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...
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,...
Editorial
Shock index: Easy to use, but can it predict outcomes following major abdominal emergency surgery?
Major abdominal emergency surgery (MAES) is commonly performed for various potentially life-threatening intra-abdominal surgical conditions with high perioperative mortality of up to 45%.1 Certain...
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...
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...
Letter to the Editor
Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial
Dear Editor,
Emergence from anaesthesia and deep sedation is the transition from unconsciousness to the return of awareness and airway reflexes. The chief patterns of...
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...
Letter to the Editor
Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
Dear Editor,
The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an...
Letter to the Editor
Sedation in gastrointestinal endoscopy in Singapore
Dear Editor,
I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use...
Letter to the Editor
Non-anaesthesiologists administering propofol in the Singapore context
Dear Editor,
Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid...
Letter to the Editor
Sedation by non-anaesthesiologists in gastrointestinal endoscopy
Dear Editor,
We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy...
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...
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...
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...
Others
Pericardial Injury Following Severe Sepsis from Faecal Peritonitis—A Case Report on the Use of Continuous Cardiac Output Monitoring
The intermittent manual bolus thermodilution method is the most common means of determining cardiac output in critically ill patients. Although widely used, there are...
Review Article
An Overview of Anaesthetic Issues in Phaeochromocytoma
New developments in technology, monitoring and pharmacology over the last decade have improved our understanding of phaeochromocytoma and its management. This review summarises the...
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,...
Original Article
Is it Feasible to Use Magnesium Sulphate as a Hypotensive Agent in Oral and Maxillofacial Surgery?
Although deliberate hypotension during surgery may potentially cause organ ischaemia, in particular of the myocardium and cerebrum, it is widely used as an adjuvant...
Others
Postanaesthetic Shivering—A Comparison of Thiopentone and Propofol
The incidence of shivering following general anaesthesia varies from 5% to 65%. Postanaesthetic shivering may increase tissue oxygen demand by as much as 500%...
Others
Sudden Profound Hypoxaemia in the Intensive Care Unit—A Case Report
Significant arterial hypoxaemia is defined as a partial pressure of oxygen (PaO2) that is less than 60 mmHg or a percentage of oxyhaemoglobin (%...
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....
Commentary
Management Training in Critical Care Medicine
Critical care medicine as a specialty has grown rapidly, both clinically and academically, over the past 25 years. In the USA, certification of competence...
Others
Combined High-frequency Ventilation (CHFV) in the Treatment of Acute Lung Injury—A Case Report
The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The...
Review Article
Critical Care Medicine in the Western Pacific Region
The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and...
Review Article
Critical Care—The Worldwide Perspective
Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s....
Original Article
Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery
The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...
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.
This article is...
Original Article
Diabetes Insipidus in Neurosurgical Patients
Diabetes insipidus (DI) is a syndrome characterised by the excretion of abnormally large volumes of dilute urine. It occurs uncommonly in neurosurgical patients, but...
Original Article
Predictors of Long-term Outcome in Severe Head Injury
Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993.
This article is available only...
Original Article
Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team
Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute...
Original Article
Audit of 2431 Admissions to the Surgical Intensive Care Unit, Singapore General Hospital
The Singapore General Hospital is a 1700-bedded tertiary hospital with subspecialty intensive care units (ICUs), i.e. Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU, Medical ICU,...
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)...
Editorial
Intensivists for the Intensive Care Unit—Do They Make a Difference?
Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have...
Others
Subclavian-oesophageal Fistula as a Complication of Foreign Body Ingestion: A Case Report
Ingested foreign bodies are a common condition in the practice of Otolaryngology. In particular, there is no doubt a greater tendency in the local...
Review Article
Epidural Analgesia in Obstetrics
Most obstetric anaesthetists have their favourite epidural concoction for use in labour, This paper surveys the variation in techniques of drug delivery and types...
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...
Review Article
Systemic Lupus Erythematosus in Singapore
Systemic lupus erythematosus (SLE) or lupus (“wolf” in Latin) in short, is an autoimmune disorder of unknown aetiology(ies) and characterised by diverse clinical manifestations...
Original Article
An In vitro Evaluation of Epidural Catheters: Tensile Strength and Resistance to Kinking
In the current era of increasing economic and medicolegal pressures, it is imperative that equipment-related limitations and complications be reduced to a minimum. Epidural...
Original Article
Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks
Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good...
Others
The Use of Magnesium Sulphate in the Intensive Care Management of an Asian Patient with Tetanus
A 29-year old Thai construction worker, previously well, was admitted to our Orthopaedic Department for sudden onset of lower back pain. Physical examination showed...
Others
Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report
A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior...
Others
Bilateral Caudate Infarct—A Case Report
The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply...
Original Article
Changing the Institutional Practice of Prolonged Mechanical Ventilation after Coronary Artery Bypass Graft Surgery to Early Extubation
In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists...
Original Article
The Outcome of Trial Off Catheter after Acute Retention of Urine
Acute retention of urine (ARU) is the commonest urological condition requiring emergency admission to hospital and is usually managed by urethral catheterisation. Previously, patients...
Review Article
Controversies in Anaesthesia—Designer Drugs
The discovery of new drugs in anaesthesia previously relied completely on chance. Chemical compounds produced by pharmaceutical companies were screened by a variety of...
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...
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...
Others
Radial Nerve Injury after Intravenous Cannulation at the Wrist—A Case Report
A 44-year-old male, right-handed and ASA 1 bus driver presented for elective mastoidectomy under general anaesthesia. Preoperative venous cannulation with a 20G cannula (Angiocath™)...
Review Article
Current Therapeutic Strategies in Glomerulonephritis
Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients...
Original Article
Dissemination of Respiratory Secretions During Tracheal Tube Suctioning in an Intensive Care Unit
Tracheal tube suctioning is frequently performed in critically ill patients. This procedure often results in dissemination of droplets from the patient’s respiratory tract with...
Others
Perioperative Wheezing—A Report of Three Cases
Perioperative “wheezing” can be due to upper or lower airway obstruction. The signs and sounds of upper airway obstruction are typically worse during inspiration,...
Others
The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report
A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral...
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,...
Others
A Case Report of the Use of Magnesium Sulphate during Anaesthesia in a Patient who had Adrenalectomy for Phaeochromocytoma
Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells of the body derived from neural crest tissue. They may secrete both adrenaline and noradrenaline in...
Original Article
Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery
Both intubation and extubation are processes associated with blood pressure and heart rate flux. While many studies have been carried out on the changes...
Commentary
Transurethral Surgery and the Adductor Spasm
Bladder tumours frequently arise from the posterolateral wall of the bladder1 over the course of the obturator nerve. It is during transurethral resection of...
Others
Subcutaneous Emphysema and Pneumomediastinum after Endotracheal Anaesthesia
Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes.
This article is available only as...
Original Article
Total Intravenous Anaesthesia Using 3-in-1 Mixture of Propofol, Alfentanil and Mivacurium
Total intravenous anaesthesia (TIVA) implies achieving the 3 components of anaesthesia (hypnosis, analgesia and muscle relaxation) by the administration of anaesthetics via the intravenous...
Original Article
The Predictive Value of Intraoperative ST-segment Monitoring as a Marker of Myocardial Injury
Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1...
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...
Original Article
Fibre-optic Aided Bougie (FAB) for Simulated Difficult Tracheal Intubation
Difficult intubation remains a key problem1 and the value of a flexible introducer (gum elastic or wire) as a first approach is well recognised...
Others
A Case Report on the Treatment of Intractable Anal Pain from Metastatic Carcinoma of the Cervix
Unremitting pain remained a primary therapeutic challenge in cancer patients. Both opioids and non-opioids are often the main stay of therapy for many.
This article...
Original Article
Intravenous Regional Anaesthesia Using Lignocaine and Tramadol
Intravenous regional anaesthesia (IVRA) has a reported success rate of between 94% and 98% for upper limb surgery. Limitations to its use include the...
Review Article
Catheter-related Infection: Diagnosis, Prevention and Treatment
Intravascular catheters are indispensable for patient care. Despite advances in catheter technology and patient care, catheter infection remains a significant clinical problem.
This article is...
Others
Book Review
This handbook serves an important function for Intensive Care Units in Singapore. It is a collective effort of 35 specialists in 5 different institutions...
Review Article
Intra-abdominal Hypertension—Implications for the Intensive Care Physician
Although the detrimental effects of raised intra-abdominal pressure have been known for over 100 years, it is only in the last two decades that...
Review Article
Anaemia in the Critically Ill—The Optimal Haematocrit
The function of haemoglobin (Hb) is to transport oxygen to the tissues. Approximately 97% of oxygen is transported via Hb, while 3% is transported...
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...
Review Article
Simulation-based Training at the University of Pittsburgh
In the domain of medical education of both the general public and healthcare professionals, the next decade will present both challenges and opportunities centred...
Original Article
Retinol Palmitate Counteracts Oxidative Injury During Experimental Septic Shock
Gram-negative bacteria induced septic shock, a condition with high mortality, is frequently seen in critical care medicine. The wall of gram-negative bacteria consists of...
Original Article
The Practice of Foregoing Life Support in the Critically Ill “Old Old”: A Singapore Perspective
Studies on the foregoing of life support (FLS) in North America, Europe and Australia have shown diversity in terms of the incidence, decision-making process...
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...
Review Article
Pulse Dye Densitometry: A Novel Bedside Monitor of Circulating Blood Volume
The monitoring of circulating blood volume (CBV) is important in the care and management of critically ill patients. Progressive blood volume depletion, if unmonitored...
Others
Case Report: Catheter-Related Epidural Abscess
Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to...
Original Article
A Twelve-year Review of Radical Cystectomies in Singapore General Hospital
Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of...
Others
A Case of Pulmonary Haemorrhage Following Jet Ventilation for Vocal Cord Surgery
Laryngospasm occurring at extubation is not an uncommon complication seen with use of endotracheal tubes and laryngeal mask airway. We report a case of...
Others
Subdural Block—From a Spinal? A Case Report
There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an...
Original Article
Problems Related to Epidural Analgesia for Postoperative Pain Control
Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with...
Original Article
Audit of Total Parenteral Nutrition in an Adult Surgical Intensive Care
Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to...
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...
Others
Clinical Update on Managing the Obstructed Airway
Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians...
Others
Anaesthetic Considerations for Lung Volume Reduction Surgery—A Case Report
Only until a few years ago, the only surgical alternative for patients with severe emphysema was lung transplantation. However, with transplantation, there are problems...
Original Article
Two-year Outcome of Normal-birth-weight Infants Admitted to a Singapore Neonatal Intensive Care Unit
With the rapid advances in the field of neonatal intensive care, the focus of interest has been on the very-low-birthweight (VLBW) infant in recent...
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...
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...
Original Article
Osteoporotic Hip Fractures in Singapore—Costs and Patient’s Outcome
Singapore is facing a rapidly ageing population. Osteoporosis, which is an age-related illness, will become an increasing problem. Osteoporotic hip fracture, because of the...
Others
Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma – Case Reports
The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to...
Original Article
A Prospective Audit of Critical Incidents in Anaesthesia in a University Teaching Hospital
Despite the highest standards of training, practice and equipment, morbidity and mortality due to anaesthesia still occur. These risks are difficult to quantify, and...
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...
Others
Bowel Surgery for Epithelial Ovarian Cancer – An Early Case Series
Epithelial ovarian cancer is the leading cause of death in patients with gynaecological malignancies in Singapore and developed countries, the main reason being the...
Original Article
Hepatic Resection for Colorectal Metastases to the Liver: The National Cancer Centre/Singapore General Hospital Experience
Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy...
Review Article
Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
The practice of gastrointestinal (GI) endoscopy over the last 3 decades has seen both a rise in volume of routine procedures, and an increase...
Editorial
Ensuring safe sedation during gastroendoscopy
Gastrointestinal (GI) endoscopy started in Singapore in 1968 with diagnostic endoscopic gastric examination, using flexible fibre-optics GI endoscopy. Fibre-optic flexible sigmoidoscopy and colonoscopy were...
Original Article
Patients who Talk and Deteriorate: A New Look at an Old Problem
Patients who talk after traumatic brain injury (TBI) and then subsequently deteriorate into a coma are defined as those with an initial Glasgow Coma...
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...
Original Article
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...
Others
An Unusual Cause of Pulmonary Haemorrhage in a Patient with Rheumatoid Arthritis
Strongyloides stercoralis is an intestinal nematode which causes a chronic but usually asymptomatic infection in humans. However, in immunocompromised patients, parasitic larvae can develop...
Review Article
Marijuana in Pregnancy
Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include...
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...
Others
Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context
Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44...
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.
This article is available...
Letter to the Editor
An Unexpected Left Hydrothorax after Left Internal Jugular Venous Catheterisation for Total Parental Nutrition and Antibiotics
Percutaneous indwelling central venous catheters are commonly used for a variety of medical and surgical indications. There are various complications associated with the insertion...
Original Article
The Impact of Experiential Learning on NUS Medical Students: Our Experience With Task Trainers and Human-patient Simulation
The realisation that students have different cognitive and learning styles has had major implications on medical curriculum design efforts. If the student’s learning style...
Original Article
SARS in Singapore – Predictors of Disease Severity
Severe acute respiratory syndrome (SARS) is a recently defined illness caused by a novel coronavirus. The outbreak in Singapore originated from Hong Kong via...
Others
Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Neonatal Hepatic Abscess in Preterm Infants: A Rare Entity
Liver abscess has been recognised since the time of Hippocrates. The first report on liver abscess was published by Bright in 1836.1 However, reports...
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...
Original Article
Contemporary Results of Endopyelotomy for Ureteropelvic Junction Obstruction
Ureteropelvic junction obstruction (UPJO) results in the gradual dilatation of the renal collecting system, and may lead to deterioration of renal function and pain....
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...
Original Article
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...
Original Article
Measuring the Quality of Care of Diabetic Patients at the Specialist Outpatient Clinics in Public Hospitals in Singapore
Singapore is a country with a high prevalence of diabetes mellitus, 1 8.2% amongst its population aged between 18 and 69 years,2 and is...
Others
The Role of Electrophysiology in the Diagnosis and Management of Cervical Spondylotic Myelopathy
Cervical spondylosis is an extremely common condition managed by both physicians and surgeons in daily clinical practice. Cervical spondylotic myelopathy (CSM), resulting from longstanding...
Review Article
The Role of Surgery in High-grade Glioma – Is Surgical Resection Justified? A Review of the Current Knowledge
High-grade glioma (malignant glioma) is the most common primary intra-axial tumour of the central nervous system (CNS). Despite recent therapeutic advances in glioma treatment,...
Original Article
Epidemiology, Management and Treatment Outcome of Medulloblastoma in Singapore
Medulloblastoma (MBL) is the most common type of malignant brain tumour in childhood. It belongs to the group of tumours known as primitive neuroectodermal...
Review Article
Recovery and Regeneration after Spinal Cord Injury: A Review and Summary of Recent Literature
Spinal cord injury (SCI), whether of traumatic or non-traumatic aetiology, often results in significant and catastrophic dysfunction and disability. It physically and psychologically affects...
Original Article
The Effect of Temperature on Illness Severity in Emergency Department Congestive Heart Failure Patients
Congestive heart failure (CHF) is one of the leading causes of morbidity and mortality around the world. It is estimated that more than 5...
Original Article
Factors Predictive of Outcome in Childhood Stroke in an Asian Population
Strokes in childhood are generally considered to be rare with an incidence of about 2.7 per 100 000 children per year.1 The aetiologies of...
Original Article
Retinoblastoma: A Recent Experience at the National University Hospital, Singapore
Retinoblastoma is the most common primary intraocular malignancy in infants and children.1 Worldwide, the incidence is 1 in 18,000 to 34,000 live births with...
Letter to the Editor
Reply from Author: Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters
We thank Dr Nicholas Chua et al for their interest in our review article. We agree and appreciate the experience and comments by the...
Letter to the Editor
Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters
We thank the authors for a comprehensive review on the role of interventional pain therapies used in cancer pain as well as a informative...
Review Article
Development of a Diabetes Registry to Improve Quality of Care in the National Healthcare Group in Singapore
In the last decade, the use of electronic medical records (EMR) has been widely recommended as a method for reducing errors, improving the quality...
Original Article
Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases
The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent...
Original Article
Are New Resuscitation Guidelines Better? Experience of an Asian Metropolitan Hospital
Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have...
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...
Original Article
Development of Bariatric Surgery: The Effectiveness of a Multi-disciplinary Weight Management Programme in Hong Kong
Obesity is one of the most common chronic illnesses in the Western World with a frequency of 10% to 15%. It causes or exacerbates...
Original Article
rTSβ as a Novel 5-fluorouracil Resistance Marker of Colorectal Cancer: A Preliminary Study
Although colorectal cancer is common in Western countries, in the past, it has been uncommon in Asian countries. However, its prevalence has gradually been...
Original Article
Presentation and Outcome Amongst Older Singaporeans Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS): Does Age Alone Drive Excess Mortality?
Singapore is a country of high income with a low level human immunodeficiency virus (HIV) epidemic, the yearly incidence of disease currently standing at...
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...
Original Article
Male Breast Cancer in Singapore: 15 Years of Experience at a Single Tertiary Institution
Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its...
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...
Original Article
Assessment of the American Joint Committee on Cancer 7th Edition Staging for Localised Prostate Cancer in Asia Treated with External Beam Radiotherapy
Prostate cancer (PCa) is the second most frequently diagnosed cancer in men, with a worldwide incidence of approximately 900,000 in 2008. Internationally, there is...
Original Article
Validation of the Paediatric Hearing Impairment Caregiver Experience (PHICE) Questionnaire
The stress experienced by parents of children with hearing impairment (HI) has been studied over the past 2 decades. Increased parenting stress is often...
Original Article
A Comparison of the Short-term Morbidity and Mortality Between Late Preterm and Term Newborns
Late preterm infants are defined as those who are born between the gestational age (GA) from 34 weeks and 0/7 days through 36 weeks...
Letter to the Editor
Recommendations for standards of neuromuscular monitoring during anaesthesia
Dear Editor,
We presented recommendations for neuromuscular monitoring during anaesthesia, which were approved by the Council of the College of Anaesthesiologists, Singapore in September 2019...
Original Article
Evidence-Based Guidelines on the Use of Opioids in Chronic Non-Cancer Pain—A Consensus Statement by the Pain Association of Singapore Task Force
Studies show that the incidence of chronic pain is approximately 18% in Australia and developed countries in Europe. In Asia, data from Hong Kong...
Original Article
The Use of Complementary and Alternative Medicine in Chronic Pain Patients in Singapore: A Single-Centre Study
Chronic pain is a prevalent disease that is often diffi cult to manage. According to a World Health Organisation survey, the worldwide prevalence of...
Original Article
Management Plan to Reduce Risks in Perioperative Care of Patients with Obstructive Sleep Apnoea Averts the Need for Presurgical Polysomnography
A significant proportion of patients with underlying obstructive sleepapnoea (OSA) remain undiagnosed when they present for surgery. Epidemiologic data have placed
the prevalence in the...
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...
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...
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...
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...
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...
Letter to the Editor
A survey of Singapore anaesthesiologists for practice and prevention of peri-operative hypothermia in adult surgical patients
Core temperature is the temperature of blood and internal organs; influenced by biorhythm, metabolism, activity and hormones. It is regulated within a narrow range,...
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...
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...