Review Article
Premature ovarian insufficiency: When ovaries retire early
Illustration by LadyFingers Co.
Premature ovarian insufficiency (POI, also known as primary ovarian insufficiency) refers to loss of ovarian activity before the age of 40 years, leading to hypergonadotropic hypoestrogenism and 4 months or more of menstrual disturbance.1 In ovarian insufficiency, the ovarian dysfunction is not necessarily definitive, which is...
Letter to the Editor
A review on adverse airway events during anaesthesia over 6 years in a tertiary referral hospital
Dear Editor,
Comprehensive reviews of perioperative critical airway events (CAE) have been conducted through audits and closed claims analyses. However, there is currently limited published data specific to Singapore. Our study aims to analyse CAE at a tertiary hospital in Singapore, ascertain their frequency, identify risk factors, and compare findings...
Original Article
Epidemiology of paediatric intensive care unit admissions, deaths and organ donation candidacy: A single-centre audit
With advancements in medical care, mortality rates in critically ill patients have decreased substantially.1,2 Contemporary studies from developed countries report paediatric intensive care mortality rates of 2–3%3,4 in 2014 to 2019, whereas mortality in developing countries can be as high as 50%5 as of 2024, indicating large disparities in...
Commentary
Towards a unified approach: Standardising radiological diagnosis and grading of vertebral compression fractures
Vertebral compression fractures (VCFs) are frequently missed on frontal and lateral chest radiographs.1 Even with abdominal computed tomography, where sagittal imaging is readily available, up to 84% of grades 2–3 compression fractures can be unreported.2 In patients with acute hip fractures, vertebral fractures were found to be unreported in...
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)....
Letter to the Editor
Intravenous epoprostenol therapy in the treatment of pulmonary arterial hypertension in Singapore
Illustration by Nata Blackthorn
Dear Editor,
Pulmonary arterial hypertension (PAH) is a progressive disease characterised by significant morbidity and mortality. Intravenous (IV) epoprostenol (Veletri, Johnson & Johnson, US), a prostacyclin analogue, has been shown to improve exercise tolerance, PAH symptoms, haemodynamics and survival.1,2 However, there is a lack of data on...
Letter to the Editor
Automated Cobb angle measurement in scoliosis radiographs: A deep learning approach for screening
Dear Editor,
Adolescent idiopathic scoliosis is the most common paediatric spinal deformity, impacting 1 in 300 children.1 In Singapore and other countries, national screening programmes have been established to detect scoliosis early, with the aim of using bracing to prevent progression to moderate or severe scoliosis, which may require surgical...
Letter to the Editor
The emergence of otter attacks in Singapore: A case series and strategies for management
Dear Editor,
Singapore is experiencing an unprecedented increase in the number of smooth-coated otters (Lutrogale perspicillata). Since 2017, the local otter population has more than doubled to at least 170. This has led to an increase in the number of otter-human attacks since 2021.1,2 While common animal attacks like dog...
Letter to the Editor
Predictors of complicated influenza infection in children presenting in a tertiary hospital in a tropical country: A case-control study
Dear Editor,
Influenza causes significant healthcare burden globally1 with highest risks in children and the elderly. In children, multiple studies have identified risk factors for severe influenza such as young age (<5 years), presence of comorbidities, abnormal vital signs (e.g. hypoxia, shock) and bacterial coinfections.2-4 We found similar findings in...
Letter to the Editor
Factors affecting outcomes among older trauma patients in Singapore: A retrospective observational study
Dear Editor,
Singapore faces a rapidly ageing population with its median age projected to be above 45 years by 2030. Our greying demographics is accompanied by a rise in chronic diseases and medication use, including polypharmacy.1 Longer life expectancy and increased activity levels have contributed to higher incidence of geriatric...
Commentary
Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...
Original Article
Anti-osteoporosis drugs reduce mortality in cancer patients: A national cohort study of elderly with vertebral fractures
Osteoporotic vertebral fractures (OVFs) are the most prevalent type of fragility fractures, affecting 25% of adults in their early 70s and 43% of those over the age of 80.1,2 Following an OVF, persistence of the vertebral deformity may lead to spinal kyphosis, which is associated with chronic lower back...
Editorial
Anti-osteoporosis drugs and reduction of mortality in cancer patients
Osteoporosis and cancer share a complex relationship, with each condition influencing the progression and outcomes of the other.1 Multiple factors, such as chemo- and hormonal therapies, and the direct invasion of bone tissue by malignant cells contribute to the accelerated bone loss seen in cancer patients.1 Various anti-osteoporosis drugs,...
Letter to the Editor
Outcomes of patients admitted for drowning
Dear Editor,
According to the latest Utstein-style consensus, drowning is defined as the primary respiratory impairment resulting from submersion or immersion in a liquid medium.1 Patients may experience hypothermia, acute respiratory distress syndrome and shock.1 The pathophysiology is poorly understood, but could relate to physiological responses to temperature, water swallowing...
Letter to the Editor
Impact of an ageing population on the intensive care unit
Dear Editor,
Intensive care unit (ICU) resources are scarce and expensive, and deciding if intensive care is suitable for older patients involves complex clinical reasoning, ethical challenges and cost considerations. Although some studies show that ICU mortality increases with age, others suggest that age alone is not predictive of poor...
Letter to the Editor
Managing and preventing severe hand injuries among sugarcane juicer operators
Dear Editor,
Of all hand injuries encountered at an emergency department, 54% are sustained in the workplace,1 in part contributed by occupational injuries among food and beverage operators that caused a loss of 16,197 man-hours in 2021 alone.2 Commonplace in Singapore and in parts of South and Southeast Asia is...
Original Article
Association of anticoagulation use during continuous kidney replacement therapy and 90-day outcomes: A multicentre study
Acute kidney injury (AKI) affects 21.6% of critically ill adult patients,1 with 5–7% requiring kidney replacement therapy (KRT).2 AKI carries significant prognostic and socioeconomic implications—chronic kidney disease (CKD) progression over 1 year has been described in 21%, 30%, and 79% of initial survivors with septic AKI reversal, recovery and...
Original Article
Low skeletal muscle mass predicts poor prognosis of elderly patients after emergency laparotomy: A single Asian institution experience
Emergency laparotomy (ELAP) for elderly patients is associated with higher mortality and increased postoperative complications compared with those undergoing elective surgery.1-3 Elderly patients, who are more likely to have comorbidities, have lower functional reserves to cope with the increased physiological demand due to their acute illness and eventual surgical...
Letter to the Editor
High burden of respiratory viral infection-associated mortality among critically ill children
Dear Editor,
Acute lower respiratory infections (ALRIs) are a leading cause of under-5 mortality globally—two-thirds could be attributable to respiratory viral infections (RVIs).1,2 The burden of paediatric RVIs in settings of tropical climate with year-long virus circulation is relatively underreported.3,4 Previous studies in these areas have estimated that around 8–11%...
Letter to the Editor
Optimum follow-up period of arthroscopic and mini-open rotator cuff repairs
Dear Editor,
Rotator cuff disorders are the most common cause of disability related to the shoulder,1 and rotator cuff repairs—via mini-open or arthroscopic techniques—are considered in patients with refractory symptoms.2 While there are multiple studies analysing short- and long-term follow-ups, there are no clear consensus regarding the minimum follow-up...
Original Article
Comparison of planned-start, early-start and deferred-start strategies for peritoneal dialysis initiation in end-stage kidney disease
Peritoneal dialysis (PD) is a well-established long-term dialysis modality for patients with end-stage kidney disease (ESKD).1 It is recommended that a PD catheter should be placed at least 2 weeks prior to the anticipated need of long-term PD treatment for a planned-start PD.2 Despite wide-spread promotion of planned-start dialysis for...
Original Article
Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation
In-hospital cardiopulmonary resuscitation (CPR) for chronic kidney disease (CKD) patients is shown to have lower survival1 and a higher proportion of survivors on maintenance haemodialysis were discharged to skilled nursing facilities.2 Despite that, haemodialysis patients still preferred CPR during cardiac arrest3 and there are lower do-not-resuscitate orders for the...
Original Article
Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis
End-stage renal failure (ESRF) is a major cause of morbidity and mortality worldwide, including Asia.1 In Singapore, incidence of chronic kidney disease (CKD) stage 5 has increased from 383.9 per million population (PMP) in 2010 to 414.8 PMP in 2015. Incidence of patients requiring dialysis has increased in tandem....
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...
Original Article
Anthropometry of Anterior Cruciate Ligament in Singaporean Chinese
Anterior cruciate ligament (ACL) reconstruction is a technically precise and demanding operation. Attention to factors such as the tunnel position, graft selection, fixation and rehabilitation play an important role in determining the final outcome.
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Original Article
Surgical Results of Open Reduction and Plating of Humeral Shaft Fractures
Management of humeral shaft fractures has been the subject of controversy (Böhler, Ekkernkamp and Muhr, Nast-Kolb and Schweiberer). The problem of non-union, wound infection and most important of all iatrogenic radial nerve palsy led many to favour a conservative approach.
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Original Article
Operative Treatment of Displaced Talar Neck Fractures
Talus is a weight bearing bone with peculiar anatomy and blood supply. It forms the ankle joint with the medial and lateral malleoli, subtalar joint with the calcaneum and talonavicular joint with the navicular bone.
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Others
A Case Report of Atasoy Antenna Procedure
The hook nail deformity is a relatively common problem after fingertip amputations. It is usually ignored but can be quite disabling.
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Original Article
Bone Mineral Density—Correlation between Quantitative Ultrasound Characteristics and Dual Energy X-ray Absorptiometry
Osteoporosis is well documented to be a significant determinant of the risk of fracture and its assessment in vivo has been based on various methods for measuring bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) has proven so far to be reasonably precise (about 1% to 2%) and accurate...
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.
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Original Article
Malaria Requiring Intensive Care
Malaria is an important and common infectious parasitic disease globally. It is associated with significant morbidity and mortality, especially in endemic areas.
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Original Article
Impact on Quality of Patient Care and Procedure Use in the Medical Intensive Care Unit (MICU) Following Reorganisation
Critical care is costly as it is labour intensive and involves expensive life support technology. In the United States, the intensive care units (ICUs) use about 15% of the total hospital cost or about 1% of the gross national product.
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Others
Traumatic Dislocation of the Testes
Traumatic dislocation of the testes is uncommon. The first case was reported by Claubry in 1818 in Paris, when a 20-year-old soldier was run over by a wagon resulting in bilateral suprapubic dislocation of his testes.
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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.
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Original Article
Double Level Fractures of the Femur Treated with Closed Intramedullary Nailing
Closed locked intramedullary nailing of the femur has become the accepted means of treating fractures of the femur. The use of locking nails has extended the technique from stable diaphyseal fracture patterns to nearly all fractures of the femur except for fractures at the very end of the bone...
Others
Osteoid Osteoma after a Stress Fracture of the Tibia: A Case Report
A 24-year-old man complained of left leg pain following 3 months of infantry training 6 years ago. There was no previous complaint of pain over his left leg and there was no trauma.
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Others
Reconstruction of a Supinated Hypoplastic Thumb with Combined Huber Transfer and Derotation Osteotomy: A Case Report
A 6-year-old Chinese girl presented with a deformity of the left thumb since birth. Her father has a similar deformity.
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Others
Extraarticular Villonodular Synovitis of the Tendoachilles: A Case Report
Pigmented villonodular synovitis is a progressive synovial lesion of uncertain aetiology associated with synovial-lined tissues of the joints, tendon sheaths and bursae. The incidence was 1.8 patients per million population.
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Others
Embolisation of a Leaking Pseudoaneurysm of the Main Artery Supplying a Replanted Arm: A Case Report
Pseudoaneurysms are conventionally treated by surgery. In recent years, non-surgical methods are being considered, including embolisation with wires, coils or gelfoam and anticoagulation.
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Others
Comparison of First Carpometacarpal Joint Arthrodesis with Contralateral Excision Arthroplasty in a Patient with Bilateral Saddle Joint Arthritis: A Case Report
The carpometacarpal joint (CMCJ) of the thumb is commonly afflicted with degenerative arthritis. Of the patients seeking surgical treatment, post-menopausal women outnumber men by a ratio of 15 to 1.
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Original Article
Hospitalised Low-risk Community-acquired Pneumonia: Outcome and Potential for Cost-savings
Community-acquired pneumonia (CAP) is a common illness with nearly 4 million adults diagnosed each year in USA with more than 600,000 hospita1isations. The associated cost of hospitalisation is enormous and approaches nearly US$4 billion per year.
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Original Article
Long-term Outcome and Disease Control in Near-fatal Asthma
Rising trends in mortality in asthma have been reported from many countries, including Asian countries such as Hong Kong. Asthma deaths have been associated with a number of avoidable factors such as deficiencies in personal and professional management that can potentially be remedied if identified.
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Others
9th Chapter of Surgeons’ Lecture: The Orthopaedic Surgeon: Historical Perspective, Ethical Considerations and the Future
The legacy of caring and humanitarianism has been the mission of the medical profession since the founding of Singapore by Sir Stamford Raffles in 1819. To this small fishing village in the Riau Archipelago on the southern tip of the Malay Peninsula came traders and entrepreneurs from China, India...
Original Article
A Study of Joint Mobility in a Normal Population
Joint mobility varies between individuals and factors such as age, sex, race and heredity influence the range of motion of a joint. Excessive mobility of a joint(s) or hypermobility is a feature found in normal individuals as well as in patients with connective tissue disorders such as Ehlers-Danlos syndrome,...
Original Article
Delayed Amputation in Lower Limb Trauma: An Analysis of Factors Leading to Delayed Amputation
The decision whether to amputate or to attempt a limb salvage procedure in a mangled extremity is a difficult one. Numerous protocols have been published in the literature to help surgeons in the decision making.
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Original Article
Establishment of Animal Models Using Experimental Rats for Allogeneic Tissue Transplantation and Quantitative Flow Cytometric Detection of Immunochimera
Allogeneic tissue and organ transplantation has long been an important medical issue, as it provides an effective treatment alternative for a broad spectrum of medical problems. It is essential to establish the animal models used for a specific type of allogeneic tissue or organ transplantation prior to its clinical...
Original Article
The Effect of Storage at -70°C and -150°C on the Torsion Properties of the Canine Femur
Allograft transplantation of bone has been established as a viable and useful reconstructive procedure when limb salvage is the option of choice. For bone allografts, this is thought to be due to the relatively avascular structure and that low-freezing or freeze-drying for periods beyond three months reduces cellular immunogenicity.
This...
Original Article
Use of Titanium Prosthesis to Bridge a Vertebral Gap in the Spine—A Preliminary Experimental Study
Bridging a vertebral gap in the spine is one of the commonest problems facing the spine surgeon after dealing with a tumour, infection or a fracture. The gold standard today is still the autogenous graft, though other solutions are the allograft, bone cement fashioned as a block, ceramics and...
Original Article
The Results of Autogenous Tibial Periosteal Transplants for Full Thickness Cartilage Defects in the Knee Joints of Pigs
Articular cartilage injuries to the knee are commonly seen by team doctors, sports physicians and orthopaedic surgeons. Despite many clinical as well as experimental studies on the healing of such defects, the ability to regenerate mature hyaline cartilage capable of withstanding daily functional stresses in the knee remains a...
Original Article
Extended Resection of Locally Advanced (T4) Stomach Cancer
Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years, it is the third (10.1%) most common cancer in males and the fifth (6.5%) most common cancer in females in Singapore.
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Original Article
Use of Low Molecular Weight Heparin for Prevention of Deep Vein Thrombosis in Total Knee Arthroplasty—A Study of its Efficacy in an Asian Population
The role of thromboprophylaxis in total knee replacement (TKR) remains controversial. In several reports, the incidence of deep vein thrombosis (DVT) has been significant.
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Original Article
Deep Vein Thrombosis after Total Knee Replacement
Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis, its incidence is quoted between 46% and 84% in various studies.
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Others
Management of Growth Arrest with Tissue-engineered Cells
Before I go on to the scientific aspects of my talk, I would like to pay tribute to Dr Yahya Cohen. Dr Cohen was born in Singapore of Jewish parents.
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Original Article
Surgical Results of Intercondylar Fractures of the Adult Femur
Fractures of the intercondylar region of the femur often resulted from high velocity accidents. This would lead to increased comminution and involvement of the articular surfaces, making them a complex group of injuries to treat.
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Original Article
Adverse Operative Risk Factors for Perforated Peptic Ulcer
Although there has been a significant decline in elective surgery for peptic ulcer disease with the introduction of H-2 blocker, the incidence of peptic ulcer perforation has remained relatively unchanged over the years. The mortality rate from perforated peptic ulcer remains high as more perforations occur in the elderly...
Others
A Case Report of Total Finger Joint Replacement Arthroplasty After Traumatic Amputation
A 41-year-old Chinese man had his dominant thumb, index and middle fingers caught by a wood-cutting machine while at work. He sustained a near-amputation of his middle finger through the proximal interphalangeal joint (PIPJ), with an intra-articular comminuted fracture of the head of the proximal phalanx (Fig. 1a) and...
Others
Re: Rikhraj I S, Tan C T, Tan S K, Teoh S H, Hastings G W. Use of Titanium Prosthesis to Bridge a Vertebral Gap in the Spine–A Preliminary Experimental Study. Ann Acad Med Singapore 1999; 28:20-4
In a recent issue of the Annals, Academy of Medicine, Singapore the above-mentioned paper was published. Figures 6 and 7 of the paper plot the displacement of bovine lumbar motion segments under torsion.
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Original Article
Biomechanical Study of C2 (Axis) Fracture: Effect of Restraint
In human, the occipito-atlanto-axial (C0-C1-C2) joint complex is an important region of the spine and often susceptible to impact injury in trauma. Traffic accidents frequently produce a distinct variety of fracture (or fracture-dislocation) of the upper cervical spine, characterised by a bilateral avulsion-fracture through the neural arch of C2...
Original Article
Results of Distal Radial Fractures Treated by Intra-focal Pin Fixation
Unstable fractures of the distal radius remain a challenge to orthopaedic surgeons. Unsatisfactory results are often associated with significant malunion.
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Review Article
Quality of Life in Long-Term Survivors of Intensive Care
Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying their acute medical problems. New interventions have been introduced with success determined by their ability to save lives.
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Review Article
Limitation of Life Support in the Critically Ill: The Hong Kong Perspective
Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly so in the specialty of intensive care where intensivists possess the necessary knowledge and tools to prolong life in many situations where patients would previously...
Original Article
Abdominal Complications after Cardiac Surgery
Despite intensive therapeutic efforts, both the incidence and mortality of gastrointestinal complications after cardiac surgery employing cardiopulmonary bypass (CPB) have not decreased during the last two decades. Gastric bleeding, ischaemic bowel disease, gallbladder disease, and pancreatitis are reportedly the most common complications.
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Review Article
An Introduction to Biodegradable Materials for Tissue Engineering Applications
The concept of tissue engineering arises from the need to develop an alternative method of treating patients suffering from tissue loss or organ failure. Current therapies in use today are not only expensive but often do not adequately fulfil their intended purpose.
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Others
Galeazzi-Equivalent Fracture in Children Associated with Tendon Entrapment—Report of Two Cases
A 12-year-old boy fell whilst running. On examination, there was swelling and deformity of the wrist and there was local tenderness of the distal third of the radius and the distal end of the distal ulna. Movement of all the fingers and thumb were limited by pain.
This article is...
Original Article
The Posterior Cruciate Ligament: An Anthropometric Study in Asians and Evaluation of Safe Limits for Bony Tunnel Creation During Reconstruction
The posterior cruciate ligament (PCL) provides the main restraint to posterior translation of the tibia on the femur and is stronger than its anterior counterpart. Indeed, it has been regarded by some authors as the primary stabiliser of the knee.
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Original Article
Advances in Surgical Treatment of Osteoporotic Fractures of the Spine
Osteoporosis is an important cause of fractures in the elderly. In the USA alone, at least 1.3 million fractures are attributed to osteoporosis a year.
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Commentary
The Bone and Joint Decade 2000-2010
With the ageing population, degeneration of joints and osteoporosis and the resultant disability pose big public health problems in many countries of the world. These, together with the more disabling infective and inflammatory diseases of joints and the all-pervasive trauma damage joints in hundreds of millions of people in...
Others
Magnetic Resonance Arthrography of the Labral-Ligamentous Complex of the Shoulder: An Update
Shoulder instability is a frequently encountered clinical problem in young active people following injury, particularly in athletes. The labral-ligamentous complex is increasingly recognised as being an important structural component that contributes to shoulder instability.
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Others
A Deceptive Cervical Lymph Node: A Solitary Spinal Osteochondroma
Osteochondromas are cartilage-capped bony exostoses that arise mainly from the metaphyses of long bones from a lateral displacement of the epiphyseal growth cartilage, but any bone formed by endochondral ossification (bones that develop from cartilage) may give rise to osteochondromas. Osteochondromas may arise in a solitary form or in...
Original Article
Limited Magnetic Resonance Imaging (MRI) and the Occult Hip Fracture
Worldwide, in the past decade, the application of magnetic resonance imaging (MRI) has increased tremendously in the management of musculoskeletal trauma. Not least is its application as a valuable diagnostic tool in occult hip fracture evaluation.
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Original Article
Extremity Osteosarcoma—A Southeast Asian Experience
Osteosarcoma is a highly malignant bone cancer occurring primarily in young patients. Although rare, it is still the commonest primary bone cancer seen in Southeast Asia.
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Review Article
Towards a Splint-free Repair for Flexor Tendon Injuries
The most problematic area in flexor tendon injuries is zone two. This zone is prone to injury as it is in the grasping part of the hand.
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Review Article
Biomechanics of the Shoulder
The shoulder is a complex of 5 articulating surfaces that together form the shoulder girdle. The glenohumeral joint together with the scapulothoracic articulation form the main components of the girdle.
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Review Article
Instrumentation in Spinal Surgery
Spinal instrumentation is defined as the use of mechanical devices that enhance or restore the segmental stability of the spine. Internal fixation of the spine began more than a hundred years ago and initially consisted of wires, and/or rods attached to the spine.
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Review Article
The Growth and Development of Orthopaedic Sports Medicine in Singapore
Orthopaedic sports medicine in Singapore took form as a subspecialty of orthopaedic surgery over a number of years. Several individuals contributed to it being set up as an orthopaedic subspecialty.
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Review Article
Paediatric Orthopaedics in Singapore
The name “Orthopaedic Surgery” is derived from the words “orthos” (meaning straight or to straighten) and “paido” (meaning child). Thus, it is not unexpected that paediatric orthopaedics was the first discipline within Orthopaedics to develop as a subspecialty.
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Others
Addresses at the 50th Anniversary Celebration of the Department of Orthopaedic Surgery, National University of Singapore on 5 April 2002
Over 200 guests were gathered at the Fullerton Hotel Ballroom on the 5th of April 2002 to commemorate the 50th anniversary of the Department of Orthopaedic Surgery, National University of Singapore. The event was dedicated to the teachers, past and present, for their commitment to education.
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Others
History of the Singapore Orthopaedic Association
The University of Malaya in Singapore was established in 1949. With this, the King Edward VII College of Medicine became the Faculty of Medicine, University of Malaya.
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Others
History of the Orthopaedic Specialty in Singapore
When the practice of orthopaedic surgery first began in Singapore, it was not a specialty in itself. There are no records as to when the first orthopaedic cases were managed, but it must have been when modern medicine was introduced into Singapore, at the beginning of the twentieth century...
Editorial
50th Anniversary Celebrations—Golden ……. but all is not gold
On an occasion such as this—the 50th anniversary of the inauguration of orthopaedic surgery as a specialty service in Singapore—acclaim, commendations, praise and endorsement of our achievements will be the order of the day. This issue of the Annals carries 13 articles representing the different facets of our achievement.
This...
Original Article
Myocardial Infarction in Singapore: A Nationwide 10-year Study of Multiethnic Differences in Incidence and Mortality
Rapid urbanisation and increasing affluence have improved the socioeconomic status of Asians. This, however, has brought with it new socioeconomic and medical problems resulting from the urbanised lifestyles entrenched in these newly industrialised economies.
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Commentary
Statins and Bone Morphogenetic Proteins: New Pathways in Bone Formation
Osteoporosis is a major public health problem causing considerable morbidity and mortality in Asian women. It is estimated that half of the world’s hip fractures will occur in Asia in 50 years’ time.
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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.
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Original Article
Influenza in Singapore: Assessing the Burden of Illness in the Community
Influenza is a major cause of morbidity and mortality worldwide. Morbidity in the working age group gives rise to frequent doctor visits and considerable sickness absence from work. Influenza in the elderly population and in high-risk groups results in hospitalisations and deaths due to complications of pneumonia.
This article is...
Others
A Case Report of Neurologically Unstable Fracture of the Lumbosacral Spine in a Patient with Ankylosing Spondylitis
Ankylosing spondylitis is associated with progressive ossification of the spinal ligaments and ankylosing of the facet joints leading to a totally stiff spine. It is often associated with osteoporosis due to chronic inflammation and disuse.
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Original Article
Epidemiology of Beta-haemolytic Group G Streptococcal Bacteraemia in Singapore (1996 to 1998)
Human isolates of group G streptococci (GGS) that form large colonies are similar to group A streptococci (GAS) in terms of virulence and cause a range of serious infections. These included infective endocarditis which had been emphasised in older reports1 but was found to be uncommon in later studies.
This...
Review Article
Bone Fragility in Asian and Caucasian Men
Bone fragility in men has been receiving greater attention during the last few years. Epidemiological studies have been done in Caucasian and Asian populations.
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Review Article
Steroid-induced Osteoporosis
Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed. The most important effects appear to be on bone formation due to direct effects on cells of the osteoblastic lineage although indirect effects related to...
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
Differentiation of Malignant Vertebral Collapse from Osteoporotic and Other Benign Causes Using Magnetic Resonance Imaging
An elderly patient presenting with backache and vertebral collapse on plain X-ray is a common clinical scenario and a diagnostic challenge. It is difficult to differentiate between benign and malignant causes for the vertebral collapse.
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Original Article
Outcomes of Acute Arthroscopic Repair and Conservative Treatment Following First Traumatic Dislocation of the Shoulder Joint in Young Patients
Traumatic dislocation of the shoulder is a serious problem especially in active and young patients. Shoulder instability and recurrent dislocation hinder patient activities.
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Others
From Genesis to Genes
I would like to thank the Singapore Orthopaedic Association (SOA) for inviting me to deliver this year’s SOA lecture. When your President, Dr AK Mitra first asked me to deliver the lecture, I felt deeply honoured but was rather hesitant about accepting it – honoured as this annual lecture...
Others
Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital
Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly population above the age of 65 will rise from 7.5% in 2002 to 18.9% by the year 2030.
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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
Book Review
A lot of young orthopaedic surgeons embark on research projects with little guidance. This book is especially directed towards young investigators in the Southeast Asian region.
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Others
Significance of the Lateral Epiphysis of the Acetabulum to Hip Joint Stability
Developmental dysplasia of the hip (DDH) remains one of the most difficult disorders to understand and treat in Paediatric Orthopaedics. The aetiology have not been clearly understood and therefore the management remains controversial.
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Original Article
Condensing Osteitis of the Medial Clavicle – An Intermediate-term Follow-up
Condensing osteitis of the clavicle is an idiopathic condition affecting the medial end of the clavicle, and is characterised by sclerosis and expansion of the inferior part of the clavicular head. The rarity of this disorder is highlighted by the experience of the senior author (SN Bell).
This article is...
Original Article
Contact Lens Microbial Keratitis and Prior Topical Steroid Use: A Disaster in the Making?
Topical steroid use in cornea ulcers is still a very contentious issue in ophthalmology. A recent review by Wilhelmus found that the use of topical steroids before the diagnosis of bacterial keratitis significantly predisposed eyes with preexisting corneal disease to ulcerative keratitis.
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Review Article
Medical Therapy in Heart Failure – Is Polypharmacy Necessary?
The clinical syndrome of heart failure is recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses. Heart failure is the end-stage of all heart diseases.
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Others
Plantar Dislocation of Lateral Tarsometatarsal Joint: A Case of Subtle Lisfranc Injury
Lisfranc fracture dislocations are uncommon injuries and the diagnosis may be easily missed. There are several variations and we present one such variant.
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Others
Thoracic Myelopathy Secondary to Ligamentum Flavum Ossification
Acquired thoracic spinal canal stenosis is an uncommon condition compared to myelopathy and radiculopathy frequently seen in the cervical and lumbar spine, respectively. Because the rib cage restricts its movement, the thoracic spine is less prone to degenerative changes in the disc and facet joints, which result in loss...
Original Article
Rising Trend of Anterior Cruciate Ligament Injuries in Females in a Regional Hospital
Female athletes are at a greater risk for injuries involving the anterior cruciate ligament (ACL) than their male counterparts in high schools and colleges in the United States. Noyes et al reported that 78% of all ACL injuries were non-contact in nature and they most often occurred on landing...
Original Article
Deep Hypothermic Circulatory Arrest in Adults Undergoing Aortic Surgery: Local Experience
The use of deep hypothermic circulatory arrest (DHCA) as a method of cerebral protection during aortic surgery was first described in 1975. Its use is based on 2 fundamental concepts.
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Others
Profunda Femoris Artery Pseudoaneurysm Presenting with Triad of Thigh Swelling, Bleeding and Anaemia
Pseudoaneurysms of the profunda femoris artery have been reported following blunt and penetrating trauma to the thigh, and orthopaedic procedures of the proximal femur. These pseudoaneurysms can present in various forms, such as a painful pulsatile mass, or even thigh compartment syndrome.
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Original Article
Cancellous Screw Fixation for Femoral Neck Fractures: One Hundred and Sixteen Patients
The incidence of hip fractures rises with increasing age, doubling for each decade beyond 50 years of age. With the increase in life expectancy and the accompanying ageing population, there has been an increase in the incidence of hip fractures from 1.17 per 1000 females >60 years old in...
Original Article
Deep Vein Thrombosis Following Hip Fracture and Prevalence of Hyperhomocysteinaemia in the Elderly
Western literature reports a high incidence of deep vein thrombosis (DVT) after hip surgery in the absence of prophylaxis. It is reported to be as high as 50% of which 20% to 30% are in the proximal vein.
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Original Article
Septic Arthritis after Arthroscopic Anterior Cruciate Ligament Reconstruction
Arthroscopic-guided reconstruction of the anterior cruciate ligament (ACL) is now recognised as the preferred reconstructive option in restoring anterior knee joint stability. According to a report by the American Academy of Orthopedic Surgeons on ACL reconstruction in October 2000, approximately 50,000 ACL surgeries were performed each year in the...
Original Article
Morbidity Following Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft
Rupture of the anterior cruciate ligament (ACL) impairs the stability of the knee, resulting in difficulty with athletic performance, increased risk of subsequent meniscal injury and increased risk of degenerative joint disease. Reconstruction of the ACL is a frequently performed procedure used to restore functional stability in ACL-deficient knees,...
Others
Severe Adult Chickenpox Infection Requiring Intensive Care
Chickenpox (varicella) in adults can be severe. It is frequently associated with pneumonia and immunosuppression as well as increased mortality rates.
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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...
Others
Necrotising Fasciitis and Traditional Medical Therapy – A Dangerous Liaison
The first case was a 54-year-old lady, with a history of insulin-dependent diabetes mellitus and hyperlipidaemia, who presented with bilateral hand pain and stiffness of 4 days’ duration.
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Others
Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening
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Original Article
Broadband Ultrasound Attenuation Reference Database for Southeast Asian Males and Females
Quantitative ultrasound (QUS) systems measuring the calcaneus are currently approved for the assessment of osteoporotic risks in Europe, Canada and the USA. A QUS bone sonometer basically measures, in ms–1 , how quickly sound travels through the bone, i.e., the velocity of sound (VOS) and, in dB MHz-1, how...
Original Article
Early Predictors of Mortality in Pneumococcal Bacteraemia
Streptococcus pneumoniae infection is the most common cause of community-acquired pneumonia worldwide.1 It has been associated with an approximately 10% rate of bacteraemia.2-4 Despite the advances in antibiotics, pneumococcal bacteraemia still carries a significant mortality rate.2-6
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Original Article
A Review of Clinical Pathway Data of 1663 Total Knee Arthroplasties in a Tertiary Institution in Singapore
Total knee arthroplasty (TKA) has been established as an effective treatment modality for patients with symptomatic knee arthritis. It provides predictable decrement in pain, correction of deformity and improved functional outcomes.
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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...
Images in Medicine
“Bone Block” and Congenital Spine Deformity
A 14-year-old female who presented with a limited range of neck motion with various congenital vertebral anomalies that included improper segmentation or extensive “fusion” of the cervical spine, hemivertebrae, and a right rigid convex thoracolumbar scoliosis (Figs. 1 and 2). She was diagnosed with Klippel-Feil syndrome (KFS) with congenital...
Original Article
Magnesium, Zinc, Copper, Manganese, and Selenium Levels in Postmenopausal Women with Osteoporosis. Can Magnesium Play a Key Role in Osteoporosis?
Osteoporosis is a condition in which an increased risk of fracture takes place due to a reduction of bone mineral content. It occurs as a result of an imbalance between bone formation and bone resorption.
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Original Article
Autologous Bone Marrow Plasma Injection after Arthroscopic Debridement for Elbow Tendinosis
Elbow tendinosis is a term used to describe a syndrome of pain involving the extensor or flexor tendon origin of the forearm musculature. It is a common problem in adults and it is called “medial” or “lateral epicondylitis” depending on the site of involvement.
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Letter to the Editor
Primary Hydatid Disease of the Humerus
Hydatid disease is a parasitic tapeworm infection caused by Echinococcus species. E.granulosus and E.alveolaris are the most common causes of hydatid disease in humans.
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Original Article
Recurrent Patellar Dislocation: Reappraising our Approach to Surgery
Traumatic patellar dislocations affect mainly adolescents and young adults. Up to 44% of patients will develop recurrent dislocation.
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Original Article
Triple Endobuttton Technique in Acromioclavicular Joint Reduction and Reconstruction
Acromioclavicular joint (ACJ) dislocation is a common injury often affecting young athletes. Cyclist, ice hockey players, weight lifters, rugby players and martial exponents are the most common athletes sustaining the injuries.
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Original Article
Return to Sports After Anterior Cruciate Ligament Reconstruction – A Review of Patients with Minimum 5-year Follow-up
Complete anterior cruciate ligament (ACL) rupture results in a mechanically unstable knee. ACL reconstruction is recommended in athletes to help restore knee stability for return to pivoting sports.
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Original Article
Clinical Evaluation of Arthroscopic-assisted Allograft Meniscal Transplantation
The menisci of the knee are fibro-cartilaginous structures essential for the normal biomechanic of the knee joint. They play a critical role in shock absorption, load transmission, joint lubrication and congruency, nutrition, stability of the knee and facilitating the rotation of the opposing articular surfaces of the joint.
This article...
Letter to the Editor
Renal Cell Carcinoma Bony Metastasis Treatment
Patellar metastases are extremely rare, ironically, primary tumours of the patella are more common than metastatic disease. A Medline search from 1960 to the present yielded only 23 reported cases of patellar metastases.
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Review Article
Osteochondral Lesions of the Talus
Osteochondral lesions of the talus are a known cause of chronic ankle pain. They are frequently found in the active population after ankle sprains.
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Original Article
The Natural History and Prognosticative Factors of Adult Extremity Soft Tissue Sarcomas: An Asian Perspective
Soft tissue sarcomas (STSs) are extremely rare tumours, making up about 1% of all malignancies. In Singapore, they accounted for 0.7% of all cancers in males and 0.5% of all cancers in females with 217 case presentations in the period between 1998 and 2002.
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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.
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Original Article
Effect of Autologous Mesenchymal Stem Cells on Biological Healing of Allografts in Critical-sized Tibial Defects Simulated in Adult Rabbits
Bridging of large bone defects is a challenging problem in orthopedic and reconstructive surgery. Options include vascularised bone autografts, non-vascularised bone autografts, allografts, bioceramics and custom-made prostheses.
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Original Article
The Need for a System of Prognostication in Skeletal Metastasis to Decide Best End-of-life Care – A Call to Arms
Decisions regarding potential surgery for metastatic disease are influenced by estimates of patient survival. For example, patients with long life expectancy may be appropriately treated with extensive resection and durable reconstruction to provide long lasting function and mobility; in contrast, a patient with a very short life expectancy may...
Original Article
Vascular Endothelial Growth Factor (VEGF) is Expressed During Articular Cartilage Growth and Re-expressed in Osteoarthritis
Growth factors are polypeptides that direct cells to proliferate, differentiate, migrate or produce matrix. They exert their effects by interacting with specific receptors on the surfaces of cells.
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Original Article
Effectiveness of Vacuum-assisted Closure (VAC) Therapy in the Healing of Chronic Diabetic Foot Ulcers
Diabetes mellitus is a common problem in Singapore, with an incidence of 8.2% in the local population aged between 18 and 69 in 2004. Ten per cent to 25% of diabetics developed foot ulcerations.
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Others
Chronic Achilles Tendon Rupture Treated with Two Turndown Flaps and Flexor Hallucis Longus Augmentation – Two-year Clinical Outcome
Chronic Achilles tendon rupture is a disabling condition resulting in ankle pain, weakened ankle plantarflexion and abnormal gait. Management of chronic ruptures is technically challenging with generally poorer outcomes and higher complication rates than that of acute repair. Current literature suggests this problem is still better tackled surgically although...
Original Article
Normative Data for Quantitative Calcaneal Ultrasound in Asian Children
Dual energy X-ray absorptiometry (DEXA) is currently the gold standard for the assessment of bone mineral density (BMD). It is the commonest tool used to predict fracture risk in patients at risk of osteoporosis. The limitation of DEXA is that it only measures bone density in two dimensions, and...
Original Article
Causes of Death in Hospitalised Human Immunodeficiency Virus (HIV)-infected Patients at a National Referral Centre in Singapore: A Retrospective Review from 2008 to 2010
The advent of the highly active antiretroviral therapy (HAART) era has greatly reduced the mortality and incidence of new diagnoses of acquired immune deficiency syndrome (AIDS)-defining illnesses (ADIs) in individuals infected with human immunodeficiency virus (HIV) in many countries. This has led to a paradigm shift in the management...
Original Article
Antibiotic Therapy and Clinical Outcomes of Pseudomonas Aeruginosa (PA) Bacteraemia
Pseudomonas aeruginosa (PA) is a virulent nosocomial pathogen and PA bacteraemia is associated with high mortality ranging from 18% to 59%. It is ranked among the top 3 gram-negative bacteria associated with bacteraemia. It is commonly reported in patients with cancer and in intensive care units (ICUs). PA bacteraemia...
Original Article
A 10-Year Profile of Trauma Admissions Caused by Interpersonal Violence: A Major Trauma Centre’s Experience
The World Health Organization (WHO) has divided violence into 3 categories: interpersonal violence, self-directed violence, and collective violence. Violence is defined as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has...
Letter to the Editor
Lemierre’s Syndrome: An Unusual Cause of Calf Abscess
Dear Editor,
Lemierre’s syndrome is a rare disease caused by Fusobacterium necrophorum, a Gram-negative anaerobic bacillus that is associated with oropharyngeal infections. We describe a case of a 16-year-old male presenting with acute calf abscess caused by an unusual organism, Fusobacterium necrophorum. Based on our review, this is the first...
Original Article
Electrocardiograph Changes, Troponin Levels and Cardiac Complications After Orthopaedic Surgery
Following orthopaedic surgery, approximately 5% of patients sustain cardiac complications which leads to increased morbidity and mortality. The mortality rate after hip fracture is as high as 10% to 26% at 6 months and cardiac-related death are common. Cardiac injury is potentially treatable and therefore early detection of myocardial...
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
Epidemiology and Clinical Evolution of Liver Cirrhosis in Singapore
Cirrhosis is the common end result of chronic damage to liver parenchyma caused by a variety of liver diseases. It results in replacement of liver tissue by fibrotic scar tissue and regenerating nodules, leading to progressive liver dysfunction and clinical complications such as portal hypertension, hepatocellular carcinoma (HCC), liver...
Original Article
Unipolar versus Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly: Is There a Difference?
Hip hemiarthoplasties are commonly performed for displaced femoral neck fractures. The advantages of hemiarthroplasty over internal fixation include earlier mobility, less reoperations and better functional outcome at 1 year.
Considerable differences of opinion exists regarding the choice between unipolar and bipolar designs. The main theoretical advantage of a bipolar over...
Letter to the Editor
Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive pathology lies anterior to the spinal cord – prolapsed intervertebral discs (PID), ossified posterior longitudinal ligament (OPLL), spondylodiscitis and retropulsion of fractured bony fragments. More...
Letter to the Editor
Single-level Anterior Corpectomy with Fusion versus 2-level Anterior Cervical Decompression with Fusion: A Prospective Controlled Study with 2-year Follow-up Using Cages for Fusion
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive pathology lies anterior to the spinal cord – prolapsed intervertebral discs (PID), ossified posterior longitudinal ligament (OPLL), spondylodiscitis and retropulsion of fractured bony fragments. More...
Original Article
An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit
Over the past 30 years, different versions of severity of illness scoring systems and prognostic models have been developed for prediction of patient outcomes in critical care. These physiological-based systems and models allow patients to be stratified according to their severity of illness and provide prediction of in-hospital mortality....
Original Article
Assessment of Age in Ulcerative Colitis Patients with Ileal Pouch Creation—An Evaluation of Outcomes
A total proctocolectomy is considered the standard of care in patients with ulcerative colitis (UC). The indications for this operation in patients with UC include failure of medical treatment or dysplastic changes following endoscopic evaluation. The timing of the surgery could hence be highly variable among patients.
This article is...
Original Article
Heterogeneity of non-cystic-fibrosis bronchiectasis in multiethnic Singapore: A prospective cohort study at a tertiary pulmonology centre
Bronchiectasis is a chronic lung disease of significant morbidity and mortality. The pathological hallmarks of the disease are abnormal dilatation of airways resulting from recurrent inflammation, airway obstruction and mucous plugging. The past 2 decades have seen a significant increase in its prevalence, exceeding the threshold of 5 per...
Editorial
Tackling osteoporosis and fragility fractures in Singapore
A shift in worldwide population ageing demographics has occurred in the 21st century. The longevity miracle is most keenly felt in Singapore, a young nation which gained its independence only in 1965, but has one of the fastest growing ageing populations in the world. It is estimated that by...
Commentary
Optimum early orthopaedic surgery in COVID-19 patients
Multiple guidelines have been established regarding the management of COVID-19 patients. However, there remains a paucity regarding specific guidelines on the optimal timing for surgeries in COVID-19 patients requiring early orthopaedic surgery. This paper aims to provide evidence-based recommendations regarding the timing to proceed with early orthopaedic surgeries in...
Review Article
Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review
Coronavirus disease 2019 (COVID-19) has spread rapidly from China to other countries around the world, with the World Health Organization characterising it as a global pandemic on 12 March 2020. The number of fatalities owing to COVID-19 is escalating rapidly. COVID-19 is caused by the Severe Acute Respiratory Syndrome...
Review Article
Obesity in COVID-19: A Systematic Review and Meta-analysis
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is established that increasing age and comorbidities such as cardiovascular diseases are associated with risk of infection, more severe disease and adverse outcomes. Obesity is an epidemic globally, causing...
Original Article
Transscaphoid Perilunate Fracture/Dislocations—Results of Surgical Treatment
Transscaphoid perilunate fracture/dislocations are relatively uncommon injuries of the wrist, constituting about 3% of all carpal injuries. However, it accounts for more than half of perilunate dislocations, the dorsal variant being by far the more prevalent.
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