred only during or after pregnancy.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Outcome of Pregnancy in Asian Women with Systemic Lupus Erythematosus: Experience of a Single Perinatal Centre in Singapore
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 commonly than men (ratio 9:1), particularly those in the child-bearing age (15:1).
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
Pregnancy after Renal Transplantation: Experience in Singapore General Hospital
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 wish to have children. Conception rate has been reported to improve dramatically from 1 in 200 dialysis patients to 1 in 50 women with a...
Original Article
Gestational Diabetes Mellitus: A Call for Systematic Tracing
The prevalence of diabetes is increasing worldwide. In Singapore, the prevalence of diabetes has increased dramatically from 4.7% in 1984 to 8.6% in 1998. Diabetic complications lead to a significant number of patients with blindness, amputations and end-stage renal failure annually.
This article is available only as a PDF. Please...
Original Article
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.
Original Article
Are Maternal Deaths on the Ascent in Singapore? A Review of Maternal Mortality as Reflected by Coronial Casework from 1990 to 1999
It is said that, worldwide, over half a million maternal deaths occur annually. This might well be a conservative estimate, given the difficulties inherent in collecting the relevant data, compounded by the under-reporting and misclassification of such deaths.
This article is available only as a PDF. Please click on “Download...
Editorial
Medical Disorders in Pregnancy—The Challenges Ahead
Nowhere is the fate of two individuals more closely intertwined than that of the mother and her fetus. Pregnancy is a unique state where the physiology of the mother is greatly altered to accommodate the newly developing “organ”—the fetus.
This article is available only as a PDF. Please click on...
Others
Clinical Update on Managing the Obstructed Airway
Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians and intensivists.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
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...
Original Article
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Two-year Outcome of Normal-birth-weight Infants Admitted to a Singapore Neonatal Intensive Care Unit
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 years. The outcome of these infants has been extensively studied and widely reported. On the other hand, data on the incidence, risk prediction and outcome...
Others
Bronchopulmonary Dysplasia and Chronic Lung Disease of Infancy: Strategies for Prevention and Management
Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal repair of lung injury in the neonatal period. Although BPD and CLD are closely related, they have differing diagnostic criteria and the spectrum of severity...
Original Article
Intussusception: A Three-Year Review
Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into another.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Clinical Update on Osteoporosis
Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...
Review Article
Osteoporosis in Relation to Menopause
Singapore has a rapidly ageing population. In 1990, only 6% of the population was above the age of 65 years but this percentage of elderly citizens will rise rapidly to 17% by the year 2030. As Singaporean women achieve longer life expectancy and live a greater portion of their...
Original Article
Burch Colposuspension: Review of Perioperative Complications at a Women’s and Children’s Hospital in Singapore
Genuine stress incontinence (GSI) is the most common cause of female urinary incontinence. When conservative treatment fails, surgery is indicated. Open Burch colposuspension is an established surgical procedure1 and remains the gold standard upon which the efficacy of newer surgical options is evaluated.
This article is available only as a...
Others
Endometrioid Adenocarcinoma of the Uterus: Surgico-Pathological Correlations and Role of Pelvic Lymphadenectomy
Endometrial cancer is the most common female genital malignancy in industralised countries today. Despite the overall favourable prognosis in this neoplasia, survival is associated with several prognostic factors. In endometrial cancer, one of the most potent prognostic factors is nodal metastasis.
This article is available only as a PDF. Please...
Others
FIGO Stage 1B2 Cervical Carcinoma – The KK Women’s and Children’s Hospital Experience
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 status of surgical margins.1 In 1994 FIGO addressed the significance of tumour diameter by designating stage 1B into 1B1 (clinical lesions no greater than 4.0...
Others
Bowel Surgery for Epithelial Ovarian Cancer – An Early Case Series
Epithelial ovarian cancer is the leading cause of death in patients with gynaecological malignancies in Singapore and developed countries, the main reason being the advanced stages of the disease (stage III or IV) at diagnosis. This is largely due to the lack of an effective screening tool to detect...
Others
Pregnancy Following Embolisation of Uterine Arteriovenous Malformation – A Case Report
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 result in torrential bleeding, especially following dilatation and curettage.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Others
Severe Newborn Encephalopathy Unrelated to Intrapartum Hypoxic Events: 3 Case Reports
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 delivery. However, the growing evidence in literature has refuted this belief.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
A Case Series of Gastrointestinal Abnormalities in Fetuses with Echogenic Bowel Detected During the Antenatal Period
Although the presence of fetal echogenic bowel (EB) has been largely regarded as benign, it has been viewed as a soft marker for various congenital anomalies. To date, no studies have been conclusive and the importance of antenatal EB amongst the low-risk population has remained confusing.
This article is available...
Others
A Case Series of Pre-Viable Severe Twin-Twin Transfusion Syndrome
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 as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Idiopathic Chronic Fetomaternal Haemorrhage Resulting in Hydrops – A Case Report
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 circulation of greater than 150 mL or more than half the fetal blood volume.
This article is available only as a PDF. Please click on “Download...
Others
Audit of ‘Crash’ Emergency Caesarean Sections Due to Cord Prolapse in Terms of Response Time and Perinatal Outcome
Umbilical cord prolapse is an uncommon intrapartum event with a reported incidence of 1 in 160 to 714 deliveries. Predisposing factors include fetal malpresentation, prematurity, small fetal size, multiple gestation, polyhydramnios and membranes rupture prior to head engagement.
This article is available only as a PDF. Please click on “Download...
Others
Quality Control Assurance in National Screening Programmes for Cervical Cancer
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 aim was to provide healthcare based on need to all citizens of the UK, free at the point of delivery.
This article is available only as...
Others
The Combined Oral Contraceptive Pill in Women Over Age Forty
In the 1970s, several studies appeared to suggest that users of oral contraceptives (OCs) were at increased risk of cardiovascular events. More recently following newer studies on lower dose OCs and re-analysis of the old studies, it was concluded that the risk of cardiovascular accidents was attributable primarily to...
Others
Contemporary Management of Fibroids
Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in most women.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Investigating the Infertile Couple
Infertility is defined as the inability to conceive after 1 to 2 years of unprotected intercourse. In general, an estimated 84% of all women would conceive after a year of intercourse.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Others
Use of Hormone Replacement Therapy in the Asymptomatic Postmenopausal Woman: What is the Current Evidence?
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 Initiative (WHI) study in July 2002.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Fetal Cells in Maternal Blood: State of the Art for Non-Invasive Prenatal Diagnosis
Without prenatal diagnosis, 1 in 50 babies are born with serious physical or mental handicap, and as many as 1 in 30 with some form of congenital malformation. These may be due to structural or chromosomal abnormalities, or single gene disorders.
This article is available only as a PDF. Please...
Others
Human Papillomavirus Triage of Patients with Atypical Squamous Cells of Undetermined Significance on Cervical Papanicolaou Smear
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 have reduced the incidence to 8.3 cases per 100,000 women with only 14,000 cases and 5000 deaths annually.
This article is available only as a PDF....
Others
Screening for Chromosomal Anomalies: First or Second Trimester, Biochemical or Ultrasound?
A chromosome abnormality contributes significantly to fetal loss during pregnancy, and perinatal morbidity and mortality. The contribution of chromosomal abnormalities to fetal loss decreases as pregnancy progresses; an estimated 50% of first-trimester spontaneous abortions are due to chromosomal abnormalities.
This article is available only as a PDF. Please click on...
Others
Should Doctors Perform an Elective Caesarean Section on Request?
Caesarean sections performed without medical indication, better known as maternal request caesarean sections, have generated intense debate in recent times. While uncommon in the past, a recent national audit in the United Kingdom (UK)1 revealed that 7% of all elective caesarean sections were performed for precisely this reason.
This article...
Editorial
Recent Advances in Obstetrics and Gynaecology
The science and art of providing quality health care to women has made tremendous strides in recent years. In the subspecialties of Obstetrics and Gynaecology, recent advances in laboratory techniques and in clinical diagnostic, surgical and laparoscopic skills have improved the prevention and early detection of disease.
This article is...
Others
Imaging-guided Bone Biopsy
Biopsy may be performed at surgery (open biopsy) or percutaneously (closed biopsy). Percutaneous bone biopsies are usually performed under imaging guidance using a variety of modalities, such as fluoroscopy1 and computed tomography (CT), and less commonly, ultrasonography (US) and magnetic resonance (MR) imaging.
This article is available only as a...
Others
Carcinoma of the Cervix: Role of MR Imaging
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 year in both developing and industrialised nations, with a higher incidence in women of low socioeconomic status.
This article is available only as a PDF. Please...
Others
Imaging of Paediatric Mediastinal Masses
A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for thoracic masses in children.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
MR Imaging of the Fetal Brain and Spine: A Maturing Technology
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 is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
The Relationship Between Scoring Systems and Cytokine Levels in Neonatal Sepsis
In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm infants are usually nonspecific. Many clinical and haematological scoring systems have been developed in the early diagnosis of neonatal sepsis.
This article is available only as...
Original Article
Clinical Characteristics of an Outbreak of Hand, Foot and Mouth Disease in Singapore
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 viruses, composed of more than 70 serotypes, accounts for at least 10 to 15 millions of asymptomatic infection per year in the United States.
This article...
Review Article
Perinatal Care at the Threshold of Viability—From Principles to Practice
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 imminent or at the threshold of viability. Considerable debate has arisen regarding the appropriate approach and strongly polarised viewpoints are held with and without supporting...
Original Article
Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital
The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and medical personnel.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Long-term Follow-up and Outcome of Extremely-low-birth-weight (ELBW) Infants
With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great degree of interest focused on the functioning of these high-risk survivors and their outcome into childhood and recently up to adolescence and early adulthood. Prospective...
Review Article
Exogenous Surfactant Therapy in Newborn Infants
Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of other neonatal respiratory disorders as well. Numerous randomised controlled trials have been conducted in neonatology to study different aspects of surfactant therapy.
This article is available...
Review Article
Mass Newborn Screening in Singapore—Position and Projections
Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome with early intervention. The development in 1960 by the late Dr Robert Guthrie of a simple test, the GuthrieTest, that enabled the detection of phenylketonuria...
Others
Neonatology In Singapore: The Way We Were, The Way Forward
Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore. As I look at the present-day status of neonatology, it gives me a sense of achievement and accomplishment.
This article is available only as a PDF....
Original Article
Chorioamnionitis and Outcome in Extremely Preterm Infants
Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is a major predisposing factor for preterm delivery.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Original Article
Changing Trends in Indications for Caesarean Sections in a Tertiary Hospital
Increasing rates of caesarean deliveries have received widespread attention in recent years and has increased widespread discussion in the public domain. The ideal caesarean section rate has never been defined and national rates of caesarean delivery vary from country to country.
This article is available only as a PDF. Please...
Review Article
Obstetric Cholestasis: Current Opinions and Management
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 and obstetric hepatosis.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Advances in Imaging in Prenatal Diagnosis and Fetal Therapy
Technology in sonography has advanced tremendously in recent years, contributing to improvements in clinical applications for prenatal diagnosis and fetal therapy. These include transvaginal scanning, harmonic imaging, Doppler imaging, 3-dimensional (3D) ultrasonography and magnetic resonance imaging (MRI) ultrafast sequences.
This article is available only as a PDF. Please click on...
Review Article
Factors Influencing Fetal Growth
Birth weight remains one of the most important measures we have of the health status of a population, being a strong predictor of both mortality and morbidity, and reflecting nutritional status and growth rates. Yet, the estimation of the normal growth potential — and hence the definition of growth...
Editorial
Challenges in Perinatal Medicine
One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This signaled the beginning of increased collaboration between the obstetricians and neonatologists in the management of high-risk pregnancies through multidisciplinary birth defect clinics and high-risk perinatal...
Others
Predicting Significant Hyperbilirubinaemia and Early Discharge for Glucose-6-Phosphate Dehydrogenase Deficient Newborns
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 past four decades, neonatology units in local restructured hospitals have hospitalised all affected newborns for at least 14 days after birth because of this risk.
This...
Others
Autoimmune Liver Disease in Children
Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1) and serologically by the presence of non-organ and liver-specific autoantibodies and increased levels of immunoglobulin G (IgG), in the absence of a known aetiology. They...
Others
HIV/AIDS in Children
The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major public health threat with wide-ranging medical, social and economic consequences. First gaining foothold among intravenous drug users and commercial sex workers, HIV quickly spreads to...
Others
Surgical Management of Colorectal Metastases to the Liver
Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver is the most common site of distant metastases from colorectal cancer.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
The Diagnosis and Management of Hypercalcaemia
Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in women and <1% in men above the age of 60 years.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
Improving the Uptake of Human Immunodeficiency Virus (HIV) Antenatal Screening in a Primary Healthcare Setting
Since the acquired immunodeficiency syndrome (AIDS) was first diagnosed in Singapore in 1985, its incidence rose from 15 cases in 1988 to 226 in 2000. There has also been a change in the profile of AIDS patients over this period.
This article is available only as a PDF. Please click...
Review Article
Adolescent Health Education Programmes: Theoretical Principles in Design and Delivery
Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually transmitted infections and unplanned pregnancy, accidental and intentional injury, including suicide, affect youth disproportionately and appear to be increasing.
This article is available only as a...
Review Article
Art and “the Language of Well-Being” in Adolescent Health Care
Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration. Creative activity parallels important strategies for mental and spiritual health—people who participate in well-designed creative processes report that it is powerfully restorative.
This article is available...
Review Article
From Recreation to Creative Expression: The Essential Features of an Adolescent Inpatient Psychosocial Support Programme
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 many years of observation, patient survey, discussion and debate about the possibility of allowing teenagers to stay in a children’s hospital.
This article is available only...
Original Article
Adolescent Admissions to a Tertiary Paediatric Hospital: A Dynamic Pattern
The nature of paediatric practice is changing worldwide. In developing countries, infant mortality from infectious diseases continues to fall with improved immunisation, medical care and pharmaceutical advances. This has resulted in a corresponding rise in the number of adolescents, who now constitute 30% of the world’s population.
This article is...
Review Article
Clinical Assessment, Management and Outcomes of a Group of Adolescents Presenting with Complex Medico-psychosocial Conditions
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 unexplained after medical assessment.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Adolescent Chronic Illness: A Qualitative Study of Psychosocial Adjustment
Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many challenges including dealing with the symptoms of illness, side effects of medications, altered body image, unpredictable disease progression, depression and anxiety.
This article is available only...
Review Article
Strategies to Promote Better Outcomes in Young People with Chronic Illnesses
The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to public health measures, such as sanitation and immunisation, better housing and sweeping improvements in health care.
This article is available only as a PDF. Please click...
Review Article
Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience
The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent and future adult health and well being. Adolescent substance use and abuse is an example of this.
This article is available only as a PDF. Please...
Review Article
Sexually Transmitted Infections in Singapore Teenagers
Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and changes. The transition from childhood to adulthood includes the formation of successful intimate relationships and avoidance of the pitfalls of sexually transmitted infections (STI), including...
Review Article
Eating Disorders in Singapore: A Review
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 of shape/weight dissatisfaction and eating abnormalities. Anorexia nervosa is characterised by significant self-induced weight loss secondary to fear of fatness, amenorrhoea (cessation of menstruation for...
Review Article
Youth Suicide and Parasuicide in Singapore
The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or herself in the knowledge, or expectation, of its fatal outcome. Parasuicide or attempted suicide is distinguished from suicide by the non-fatal outcome.
This article is available...
Original Article
Five-Year Review of Adolescent Mental Health Usage in Singapore
The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in almost every area, including epidemiology, classification and treatment.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Others
The Perils of Puberty
Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such as cytochrome P450 systems, accretion of peak bone mass, and the development of sexually dimorphic adult patterns in blood lipids, blood pressure, haemoglobin and red...
Editorial
Adolescent Health—A New Perspective in Singapore
In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field of Adolescent Health has only recently been recognised to be an important specialty which has not received due emphasis in the medical curriculum for undergraduates,...
Letter to the Editor
Labour epidural practice in a tertiary training centre
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 of cervical dilatation. Lumbar epidural, the gold standard for labour analgesia, is recently recommended over other alternative methods of analgesia such as pressurised gaseous nitrous...
Others
MELAS: A Case Report
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 multiple dental caries, phenytoin-induced gingival hyperplasia and severely worn-down and eroded dentition. He is under regular follow-up by the Paediatrics Department of the National University...
Original Article
Evaluation of a Bedside Test for Phosphorylated Insulin-like Growth Factor Binding Protein-1 in Preterm Labour
The diagnosis of preterm labour poses a problem. Preterm labour accounts for about 50% of preterm births; however, most data reveal that only about 20% of women presenting with suspected preterm labour actually deliver preterm.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey
Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an area of considerable interest, and many unanswered questions surround this organism and the types of diseases it causes.
This article is available only as a PDF....
Others
Inaugural College of Obstetricians & Gynaecologists Lecture: Recent Developments in Obstetric Care and Maternal Fetal Medicine in Singapore
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 to view the full article.
Others
The Importance of High Resolution Chromosome Analysis in the Diagnosis of Birth Defects: Case Reports of Holoproscencephaly and Cystic Hygroma
Optimal chromosome preparation is a function of many factors. These include cell density culture initiation, optimal time for harvest, concentration and exposure duration to a mitotic arrestant, appropriate hypotonic treatment and adequate fixation with modified Carnoy’s fixative.
This article is available only as a PDF. Please click on “Download PDF”...
Original Article
Tailoring the Field and Indication of Adjuvant Pelvic Radiation for Patients with FIGO Stage Ib Lymph Nodes-Negative Cervical Carcinoma Following Radical Surgery Based on the GOG Score – A Pilot Study
Although no significant survival difference exists between primary surgery and radiotherapy (RT) for the treatment of FIGO stage Ib cervical cancer, radical surgery is the preferred modality of treatment as conservation of the ovarian and vaginal function is of prime importance. It also allows the study of prognostic histopathological...
Others
A Case of Cystic Leiomyoma Mimicking an Ovarian Malignancy
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. Please click on “Download PDF” on top to view the full article.
Review Article
Marijuana in Pregnancy
Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include a unique blend of effects of alcohol, opioids, tranquilisers and hallucinogens, the clinical picture could be very unpredictable and the diagnosis is often difficult.
This article...
Original Article
Abnormal Liver Function Tests in the Symptomatic Pregnant Patient: The Local Experience in Singapore
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 addition to the causes affecting the non-pregnant population. The spectrum of disease is varied and the abnormal LFT can be mild with no long-term consequence,...
Original Article
Twin Births in Singapore: A Population-Based Study Using the National Birth Registry
Twin studies are regarded as one of the better ways to study the effects and significance of gene, environment and interactions of both. The study of monozygotic (MZ) and dizygotic (DZ) twins allows for an estimation of the relative importance of genes and environment.
This article is available only as...
Letter to the Editor
A Fatal Turkish Case of Campomelic Dysplasia
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) in association with a posterior cleft palate, flattened facies and hypoplastic scapulae. It was first fully and originally described by Spranger et al and Maroteaux...
Original Article
Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore
Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase in prevalence has also been attributed to the changes in lifestyle and urbanisation in developed countries.
This article is available only as a PDF. Please click...
Others
Is it Possible to Slow the Progression of Myopia?
The rates of myopia, including high myopia , have been reported to be rising to epidemic proportions in Asia and solutions to this huge public health problem are urgently needed. Many researchers agree that myopia is not determined solely by genes and that environment may play a huge role.
This...
Others
Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome
Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first described in 1961 and the phenotype was subsequently expanded in 1972.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article
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 setting, such as nebulisers, water baths, dialysis machines and intravenous fluids.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
Gender Disparity in Paediatric Hospital Admissions
Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories appears not to attract much attention or research interest. Gissler and colleagues, in a longitudinal follow-up of all children born in Finland in 1987, reported...
Original Article
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...
Original Article
Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience
Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an enzyme deficiency which led directly to the disruption of cellular metabolism. However 40 years later, it was discovered that many inherited diseases were not due...
Original Article
Does Visual Turbidity Correlate With Serum Triglyceride Levels in Babies on Total Parenteral Nutrition?
Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles endogenously produced chylomicrons.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Corticosteroids are not Present in a Traditional Chinese Medicine Formulation for Atopic Dermatitis in Children
Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have a history of AD.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore
Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the general public, with many of them utilising it for a whole spectrum of ailments.
This article is available only as a PDF. Please click on “Download...
Others
Book Review
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 answers the everyday questions that general practitioner (GP) will ask in their clinical practice.
This article is available only as a PDF. Please click on “Download...
Others
Recurrent Non-immune Fetal Hydrops: A Case Report
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 ages with an overall perinatal mortality rate (PNMR) of 86.6%. If the diagnosis is made before 24 weeks’ gestation, the PNMR is 95%, with 30%...
Original Article
The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004
Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8 months.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia
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 estimated incidence of 1 in 350,000 in a newborn screening programme.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis
Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this entity became more frequent after the introduction of vasoactive drugs for intracavernosal injections.
This article is available only as a PDF. Please click on “Download PDF”...
Editorial
Paediatrics to Geriatrics: The Continuum
In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it was no different up to the mid 1980s.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Original Article
Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore
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 from close contact.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
A Rotavirus Vaccine for Infants: The Asian Experience
Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20% of all diarrhoea-related deaths and global mortality among children less than 5 years of age is estimated at nearly half a million.
This article is available...
Editorial
Therapeutic Hypothermia for Neonatal Hypoxic-Ischaemic Encephalopathy
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 over 5 million neonatal deaths worldwide annually.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Others
Outcome of Organic Acidurias in China
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Organising Services for IMD in Thailand: Twenty Years Experience
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Newborn Screening in Pakistan – Lessons from a Hospital-based Congenital Hypothyroidism Screening Programme
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Newborn Screening in Bangladesh
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Newborn Screening in China: Phenylketonuria, Congenital Hypothyroidism and Expanded Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Minimising Harm from Newborn Screening Programmes
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Financing Newborn Screening Systems: US Experience
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Inborn Errors of Metabolism Presenting as Neonatal Encephalopathy: Practical Tips for Clinicians
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Legal Issues in Neonatal Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
External Quality Assurance Programme for Newborn Screening of Glucose-6-Phosphate Dehydrogenase Deficiency
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Glucose-6-Phosphate Dehydrogenase Deficiency: Correlation between the Genotype, Biochemistry and Phenotype
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Disorders of Vitamin B12 Metabolism Presenting Through Newborn Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Diagnosis of Tetrahydrobiopterin (BH4) Responsive Mild Phenylketonuria in Japan over the Past 10 Years
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Fatty Acid Oxidation Defects
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Disorders of the Carnitine Cycle and Detection by Newborn Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Spectrum of Inherited Metabolic Disorders in Malaysia
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Establishing a Universal Newborn Hearing Screening Programme
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Current Understanding of Auditory Neuropathy
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
A Multidisciplinary Approach to Paediatric Hearing Loss: Programme at the Centre for Hearing Intervention and Language Development, National University Hospital, Singapore
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Early Intervention For Hearing Impairment: Appropriate, Accessible and Affordable
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Impact of the National Hearing Screening Programme in China
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Outcome of Early Cochlear Implantation
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Eliminating Iodine Deficiency: Obstacles and Their Removal
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Issues on Universal Screening for Galactosemia
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: Supporting Arguments
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
My Early Experiences in Establishing Neonatal Screening and the Reason for Regional Meetings of the International Society for Neonatal Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Diagnosis and Management Support for an Expanded Newborn Screening Programme
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Considerations in Choosing Screening Conditions: One (US) Approach
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Clinical Applications of Molecular Genetics: The Model of Congenital Adrenal Hyperplasia
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Newborn Screening in Japan: Restructuring for the New Era
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Improved Health and Development of Children who are Deaf and Hard of Hearing Following Early Intervention
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Towards Universal Newborn Screening in Developing Countries: Obstacles and the Way Forward
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Improving Child Health – Newborn Screening for All?
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Editorial
Neonatal Screening – A Global Perspective
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
A Case of Lemierre’s Syndrome Presenting with Multiple Pulmonary Abscesses Associated with a Tension Hydropneumothorax Resulting in a Mediastinal Shift
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 of the internal jugular vein (IJV), leading to metastatic abscesses mainly of the lungs, but organs such as the liver, bones, joints and kidneys can...
Original Article
Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia
Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected vision equal to or worse than 20/40, and it varies from as low as 2.72% in South Africa to as high as 15.8% in Chile.
This...
Original Article
Right Atrial Isomerism – Preponderance in Asian Fetuses. Using the Stomach-distance ratio as a Possible Diagnostic Tool for Prediction of Right Atrial Isomerism
Atrial isomerism is a disorder of lateralisation characterised by symmetric development of normally asymmetric cardiac atria and organ systems. The synonyms for these defects include heterotaxy syndrome, polysplenic/ asplenic syndrome, right/left isomerism, isomerism of the atrial appendages and situs ambiguous.
This article is available only as a PDF. Please click...
Letter to the Editor
Assessment of Medical Graduates Competencies
Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...
Commentary
When Words Really Matter
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 only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Behavioural Sleep Disorders in Children and Adolescents
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 often overlooked by healthcare practitioners.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Cardiovascular Changes in Children with Snoring and Obstructive Sleep Apnoea
Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the prevalence of childhood OSA diagnosed by varying criteria was 1% to 4%.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty.
This article is available only as...
Review Article
Sleep Disorders in Children: The Singapore Perspective
Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in 1% to 3% of children.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
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...
Review Article
The Scope of Paediatric Sleep Medicine
Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of sleep develops and matures, resulting in changing patterns of normal behaviours and of sleep disorders.
This article is available only as a PDF. Please click on...
Original Article
Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder
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 current version of the Diagnostic and Statistical Manual of Diseases (DSM), fourth edition, has 2 lists of behavioural symptoms grouped under “inattentive” and “hyperactive-impulsive” symptoms,...
Original Article
Inflammatory Cytokines and Childhood Obstructive Sleep Apnoea
Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway occlusion during sleep that are associated with daytime behavioural changes and abnormalities in cardiovascular function. In adults, it has been shown that OSA is an independent risk factor for cardiovascular diseases.
This article is available only as a...
Original Article
Nasal Obstruction in Children with Sleep-disordered Breathing
Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in the newborn nursery. Later, during development in the first years of life, abnormal nasal breathing has important consequences for facial growth.
This article is available only...
Original Article
Incidence, Risk Factors of Retinopathy of Prematurity Among Very Low Birth Weight Infants in Singapore
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 rates for premature infants,2 and this has been accompanied by an increase in the incidence of ROP.3-5 ROP is a leading cause of childhood blindness6,7...
Letter to the Editor
Chylous Ascites in Recurrent Gynaecological Malignancies
Chylous ascites is an unusual phenomenon where there is accumulation of chyle in the peritoneal cavity. It is especially rare following treatment of gynaecological cancers.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Placental Calcification in Pseudoxanthoma Elasticum
Pseudoxanthoma elasticum (PXE) is an inherited multisystem disorder of the elastic tissue leading to skin disease as well as ocular and cardiovascular complications. Although earlier literature on pregnancy in PXE contained reports of severe complications, most patients show no serious complications during pregnancy.
This article is available only as a...
Others
Holoprosencephaly: An Antenally-diagnosed Case Series and Subject Review
Holoproscencephaly (HPE) is an uncommon congenital developmental defect of the forebrain structures to divide into separate hemispheres and ventricles during embryogenesis. The prevalence rate of HPE is estimated to be between 1 in 11,000 to 1 in 20,000 live births, and 1 in 250 during early embryogenesis.
This article is...
Original Article
Immunogenicity, Reactogenicity and Safety of a Diphtheria-Tetanus-Acellular Pertussis-Inactivated Polio and Haemophilus Influenzae Type b Combination Vaccine in a Placebo-controlled Rotavirus Vaccine Study
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 B has been in place for many years and its success has been dramatic. Despite being previously endemic to Singapore in the 1950s, diphtheria has...
Images in Medicine
Transfusion-dependent Microcytic Anaemia in a 10-year-old Girl
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, 31 μmol/L) 3 years ago (Figs. 1 and 2). Test for haemoglobin electrophoresis on agarose gel did not reveal any abnormal bands.
This article is available...
Images in Medicine
Caudal Regression Syndrome
A white female with an uncomplicated history of birth delivery and a familial history of diabetes mellitus presented to the orthopaedic clinic at the age of 16 months old with bowel dysfunction, inability to walk, one kidney, and a gibbus noted at T12. A “frog-like” appearance was noted of...
Letter to the Editor
Laparoscopic Heller’s Cardiomyotomy for Achalasia of the Cardia in a Pregnant Patient
Laparoscopy was first used for the evaluation of acute abdominal pain in pregnancy by gynaecologists in 1980. The most commonly reported laparoscopic procedure during pregnancy is laparoscopic cholecystectomy.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Letter to the Editor
Spontaneous Vaginal Expulsion of a Filshie Clip
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 available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
3rd College of Paediatrics and Child Health Lecture – The Past, the Present and the Shape of Things to Come…
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 lack of hygiene, and the social conditions were apparently appalling.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Original Article
Auricular Anthropometry of Newborns at the Singapore General Hospital
Abnormalities of the external ear are described in many syndromes and genetic conditions. Melnick et al reported an incidence of 1 in 90 births for external ear malformations and branchial sinuses and tags, with about 1 in 670 births having malformations of the pinna.
This article is available only as...
Others
Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation
Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations, especially among children. The severity of the envenomation is related to haemodynamic and cardiorespiratory alterations, with cardiac failure and cardiogenic pulmonary oedema being the major...
Review Article
Care of Women in Menopause: Sexual Function, Dysfunction and Therapeutic Modalities
Menopause is a life change described by biological alterations occurring in the context of important social changes. There is an increasing appreciation for the role of sexual function in menopause and its importance for a woman’s health and well-being.
This article is available only as a PDF. Please click on...
Original Article
Screening Tools for Bacteraemia in a Selected Population of Febrile Children
Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from bacteraemia and sepsis, which is accompanied by findings of serious systemic illness.
This article is available only as a PDF. Please click on “Download PDF” on...
Original 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...
Original Article
Impact of the Singapore National Asthma Program (SNAP) on Preventor-Reliever Prescription Ratio in Polyclinics
According to the World Health Organization/Global Initiative on Asthma (WHO/GINA) report on the global burden of asthma, Singapore is an intermediate-risk country for asthma prevalence, which is about 5% of the population. But has one of the highest rates of asthma deaths in the world.
This article is available only...
Others
An Unexpected Presentation of Endometriosis – A “Parasitic” Cyst of the Bowel in a Menopausal Woman on Hormone Therapy
Endometriosis commonly affects women during their reproductive years and may involve any organ. Although rare, endometriosis has been reported in postmenopausal women and is often associated with hormone replacement or tamoxifen.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Review Article
Menopause, Hormone Therapy and Cardiovascular and Cerebrovascular Disease
Cardiovascular disease is a major cause of morbidity among postmenopausal women. Up to the age of 50 years, the prevalence of coronary artery disease (CAD) among women is lower than among men, but the incidence rises significantly after the menopause.
This article is available only as a PDF. Please click...
Images in Medicine
Paediatric perineal skin pit: More than skin deep?
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, his parents were informed that he had a “bilobed scrotum and a deep perineal skin pit” that may pose hygiene and cosmetic issues. They had...
Letter to the Editor
Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis
Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis is rare.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Morbidity of Parainfluenza 3 Outbreak in Preterm Infants in a Neonatal Unit
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. It is the second commonest cause of pneumonia and bronchiolitis after RSV.
This article is available only as a PDF. Please click on “Download PDF” on...
Letter to the Editor
An Unexpected Outcome following Radial Head Excision for Jeffrey Type II Fracture-Dislocation of the Proximal Radius in a Child
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 radial head. At 3 years of follow-up, he had regained full painless flexion and extension with loss of pronosupination.
This article is available only as a...
Letter to the Editor
Temporary Tattoo Associated Type IV Delayed Hypersensitivity Dermatitis in a Child – A Case Report and Call for Parental Caution in Singapore
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 available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
The Influence of Maternal Ethnic Group and Diet on Breast Milk Fatty Acid Composition
Human milk is the ideal food which provides the complete nutritional requirements for infants during the first 6 months of life. The lipids accumulated in an infant represent the majority of all energy retained in the growing tissues during this crucial period of rapid growth and development.
This article is...
Images in Medicine
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.
Images in Medicine
An Exanthem with An Annular Pattern in a 2-year-old Girl
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 trunk and hands. The parent’s concern was the rash’s duration and association with 2 episodes of fever.
This article is available only as a PDF. Please...
Original Article
Clinical Features Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis
Causes of neonatal cholestasis (NC) are long and diverse but the responses of newborn liver, either physiological or anatomical, are limited. This is because the ability of a developing liver of responding in the face of a variety of insults are limited.
This article is available only as a PDF....
Original Article
Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children
Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can cause significant morbidity and mortality in children as well as adults.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
A Clinicopathologic Study of Uterine Smooth Muscle Tumours of Uncertain Malignant Potential (STUMP)
Smooth Muscle Tumours of Undetermined Malignant Potential or STUMPs are interesting tumours from both the standpoint of histological diagnosis and classification as well as clinical management mainly because, as a group, its natural history is poorly understood. Prognostic criteria of how STUMP tumours will behave have been studied and...
Letter to the Editor
Bannayan Riley Ruvalcaba Syndrome
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 disorder is linked to germline mutations of the phosphatase and tensine homologue gene (PTEN), a tumour suppressor gene which has a significant role in the...
Images in Medicine
Dyke-Davidoff-Masson Syndrome
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 newborn period. He had developmental delay since infancy and was noticed to have right-sided tonic clonic seizures since the age of 3 years, which was...
Review Article
Childhood Food Allergy: A Singaporean Perspective
Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the term IgE-mediated food allergy is appropriate.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?
Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of devices has been developed for use over the years, with significant advances achieved in terms of profile and safety.
This article is available only as a...
Original Article
Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns
Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise in numbers of infected cases despite initial containment followed by mitigation efforts. Local incidence for acute upper respiratory infections (which was a reasonable surrogate for...
Original Article
Obstetric Outcomes of Influenza A H1N1 (2009) Infection in Pregnancy – Experience of a Singapore Tertiary Hospital
Influenza A H1N1 (2009) is a new viral strain containing gene segments from human, swine and avian lineages. Soon after reports of human cases of the infection in April 2009, the World Health Organization declared the situation a public health emergency of international concern.
This article is available only as...
Letter to the Editor
Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the light of some of the points raised such as frequent comorbidities that occur with ADHD as is the case of Autistic disorder and other conditions...
Letter to the Editor
Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than curing for attention deficit hyperactivity disorder (ADHD) is taking place. There are some evidence-based points that should be noted.
This article is available only as a...
Others
Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report
The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to the development of several intravitreal anti-angiogenic therapeutics. Ranibizumab (Lucentis, Genentech, San Francisco, USA) and pegaptanib (Macugen, OSI/Eyetech Pharmaceuticals, New York, USA) have been FDA-approved for...
Original Article
Dedicated Cytogenetics Factor is Critical for Improving Karyotyping Results for Childhood Leukaemias – Experience in the National University Hospital, Singapore 1989-2006
Acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) make up the bulk of childhood leukaemia cases. With risk stratified therapy being one of the cornerstones of the treatment of childhood leukaemia, it is important to determine the prognostic factors on which risk stratified therapy depends.
This article is available...
Original Article
Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007
Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is of public health importance because of the teratogenic effects of the virus on the developing fetus.
This article is available only as a PDF. Please click...
Original Article
Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study
The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months and partial breastfeeding thereafter for at least 12 or 24 months....
Images in Medicine
A Missed Bilateral Choanal Atresia
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 stenosis
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Letter to the Editor
Dilemmas in Management of Brain Tumours in Pregnancy
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 of glioblastoma multiforme (GBM) in pregnancy in which the patient underwent emergency craniotomy and adjuvant radiotherapy before delivering a healthy baby with good outcome.
This article...
Others
A Unique Pair of Monozygotic Twins with Concordant Clear Cell Renal Cell Carcinoma: A Case Report
Studies of monozygotic and dizygotic twins represent an important approach in estimating the relative contributions of genes and environment to the development of various cancers and disease in general. However, remarkably and almost curiously, there has been no monozygotic twin-pair concordant for clear cell renal cell carcinoma (ccRCC) reported...
Original Article
Health-related Quality of Life in Children with Cancer Undergoing Treatment: A First Look at the Singapore Experience
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. HRQOL, compared to QOL, is a more defined conceptual term which encompasses only health-related aspects of life directly amenable to healthcare services and medical products.
This...
Original Article
Clinical Outcomes of High-risk Labours Monitored Using Fetal Electrocardiography
Intermittent auscultation (IA), cardiotocography (CTG), amniotic fluid colour and fetal scalp capillary blood gas analysis are currently accepted standards for intrapartum fetal monitoring. According to the results of recent randomised clinical trials, intrapartum CTG monitoring is a very sensitive method; however, its very low specificity seems to be strongly...
Original Article
Microsurgical Reversal of Sterilisation – Is This Still Clinically Relevant Today?
Different contraceptive options are available today; however, tubal sterilisation is still one of the most prevailing contraceptive alternatives. Locally, many prefer mechanically occluding the tubes with Filshie clips.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore
The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist into adulthood and increases the risk of cardiovascular metabolic diseases, giving rise to an increased healthcare burden. In Singapore, the prevalence of obesity for adults...
Original Article
Short- and Long-Term Outcomes at 2, 5 and 8 Years Old for Neonates at Borderline Viability—An 11-Year Experience
Singapore was listed consistently among the top 3 countries in the world with the lowest infant mortality rate. In particular, Asia had seen its infant mortality rate improve dramatically with time. Advances in perinatal care had however, failed to improve the survival of extremely low birth weight infants of...
Original Article
Neonatal Outcome of the Late Preterm Infant (34 to 36 Weeks): The Singapore Story
Neonatologists were caught looking the other way in the early part of the millennium. While they were keenly following the progress of extreme preterms and their travails, preterms born at the other end of the spectrum were being quietly ignored as “well babies”. In July 2005, the National Institute...
Original Article
Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?
The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The Fetal Medicine Foundation, London, has refined and populated this screening test that uses a combination of maternal age, nuchal translucency (NT) thickness and biochemical markers,...
Editorial
Prenatal Diagnosis of Chromosomal Abnormalities—Shifting Paradigm
It is very likely that in 10 years time, invasive prenatal diagnostic tests like amniocentesis and chorionic villus sampling (CVS) will join the club of forgotten obstetric procedures like vaginal breech delivery and rotational forceps delivery. In 1968, Henry Nadler1 and his team were the first to report prenatal...
Letter to the Editor
Prevalence of vitamin D deficiency and insufficiency in Malaysian infants
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 vitamin D deficient or insufficient. In a study on the state of Kelantan in Malaysia (2010–2012), 60% of pregnant women were vitamin D deficient. Maternal...
Letter to the Editor
Impact of true fetal mosaicism on prenatal screening and diagnosis
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 other aneuploidies, complementing the traditional approach of first trimester screening (FTS). FTS comprises ultrasound of the nuchal thickness and blood test to measure the levels...
Letter to the Editor
Maternal obesity and risk of adverse obstetric outcomes in Malaysia
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 association between maternal hyperglycaemia and pregnancy outcomes, the effect of obesity in pregnancy has drawn some controversial conclusions.1Data are even scarcer in Southeast Asia countries....
Editorial
Uterine rupture in Singapore: Trends and lessons learnt
Uterine rupture is arguably one of the most dreaded acute obstetric complications in obstetrics. Synonymous with significant maternal and perinatal morbidity and mortality risks, uterine rupture is usually encountered in the context of vaginal births after previous caesarean section (VBAC).
This article is available only as a PDF. Please click...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...
Original Article
Epidemiology and risk stratification of minor head injuries in school-going children
Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports and road traffic injuries are common causes in school-going children. Majority of paediatric head injury cases are mild traumatic brain injuries, defined as a Glasgow...
Original Article
Cervical screening in foreign domestic workers in Singapore
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 100,000 and a corresponding mortality rate (ASMR) of 10 per 100,000. In Singapore, cervical cancer is the 10th most common cancer in women with an...
Original Article
Risk factors and outcomes of uterine rupture in Singapore: Emerging trends
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 with geographical location and obstetric practice. With the changes in obstetric practice over the years, caesarean section rates have increased in our population with undesirable...
Original Article
Perinatal Drug Abuse in KK Women’s and Children’s Hospital
In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance abuse in a pregnant population to be approximately 11% (range 0.4% to 27%) in a survey of 35 perinatal centres in the United States.
This article...
Original Article
A Pilot Study of the Efficacy and Tolerability of Intralesional Recombinant Human Beta-Interferons in Cervical Intraepithelial Neoplasia
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 interferons are a family of proteins which possess anti-viral action, inhibit cell proliferation and modulate the natural immune response2 and which therefore may be...