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Optimising percutaneous valve-in-valve TAVI with bioprosthetic valve fracture

Dear Editor, Percutaneous transcatheter aortic valve implantation (TAVI) has become an established therapy for inoperable patients, for high, intermediate and low surgical-risk patients over 65...

Comparing the effectiveness, safety and cost of teleconsultation versus face-to-face model of pharmacist-led anticoagulation clinic: A single institution experience

Dear Editor, Teleconsultation-based (TELE) anticoagulation clinic (ACC) is an alternative modality, but its use in Singapore’s clinical setting has not been well studied. In Tan...

Direct oral anticoagulant: Looking beyond convenience

Since the 2010 Food and Drug Administration approval of Dabigatran as the first non-vitamin-K antagonist oral anticoagulants or direct oral anticoagulants (DOACs) as it...

Strategies to prevent cardiovascular disease in Singapore: A call to action from Singapore Heart Foundation, Singapore Cardiac Society and Chapter of Cardiologists of the Academy of Medicine, Singapore

Despite the success of Singapore’s public health systems in providing medical care through the country, there is still much to be achieved in terms...

Cardiovascular effects of COVID-19 in children

The global coronavirus disease 2019 (COVID-19) pandemic was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While the respiratory system is  the...

COVID-19: The virus, vaccine and paediatric heart

The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality around the world. The development of vaccines has cushioned the effect...

Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests

Congenital heart diseases (CHDs) are the most common major congenital anomaly at up to 28%1 and are responsible for 5.7% of all infant mortality.2...

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...

Leveraging ChatGPT to aid patient education on coronary angiogram

Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of...

Effects of sex on clinical outcomes of hypertrophic cardiomyopathy in Singapore

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiomyopathy.1 The phenotypic expression of HCM is highly diversified with varying extents of myocardial hypertrophy, which can...

Promise and pitfalls of ChatGPT for patient education on coronary angiogram

The past decade has seen extraordinary and rapid progress in the field of artificial intelligence (AI), which produces computer systems capable of performing tasks...

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

Direct oral anticoagulants (DOACs) have become entrenched as the dominant anticoagulant over the last decade for patients with venous thrombosis and atrial fibrillation.1 Compared...

Preferences for oral anticoagulant medications for managing atrial fibrillation

Dear Editor, Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against the elevated risks of...

Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes

Sudden cardiac death in athletes during exercise is rare, with an estimated incidence of 1–2 per 100,000 people per year in young athletes,1 and...

Improving electrocardiogram interpretation in Asian athletes: A call to action

The field of sports cardiology has evolved substantially over the past 2 decades due to improved understanding of the athlete’s heart, causes of sudden...

Outcomes of selexipag for treatment of pulmonary arterial hypertension in an Asian population

Dear Editor, Pulmonary arterial hypertension (PAH) is a progressive condition characterised by increased pulmonary arterial pressure and pulmonary vascular resistance, resulting in right ventricular dysfunction...

Suboptimal adherence to medical therapy in patients undergoing lower limb angioplasty in Singapore

Dear Editor, Chronic limb-threatening ischaemia (CLTI) is the advanced stage of peripheral arterial disease (PAD) and patients with this condition face a very high risk...

Approach to bradyarrhythmias: A proposed algorithm

Bradyarrhythmias are common and occur in both physiological and pathological states. Bradycardia is defined as a heart rate of fewer than 60 beats per...

Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis

Atrial fibrillation (AF) is a pertinent health condition that is seeing a sustained rise in global incidence and prevalence.1 In particular, paroxysmal AF (PAF),...

Catheter ablation as first-line treatment for paroxysmal atrial fibrillation

Pharmacotherapy has been the mainstay of atrial fibrillation (AF) treatment. As AF progresses from paroxysmal to persistent, electrical and structural remodelling of the atria...

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

The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and...

Sex and ethnicity modified high 1-year mortality in patients in Singapore with newly diagnosed atrial fibrillation

Atrial fibrillation (AF) is the most common clinically significant arrhythmia and is associated with increased risks of stroke, dementia, heart failure (HF) and death.1...

Different strokes for different folks

Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey’s observation of fibrillating auricles in open chest animal models in 1628. Willem Einthoven...

Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction

Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to...

Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction

With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction...

Iatrogenic atrial septal defect after catheter ablation—to close or not to close?

Dear Editor, Transseptal access to the left heart is increasingly performed for electrophysiological procedures and for structural heart disease interventions such as balloon mitral valvuloplasty...

Cardiac sarcoidosis: Difficulties in diagnosis and treatment

Sarcoidosis is a multisystem, granulomatous disorder of unknown aetiology. It affects the lungs in 90% of cases, but is also known to affect other...

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...

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...

Out-of-hospital cardiac arrest in Singapore: Can we do better?

Cardiac arrests are unpredictable events that frequently result in death or significant residual morbidity among survivors. These sudden events affect not only the individual,...

Sepsis and cardiovascular events: The story so far

Sepsis is a state of life-threatening organ dysfunction that results from a dysregulated host immune response to infection.1 Sepsis is a common condition that...

Previous history of hyperthyroidism in emergency department patients with atrial fibrillation does not increase the risk of thromboembolism and death

Dear Editor, Atrial fibrillation (AF) is frequently encountered in the emergency department (ED) and is a major risk factor for thromboembolic events. The clinical decision...

Pressures, indexes and peripheral arterial disease: Time to rethink our approach?

Most patients with peripheral arterial disease (PAD) are asymptomatic. Despite the absence of symptoms, these patients have a significantly increased risk of death and...

Drug Treatment of Hypercholesterolaemia

Serum cholesterol has been established as a major risk factor for coronary heart disease (CHD). There is a linear association between serum cholesterol level...

Goldberger’s Triad in Dilated Cardiomyopathy—Can it Predict the Severity of Left Ventricular Dysfunction?

In 1982, Goldberger described a novel electrocardiogram (ECG) triad that was highly specific for patients with dilated cardiomyopathy and congestive heart failure (attributable to...

Thyroid Storm Presenting as Jaundice and Complete Heart Block

Thyroid storm is defined as a severe and often life-threatening exacerbation of thyrotoxicosis which is usually characterised by hyperthermia, tachycardia, severe agitation and altered...

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...

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 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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Simultaneous Transcatheter Valvuloplasty and Amplatzer Septal Occlusion for Pulmonary Valvar Stenosis and Secundum Atrial Septal Defect

Congenital pulmonary valvar stenosis (PVS) and secundum atrial septal defect (ASD) are relatively common forms of congenital heart disease (CHD). Since the first successful...

Electrocardiographic Abnormalities in Combined Hypercalcaemia and Hypokalaemia—Case Report

The electrocardiographic abnormalities in isolated hypercalcaemia and hypokalaemia have been well documented in the literature. However, electrocardiogram (ECG) findings in combined hypercalcaemia and hypokalaemia...

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...

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...

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...

Interventional Electrophysiology and its Role in the Treatment of Cardiac Arrhythmia

Cardiac arrhythmias are disorders of the electrical system of the heart which can present as benign ectopics or as life-threatening arrhythmias and sudden cardiac...

Incessant Ectopic Atrial Tachycardia and Tachycardia-related Cardiomyopathy: Therapeutic Options and Potential for Cure

Incessant ectopic atria tachycardia (IEAT) is a rare and insidious arrhythmia which is frequently misdiagnosed and if untreated, leads to ‘exhaustion’ of the myocardium...

Intracoronary Brachytherapy: The Beginning of the End of Restenosis?

Restenosis remains a major clinical problem 20 years after the introduction of coronary angioplasty by Andreas Gruentzig in the treatment of coronary artery disease....

The Effect of Fenofibrate on Insulin Sensitivity and Plasma Lipid Profile in Non diabetic Males with Low High Density Lipoprotein/Dyslipidaemic Syndrome

Hyperinsulinaemia and insulin resistance have been postulated to relate directly to both hypertension and coronary artery disease in type II diabetes and possibly also...

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....

Homocysteine and Atherosclerotic Disease: The Epidemiologic Evidence

Homocysteine is a thiol-containing amino acid formed during the metabolism of methionine. The metabolic fate of homocysteine may be influenced by the alterations in...

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...

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...

Trends in Mortality, Incidence, Hospitalisation, Cardiac Procedures and Outcomes of Care for Coronary Heart Disease in Singapore, 1991-1996

In line with trends in many high-income countries, Singapore has experienced some declines in mortality from coronary heart disease (CHD) since the 1980s. Whether...

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...

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...

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....

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...

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...

Initial Experience With an Autocapture Pacemaker System

The longevity of a pacemaker generator varies directly with the total deliverable amount of electrical charge (Q, in coulombs) and inversely with the rate...

The Differential Diagnosis of Supraventricular Tachycardia Using Clinical and Electrocardiographic Features

Noninvasive evaluation of the mechanism of the arrhythmia is important in the management of supraventricular tachycardia (SVT). It guides one in the choice of...

Cardiac Marker Point-of-care Testing: Evaluation of Rapid On-site Biochemical Marker Analysis for Diagnosis of Acute Myocardial Infarction

In the present era of revascularisation therapy, rapid and accurate diagnosis of acute myocardial infarction (AMI) is important, as these patients may benefit from...

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...

Cardiovascular Disease: Genes and Public Health

The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is...

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...

Incidence of Ischaemic Heart Disease and Stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study

Comparisons of disease frequency in different ethnic groups help to unravel the contributions of nature and nurture in their aetiology and to identify environmental...

Technetium-99m Sestamibi for the Assessment of Myocardial Salvage Following Reperfusion Therapy in Acute Myocardial Infarction

Reperfusion therapy for acute myocardial infarction is feasible with thrombolytic therapy as well as acute percutaneous transluminal coronary angioplasty (PTCA). Both modalities of treatment...

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...

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,...

Diagnosis of Pacemaker Lead Infection Using Transoesophageal Echocardiography: A Case Report

The expanding indications for permanent cardiac pacing mandate an awareness of the potential complications associated with device implantation. After failure of pacing and sensing,...

Systemic antibiotic prophylaxis for recurrent infective flares in children and adolescents with atopic dermatitis

Dear Editor, Atopic dermatitis (AD) is a chronic inflammatory skin disease, affecting approximately 20% of children in Singapore.1 It is associated with skin barrier defects2...

Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality worldwide. The development of mRNA vaccines has heralded much hope in...

Isolated Non-compaction of Ventricular Myocardium: A Report of Three Cases

Non-compaction of ventricular myocardium is a rare morphogenic arrest of compaction of the ventricular myocardial fibres during intrauterine life. Usually, the left ventricle is...

Impairment of Endothelial Function—A Possible Mechanism for Atherosclerosis of a High-fat Meal Intake

The impairment of endothelial vasodilatory function has been considered an early event in atherogenesis. This has been studied in association with various cardiovascular risk...

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....

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...

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...

A Preliminary Study of the Utility of Combined Cardiac Markers in the Evaluation of Patients Presenting Early with Suspected Acute Coronary Syndrome

The management of patients presenting with chest pain of recent onset can prove to be a diagnostic challenge. These patients vary from having atypical...

Homocysteine, Folate and Vitamin B12 as Risk Factors for Acute Myocardial Infarction in a Southeast Asian Population

Since the beginning of the last decade, hyperhomocysteinaemia has been identified as a risk factor for acute coronary syndromes. A few large prospective studies...

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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....

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...

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...

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...

Allopurinol Hypersensitivity Syndrome and Acute Myocardial Infarction—Two Case Reports

Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe multiorgan disease. It usually begins 2 to 6 weeks (up...

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

Oral anticoagulation therapy is used for a number of conditions, namely deep venous thrombosis, pulmonary embolism, mechanical heart valves, embolic stroke as well as...

Two Case Reports on Incessant Left Ventricular Tachycardia: Curative Therapy with Radiofrequency Ablation

Left ventricular tachycardia is a recognisable condition in patients with otherwise structurally normal heart. It may arise from various foci in the left ventricle. This...

Prevention of Restenosis after Percutaneous Coronary Intervention: The Continuing Challenge

Since Andreas Gruntzig first demonstrated its use in humans in 1977, the utilisation of percutaneous transluminal coronary angioplasty (PTCA) has grown tremendously throughout the...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

A Case Series of Sotalol-induced Torsade de Pointes in Patients with Atrial Fibrillation – A Tale with a Twist

In the light of the Cardiac Arrhythmia Suppression Trial (CAST) which suggested that class I antiarrhythmics may be linked to an increase in mortality,...

The Use and Abuse of Steroids in Perinatal Medicine

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

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...

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...

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...

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...

Immediate and Mid-Term Safety and Efficacy of Single Lead VDD Pacemakers for Patients with Atrioventricular Block and Normal Sinus Node Function—A Single Centre Experience

In patients requiring a cardiac pacemaker for any indication, the ideal goal of therapy is to achieve atrioventricular (AV) synchrony. This replicates the normal...

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...

Torsades de pointes in a woman presenting with syncope

A 57-year-old woman presented with first onset syncope, which was witnessed by her family members. It occurred in the middle of a conversation and...

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...

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...

Spironolactone Does Not Prevent Restenosis After Coronary Stenting in Humans

High restenosis rate, which has been documented to occur in approximately 30% to 50% of cases, still remains a major concern, although percutaneous transluminal...

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...

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...

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...

Nuclear Cardiology in Singapore: A Review

The past decade has witnessed significant advances and rapid growth in the field of nuclear cardiology. In Singapore, our experience has been similar to...

Stem Cell Cardiomyoplasty: State-of-the-Art

Congestive heart failure (CHF) remains the most common diagnosis made in cardiology wards today. At present, no long-term therapeutic option for end-stage CHF is...

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...

Coronary Artery Disease: Comprehensive Evaluation by Cardiovascular Magnetic Resonance Imaging

Coronary artery disease (CAD) is a major health problem worldwide. With advances in CAD intervention and improvements in treatment and management of CAD, there...

Drug-eluting Stents: The End of Restenosis?

Percutaneous coronary intervention (PCI) is the preferred revascularisation approach for most patients with coronary artery disease because, with comparable clinical outcomes in selected patients,...

Coronary Artery Ectasia: A Ten-year Experience in a Tertiary Hospital in Singapore

Coronary artery ectasia (CAE) is the abnormal dilatation of a segment of the coronary artery to a diameter of at least 1.5 times that...

Pilot Survey of the Diagnosis and Management of Heart Failure in Primary Care: A Singaporean Perspective

Congestive heart failure is an increasingly common disorder and a major cause of morbidity and mortality in developed countries around the world. It is...

High-sensitivity C-reactive Protein is Predictive of Medium-term Cardiac Outcome in High-risk Asian Patients Presenting With Chest Pain Syndrome Without Myocardial Infarction

Patients with chest pain often pose a diagnostic conundrum to the attending physician especially when symptoms are not typical of angina and the electrocardiogram...

Cardiovascular Medicine and Surgery in Singapore: The Next Lap

Fourteen years ago, an editorial in the Annals announced the coming of age of cardiology in Singapore. Among the issues raised in that editorial...

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....

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...

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...

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...

Clinical Indications for Positron Emission Tomography (PET) Scanning

The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their...

Clinical Applications of Positron Emission Tomography in Cardiology: A Review

Ischaemic heart disease associated with depressed left ventricular function is a common clinical management dilemma. There is overwhelming evidence that such patients have a...

Positron Emission Tomography – A Vital Component of Molecular Imaging

Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of...

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...

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...

16th Seah Cheng Siang Memorial Lecture – The Changing Face of Cardiology Practice, Training and Research in Singapore

Professor Seah Cheng Siang was one of the most illustrious physicians of his era. During his professional career, he held the following positions: Head,...

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...

Building Collaboration in Cardiac Imaging

Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery...

Guidelines on Cardiac CT in Singapore (2006)

The heart is difficult to image because of its complex wall motion and variability of the cardiac cycle. Recent advances in 16 and 64-slice...

The Association of Smoking with Components of the Metabolic Syndrome in Non-diabetic Patients

Metabolic syndrome (MS) is conceptualised as a constellation of physiologic or anthropometric abnormalities. Typically, it includes excess weight, hyperglycaemia, elevated blood pressure, low concentration...

Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis

Coronary artery disease (CAD), also called coronary heart disease, is the leading cause of death for both men and women. CAD is usually caused...

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...

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...

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...

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...

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...

Concomitant Coronary Artery Disease Among Asian Ischaemic Stroke Patients

Coronary artery disease (CAD) is the leading cause of mortality following ischaemic stroke. The annual risk for myocardial infarction following ischaemic stroke is approximately...

Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative

Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms...

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...

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...

Risk Factor Profile and Treatment Patterns of Patients with Atherothrombosis in Singapore: Insight from the REACH Registry

Atherothrombosis is a global problem that affects every ethnic group. It can lead to ischemic stroke, myocardial infarction or vascular death. This article is available...

Non-compaction Cardiomyopathy Presenting with Classical Angina Pectoris

Non-compaction cardiomyopathy (NCC) is an unclassified cardiomyopathy, previously known as “spongy left ventricular myocardium”. It is characterised by prominent myocardial trabeculations and deep intertrabecular...

A Case of Myopericarditis in a Patient with Methicillin-resistant Staphylococcus aureus Community-acquired Pneumonia

We described a healthy and physically active 41-year-old man who presented to a private practitioner with right axillary pain and fever. Physical examination revealed...

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...

The Relation Between Insulin Resistance Determined by Haemostatic Modelling and Slow Coronary Flow

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

Improving Access to Outpatient Cardiac Care at the National Heart Centre – A Partnership Between Specialists and Primary Care

There is evidence that shows that the use of healthcare delivered by private providers, particularly procedures and hospital care, depends on supply. For example,...

Pattern and Outcome of Subsidised Referrals to Cardiology Specialist Outpatient Clinics

Singapore faces an increasing demand for public healthcare from an ageing population in need of chronic care. At our cardiology specialist outpatient clinics, the...

Phaeochromocytoma the Great Mimicker: A Case Report

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

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...

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...

The Angiographic Aspects of Myocardial Bridges in Turkish Patients who have Undergone Coronary Angiography

Myocardial bridge, intramural coronary artery, coronary artery over bridging and myocardial loop are essentially the different terms used to designate the same phenomenon. Myocardial...

Upper Limb Ischaemia – A Single Centre Experience

Upper limb ischaemia is an uncommon entity which presents less commonly as compared to lower limb ischaemia, and has a wide range of aetiology...

Management of Acute ST-Elevation Myocardial Infarction: Reperfusion Options

Cardiovascular disease is a leading cause of death globally. More than 920,000 myocardial infarctions (MI) are diagnosed annually in the United States. Of these,...

A Case of Acute Myocardial Infarction 24 hours after Acute Ischaemic Stroke

It is well known that thrombolysis for acute myocardial infarction (AMI) may lead to disintegration of pre-existing intracardiac thrombi with subsequent cerebral embolisation. It...

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...

The Growing Burden of Cardiovascular Disease: Role of the Arterial-Cardiac Interaction

World Heart Day was inaugurated to increase global awareness that cardiovascular disease (CVD) is the world’s leading cause of death, claiming, according to the...

Comparison of Cardiac Output Measurement by Arterial Waveform Analysis and Pulmonary Artery Catheter in Mitral Stenosis

Cardiac output (CO) is a vital measurement that influences clinical decision-making. Although thermodilution via a pulmonary artery catheter (PAC) is considered the gold standard...

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...

Unusual Pacemaker Lead Placement in an Unsuspecting Heart

A 51-year-old man, with a negative cardiac medical history, presented with symptomatic 2:1 atrioventricular block. A permanent pacemaker was implanted. This article is available only...

Embolised Injection Needle Fragment to the Heart, Mimicking a Subcutaneous Charm Needle

Embolisation of a fragmented injection needle to the heart is rare, even in intravenous drug abusers. The presence of an embolised needle fragment to...

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...

Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients

The term “stroke” comprises all diseases in which a region of the brain is transiently or continuously affected by ischaemia or haemorrhage, and/or in...

Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis

Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the...

Risk Factors and Clinical Outcomes for Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients with Normal Serum Creatinine

Contrast-induced nephropathy (CIN) is a common complication post-percutaneous coronary intervention (PCI). CINis associated with increased morbidity, mortality, prolonged hospitalisation and long-term renal impairment. This article...

Brachial Approach for Coronary Angiography and Intervention: Totally Obsolete, or a Feasible Alternative When Radial Access is Not Possible?

The possible methods of reaching the coronary vasculature using a percutaneous technique are limitless: the radial, femoral, brachial, ulnar, subclavian and axillary arteries, and...

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...

Angioplasty on an Infarct-related Anomalous Right Coronary Artery Arising from Posterior Coronary Sinus

A 60-year-old chronic smoker had delayed presentation (>18 hours) of acute inferior myocardial infarction with electrocardiogram showing 1.0 mm ST-segment elevation in leads II,...

Complete Atrioventricular Block Complicating Acute Anterior Myocardial Infarction can be Reversed with Acute Coronary Angioplasty

Complete atrioventricular block (AVB) develops in more than 5% of patients with myocardial infarction (MI). These patients have poorer outcomes compared to those without...

Acute Myocardial Infarction in Pregnant Women

Acute myocardial infarction (AMI) is an important cause of mortality and morbidity worldwide. It typically occurs in middle-aged or elderly people with cardiovascular risk...

Risk Stratification for Sudden Cardiac Death after Acute Myocardial Infarction

In today’s modern era of evidence-based medicine and interventional cardiology, most patients who suffer an acute myocardial infarction (AMI) are started on medication with...

Adjunctive Pharmacologic Agents and Mechanical Devices in Primary Percutaneous Coronary Intervention

Primary percutaneous coronary intervention (PPCI) has been shown to be superior to thrombolysis in patients presenting with ST-segment elevation acute myocardial infarction (STEMI), with...

Management of Antiplatelet Therapy During Acute Percutaneous Coronary Intervention: New Strategies and Therapeutics

Platelet adhesion, activation, and aggregation are stimulated during an acute coronary syndrome (ACS), the result of intimal injury due to rupture of an atherosclerotic...

Risk Assessment Models in Acute Coronary Syndromes and Their Applicability in Singapore

Strategies for managing cardiovascular disease are evolving rapidly. This evolution and improvement in care is responsible for reducing mortality especially in patients presenting with...

Current Trends in Diagnostic Biomarkers of Acute Coronary Syndrome

Advances in our understanding of the pathophysiology of acute coronary syndrome (ACS) have led to the marked increase in development of biomarkers for diagnosis,...

Update on Clinical Imaging of Coronary Plaque in Acute Coronary Syndrome

Acute coronary syndrome (ACS) encompasses the clinical spectrum of unstable angina (UA) and acute myocardial infarction (AMI). Most ACS are precipitated by luminal thrombi...

Panic Attack and its Correlation with Acute Coronary Syndrome – More Than Just a Diagnosis of Exclusion

Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for...

Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?

In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence...

Clinical and Angiographic Findings of Complete Atrioventricular Block in Acute Inferior Myocardial Infarction

Complete atrioventricular block (AVB) complicates inferior wall myocardial infarction (MI) in 11% to 15% of cases. It usually clusters with conditions indicative of poor...

Reperfusion Strategy and Mortality in ST-Elevation Myocardial Infarction among Patients with and without Impaired Renal Function

Randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fi brinolytic therapy in the treatment of ST-segment elevation myocardial...

Gender Disparity in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes – Does it Still Exist in Contemporary Practice?

Globally, cardiovascular disease (CVD) is the single most common cause of death among women; and in parallel with an increasing life expectancy, the proportion...

The Impact of Gender on the Outcomes of Invasive versus Conservative Management of Patients with Non-ST-Segment Elevation Myocardial Infarction

Recent studies have suggested differences in clinical outcomes between men and women following acute myocardial infarction (AMI). Some studies have indicated poorer survival of...

Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study...

Acute Coronary Syndrome: from Epidemiology to Treatment

The term “acute coronary syndrome” (ACS) was introduced a decade ago to describe a spectrum of conditions resulting in acute myocardial ischaemia. It comprises...

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...

Off-Pump versus On-Pump Coronary Artery Bypass Procedures: Postoperative Renal Complications in an Asian Population

To date, the major part of routine cardiac surgery is performed using extracorporeal circulation with cardioplegic arrest. Regardless the technique of cardioplegia, temporary renal...

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...

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...

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...

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...

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...

Catheter Entrapment During Cardiac Electrophysiology Study

A 50-year-old man underwent cardiac electrophysiology study for palpitations. Under fluoroscopic guidance, 1 deflectable decapolar and 2 quadripolar diagnostic catheters were introduced smoothly into the...

Treatment of Coronary In-stent Restenosis with Drug-eluting Balloon Catheter: Real-world Outcome and Literature Review

Dear Editor, Currently, coronary stent implantation is employed in approximately 90% of percutaneous coronary intervention (PCI) cases. Despite the use of drug-eluting stents (DES), coronary...

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...

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...

Long-term Outcomes of Medical Therapy Versus Coronary Revascularisation in Patients with Intermediate Stenoses Guided by Pressure Wire

Although coronary angiography has been used as the “gold standard” imaging technique for the diagnosis of coronary artery disease, it is essentially a lumenogram...

Chest Pain, Something is Not Right…Or Left

A 46-year-old female was referred for evaluation of central chest pain unrelated to exertion. She was known to have diabetes mellitus, hypertension, and dyslipidaemia....

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...

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...

A Novel “Box Lesion” Minimally Invasive Totally Thoracoscopic Surgical Ablation for Atrial Fibrillation

  Atrial fibrillation (AF) is the most common and severe cardiac arrhythmia. It affects 0.4% to 1% of the general population, and the prevalence of...

Improved door-to-balloon time for primary percutaneous coronary intervention for patients conveyed via emergency ambulance service

Early reperfusion of ST-segment elevation myocardial infarction (STEMI) has been shown to result in better outcomes,1-3 and guidelines for treatment of STEMI recommend a...

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...

Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging

Transthyretin amyloidosis (or ATTR amyloidosis) is an under-recognised multisystemic disorder, arising from misfolding of transthyretin proteins into insoluble amyloid fibrils. As amyloid fibrils deposit...

New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore

Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown....

ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series

Coronavirus disease 2019 (COVID-19) has been associated with thromboembolic phenomenon in the early phase of disease. Growing evidence suggests a hypercoagulable state as well...

Medical management of PAD: Expand or consolidate?

In this issue of the Annals, a rapid review of adherence to evidence-based medical treatment highlights an important and underappreciated aspect of the management...

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...

Dynamic mitral regurgitation treated with MitraClip

The dynamic nature of mitral regurgitation (MR) has been well appreciated but clinically under-recognised. In addition, evidence on therapeutic options for dynamic MR has...

Percutaneous paravalvular leak repair for severe aortic regurgitation after transcatheter aortic valve implantation (TAVI)

Paravalvular leaks (PVLs) are not uncommon after surgical valve replacement. The need for re-operation for clinically significant leaks is between 1 and 3%. Percutaneous...

Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there...

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...

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,...

Cerebral venous thrombosis in a patient with mild COVID-19 infection

Emerging reports suggest venous and arterial thromboembolic diseases can complicate recovery from COVID-19. Postulated mechanisms include hypercoagulability, hypoxia, immobilisation, excessive inflammation and diffuse intravascular...

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...