Letter to the Editor
vNOTES hysterectomy with a homemade glove port: Initial experience in Singapore
Dear Editor,
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an established surgical method of performing hysterectomy via the vaginal route and is one of the latest editions to the realm of minimally invasive surgery. Since the first vNOTES performed by Su et al. in Taiwan in 2012, vNOTES has...
Letter to the Editor
A review on adverse airway events during anaesthesia over 6 years in a tertiary referral hospital
Dear Editor,
Comprehensive reviews of perioperative critical airway events (CAE) have been conducted through audits and closed claims analyses. However, there is currently limited published data specific to Singapore. Our study aims to analyse CAE at a tertiary hospital in Singapore, ascertain their frequency, identify risk factors, and compare findings...
Original Article
Long-term survival and clinical implications of allogeneic stem cell transplantation in relapse/refractory lymphoma: A 20-year Singapore experience
Over the past few decades, a wide array of novel therapies has become available for the treatment of relapsed/refractory (R/R) lymphoma. Despite these advancements, outcomes and the durability of disease control remain poor for many patients. While autologous hematopoietic stem cell transplantation (auto-HSCT) may be appropriate for some lymphoma...
Letter to the Editor
COVID-19 residual symptoms and adverse drug reactions after oral antiviral therapy in the Singapore primary care setting
Dear Editor,
The COVID-19 pandemic remains a significant public health threat with over 7 million deaths worldwide (as of 14 January 2024).1 In Singapore, oral antivirals (OAVs) nirmatrelvir/ritonavir and molnupiravir were approved in 2022 for treating mild-to-moderate COVID-19 in adults at risk of progression to severe disease.2,3 Clinical trials in...
Original Article
Impact of family and caregiver factors on development and behaviours in maltreated young children
Child maltreatment is defined as the neglect and abuse of children under 18 years old. It encompasses physical/emotional ill-treatment, sexual abuse, negligence and/or exploitation that causes harm to the child.1 Evidence has shown that Adverse Childhood Experiences (ACEs), such as maltreatment experienced during childhood, have a significant impact on...
Original Article
Assessing the impact of frailty in elderly patients undergoing emergency laparotomies in Singapore
The ageing population is a growing global phenomenon. In 2019, 14.4% of the population in Singapore, equivalent to 3.9 million people, were aged 65 years or older.1 This percentage is expected to increase to 25% by 2030, primarily due to increased life expectancy and lower fertility rates.1 Consequently, older...
Editorial
The value of frailty assessments in older surgical patients undergoing emergency laparotomies in Singapore
Mortality in emergency laparotomy (EL) far exceeds that of elective bowel surgery, and standards for the National Emergency Laparotomy Audit (NELA) in the UK were introduced due to the high mortality within 1 month of EL.1 In Singapore, 30-day mortality varies between 5.4% and 14.7% after EL.2,3 However, 30-day...
Letter to the Editor
Oral antiviral utilisation among older adults with COVID-19 in primary care: A population-wide study during successive Omicron waves in Singapore
Dear Editor,
Studies have repeatedly demonstrated the real-world effectiveness of oral antivirals (OAVs) in preventing hospitalisation and death in patients with mild-to-moderate COVID-19 at high risk for progression to severe COVID-19 when initiated within 5 days of symptom onset, even during waves of Omicron transmission.1 However, there is a need...
Original Article
Frailty-aware surgical care: Validation of Hospital Frailty Risk Score (HFRS) in older surgical patients
Frailty is a clinically recognisable state of vulnerability in older people, resulting from age-associated decline in physiological reserves and function across multiple organ systems, such that the ability to cope with acute stressors is compromised.1 Frailty is prevalent among older people2 and is associated with higher rates of utilisation...
Letter to the Editor
Development of immediate and chronic spontaneous urticaria following mRNA COVID-19 vaccination: Tolerability of revaccination and immunological study
Dear Editor,
Coronavirus 2019 (COVID-19) vaccination remains one of the key public health measures against the SARS-CoV-2 infection, significantly reducing illness severity and mortality rates. Urticaria and/or angioedema are cutaneous reactions that have been reported in response to messenger RNA (mRNA) COVID-19 vaccination and potentially affect fitness for revaccination.1...
Letter to the Editor
Perinatal outcomes of pregnancies affected by COVID-19 in Singapore: A cohort study
Pregnant women and infants were not spared from the coronavirus disease 2019 (COVID-19) after it was first identified in December 2019.1,2 In the beginning of the pandemic, a lack of data on transmission risks and outcomes of pregnancies affected by SARS-CoV-2, impacted perinatal clinical decision-making.1,3 We report the perinatal...
Letter to the Editor
Outcomes of COVID-19 infection in patients on dialysis and kidney transplant recipients: A single-centre audit
Dear Editor,
Patients with end-stage kidney disease (ESKD) are at increased risk of adverse outcomes following COVID-19 infection. Their vulnerability stems from multiple factors including kidney failure, comorbid illnesses, close contact in the haemodialysis centre, and transplant immunosuppression. European registry data in the pre-vaccination era report a COVID-19 mortality rate...
Letter to the Editor
The practice patterns and perceptions of surgeons in Singapore regarding breast-conserving surgery
Dear Editor,
Breast-conserving surgery (BCS) is often the preferred treatment in operable breast cancer.1 While tumour biology and systemic therapy are major determinants of disease control, surgical effectiveness remains a key factor in ipsilateral breast tumour recurrence.1 As heterogeneity in surgical approach has been observed, we sought to understand Singaporean...
Commentary
Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground
In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....
Review Article
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 primary infectious target of SARS-CoV-2, systemic symptoms are fairly common and organ systems throughout the body can be affected with multisystem organ failure in the...
Original Article
Long COVID prevalence, risk factors and impact of vaccination in the paediatric population: A survey study in Singapore
On 5 May 2023, more than 3 years since the start of the COVID-19 pandemic, the World Health Organization (WHO) declared that COVID-19 no longer constituted a public health emergency. Despite high numbers of children and younger persons (CYPs) having acute COVID-19,1 information on the quality of health and...
Original Article
Thiazide and thiazide-like diuretics associated with improved cardiovascular and renal outcomes for chronic kidney disease patients
Chronic kidney disease (CKD) is an increasingly pressing global health issue due to its strong link to serious complications such as end stage renal disease (ESRD), cardiovascular disease (CVD) and mortality.1 Over the last few decades, its impact has become more severe, moving from 27th to 18th on the...
Editorial
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 of the virus and thus, provided hope in the fight against the disease.1 Yet, there are still small battles with COVID-19, at the bench and...
Letter to the Editor
Breast conservation treatment and frozen section analysis of margins
Dear Editor,
Re. Surgical margins assessment reduces re-excision rates in breast-conserving surgery I read with interest the article by Woon et al. published in a recent issue of the Annals on the reduction of re-excision rates with the use of intraoperative frozen section (FS) analysis.1 This certainly has the potential...
Editorial
Micronutrients and kidney health
Chronic kidney disease (CKD) is a structural and functional disorder of the kidney caused by many diseases, such as diabetes, hypertension and glomerular disease.1 There are many factors that contribute to the development and progression of CKD, and often, we do not look at the exposure of heavy metals...
Letter to the Editor
A perfect match: The story of robotics in gynaecology
Dear Editor,
The first use of surgical robotics started in the domain of orthopaedic and urological surgery. However, it was the initial concept of using a robot in performing remote damage control surgeries on the battlefield that sparked the commercialisation of robotic surgical technology for use in operating rooms.1 The...
Original Article
Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore
The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe symptoms of COVID-19, losing loved ones to the disease, financial insecurity, and social isolation. Furthermore, children and youths experienced disruption to their usual routine such...
Original Article
Impact of COVID-19 on mental health and social service provision in Singapore: Learnings from a descriptive mixed-methods study for future resource planning
Coronavirus disease 2019 (COVID-19) was declared a global health emergency by the World Health Organization in January 2020.1 Singapore reported its first case of COVID-19 on 23 January 2020 and the subsequent emergence of clusters led to a string of restrictions to contain the outbreak and protect the health...
Editorial
Impact of COVID-19 on mental health and healthcare service delivery
The COVID-19 pandemic has claimed more than 6.8 million lives globally.2 While there is yet a cure for the disease, vaccines are now available to minimise transmission risk and protect against severe infection. However, COVID-19 vaccines have had a mixed reception, with concerns of their side effects and of...
Letter to the Editor
Robotic surgery in morbidly obese women with endometrial cancer in Singapore
Dear Editor,
The standard of care for endometrial cancer is a total hysterectomy with bilateral salpingo-oophorectomy, and pelvic lymph node dissection (THBSO-PLND). Obesity is a known risk factor for endometrial cancer, and obese patients are challenging to operate on due to their anatomy and comorbidities. A recent database search showed...
Letter to the Editor
Delayed treatment with nirmatrelvir/ritonavir could remain effective in patients with Omicron BA2.2 variant of COVID-19
Dear Editor,
In late February 2022, the Omicron BA.2.2 subvariant drove the outbreak of COVID-19 and rapidly spread through many parts of the world. Omicron-infected individuals aged ≥80 years who are unvaccinated are particularly at high risk of poor outcomes.
COVID-19 vaccines and antiviral therapeutics have protected individuals most at risk...
Letter to the Editor
Rash characteristics of paediatric patients with COVID-19 in Singapore
Dear Editor,
Children with COVID-19 infection can present with a variable spectrum of clinical manifestations, and sometimes mucocutaneous manifestations can be the only manifestation of COVID-19 infection in children.1,2,3 We report 4 cases of paediatric patients who had COVID-19 with mucocutaneous involvement, admitted to a tertiary children’s hospital in Singapore....
Original Article
Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome
A spectrum of immune dysregulation has been described following SARS-CoV-2 infections—from the cytokine storm in the acute phase, to hyperinflammatory syndromes that occur after the resolution of the initial infection.1 Multisystem inflammatory syndrome (MIS) was first reported in children in April 2020 as a hyperinflammatory syndrome with features similar...
Letter to the Editor
Association between self-care and chronic kidney disease in patients with type 2 diabetes mellitus
Dear Editor,
Chronic kidney disease (CKD) is one of the key complications occurring in 25–40% of patients with type 2 diabetes mellitus (T2DM).1 Our earlier study also showed that CKD was present in 53% of patients with T2DM recruited from a secondary care diabetes centre and primary care polyclinic...
Letter to the Editor
Surgical margins assessment reduces re-excision rates in breast-conserving surgery
Dear Editor,
Breast-conserving surgery (BCS) followed by radiation therapy for breast cancer offers improved cosmetic results and comparable long-term survival rates as mastectomy.1 However, BCS is associated with a higher risk for local recurrence, and published literature has reported re-excision rates as high as 20–70% due to positive resection...
Original Article
Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients
The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with solid and haematological malignancies to SARS-CoV-2 infections.1,2 Global efforts to combat SARS-CoV-2 led to the unprecedented rapid development of multiple vaccines, with reported efficacies of...
Editorial
Early COVID-19 booster is beneficial in cancer patients
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in Wuhan, China, on 31 December 20191 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare systems around the world, and rendered...
Letter to the Editor
A strategy to make COVID-19 vaccination more accessible to the elderly
Dear Editor,
Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services.
While the...
Review Article
The Omicron-transformer: Rise of the subvariants in the age of vaccines
The emergence and evolution of SARS-CoV-2 have been publicly tracked in unprecedented detail through a combination of intensive genomic sequencing and open-access sharing of data.1 This surveillance information describes how waves of COVID-19 infections have been driven by the emergence of new variants of concern (VOCs) and their subvariants....
Review Article
National surgical antibiotic prophylaxis guideline in Singapore
Surgical antibiotic prophylaxis (SAP) refers to the administration of antibiotics prior to clean and clean-contaminated surgeries to prevent postoperative surgical site infections (SSIs). An optimal SAP should be highly effective in preventing SSI. An ideal prophylactic antibiotic regimen is: (1) effective against pathogens—generally skin flora—most likely to contaminate the...
Original Article
Multisystem inflammatory syndrome in children in Singapore
While children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulting in coronavirus disease 2019 (COVID-19) have milder manifestations compared to adults,1,2 a rare multisystem inflammatory syndrome leading to multiorgan failure and shock (multisystem inflammatory syndrome in children ) has been recognised to affect children with exposure to...
Editorial
Multisystem inflammatory syndrome in children: A unique manifestation of COVID-19
During the coronavirus disease 2019 (COVID-19) pandemic, children have been relatively spared from the severe symptomatic infection affecting adults, particularly the elderly and those with comorbidities. One of the most challenging aspects of paediatric SARS-CoV-2 infection has been the discovery of a unique late manifestation of infection characterised by...
Review Article
Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations
Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into an ongoing global pandemic.2 In May...
Letter to the Editor
Teaching and learning during the COVID-19 pandemic: Perspectives of medical students in Singapore
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has resulted in many changes to medical education, including the site and mode of teaching, conducting of examinations and a shift towards prioritising the mastery of clinical skills relevant to infection control. Hence, Ng et al.’s suggestions on how to maximise learning...
Letter to the Editor
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 (BMV), left atrial appendage closure (LAAC) and transcatheter mitral valve repair (TMVr). Most of the iatrogenic atrial septal defects (iASDs) close spontaneously, and for those...
Letter to the Editor
Neuralgic amyotrophy in COVID-19 infection and after vaccination
Dear Editor,
Various neurological manifestations associated with coronavirus disease 2019 (COVID-19) have been described,1 conditions which left a significant proportion of patients with permanent disability. Continued vigilance is crucial with emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants that cause the disease. Vaccination against COVID-19 remains the...
Original Article
Epidemiological trends and outcomes of children with aural foreign bodies in Singapore
Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to their inquisitive minds and experimental nature.1 Aetiologies for aural FBs include accidental or intentional insertion of FBs into body orifices, ear irritation caused by rhinitis...
Original Article
Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore
Within 3 weeks of the World Health Organization declaring the COVID-19 pandemic on 11 March 2020, the Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) developed a set of nutrition guidelines that addresses issues on nutrition assessment; timing and feeding route; caloric...
Editorial
Challenges and considerations in delivering nutritional therapy in the ICU during COVID-19 pandemic
Coronavirus disease 2019 (COVID-19) has created unprecedented challenges for healthcare workers in Singapore and across the world. Providing clinical nutrition and metabolic care to patients with COVID-19 has been highly challenging. In this issue of the Annals, Lew et al.1 reported the results of a multicentre retrospective observational study...
Letter to the Editor
BNT162B2 COVID-19 mRNA vaccination did not promote substantial anti-syncytin-1 antibody production nor mRNA transfer to breast milk in an exploratory pilot study
Dear Editor,
Vaccine hesitancy still threatens global efforts to end the COVID-19 pandemic caused by SARS-CoV-2 and its emerging variants. Social media-driven “conspiracy theories” cast doubts on vaccine safety for reproductive health,1 including concerns that vaccine-induced SARS-CoV-2-neutralising antibodies (NAb) cross-react with human syncytin-1—a protein involved in gamete fertilisation and...
Commentary
COVID-19 vaccination acceptance of healthcare workers in Singapore
The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end April 2022.1 With the introduction of vaccines that are effective in reducing severe COVID-19 illnesses and deaths, Singapore had since pivoted from a COVID-19 elimination...
Original Article
Prevalence and correlates of psychological distress and coronavirus anxiety among hospital essential services workers in Singapore
The Coronavirus Disease 2019 (COVID-19) has affected almost all geographies in the world since 2020. Many countries have imposed strict isolation measures to contain the spread of this disease. While the majority of the population has been working from home, essential workers continue manning the frontlines, facing risks such...
Letter to the Editor
Evaluation of a health screening protocol for recovered COVID-19 patients before “return-to-play” and strenuous physical activity
Dear Editor,
We conducted a prospective, single-centre cohort study to develop guidance for military personnel returning to strenuous activities following SARS-CoV-2 infection. The patients underwent a clinical review followed by a protocol to screen for cardiac, respiratory, haematological, endocrine/renal and neurological complications after recovery from infection.
Both the study and screening...
Original Article
Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation
In-hospital cardiopulmonary resuscitation (CPR) for chronic kidney disease (CKD) patients is shown to have lower survival1 and a higher proportion of survivors on maintenance haemodialysis were discharged to skilled nursing facilities.2 Despite that, haemodialysis patients still preferred CPR during cardiac arrest3 and there are lower do-not-resuscitate orders for the...
Original Article
Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis
End-stage renal failure (ESRF) is a major cause of morbidity and mortality worldwide, including Asia.1 In Singapore, incidence of chronic kidney disease (CKD) stage 5 has increased from 383.9 per million population (PMP) in 2010 to 414.8 PMP in 2015. Incidence of patients requiring dialysis has increased in tandem....
Editorial
Survival outcome of haemodialysis and peritoneal dialysis
End-stage renal disease (ESRD) is a challenging and growing health issue, with number of patients increasing globally. The use of dialysis has greatly improved the survival and life expectancy of ESRD patients. Haemodialysis (HD) and peritoneal dialysis (PD) are 2 broad dialysis modalities used for ESRD. Despite the advancement...
Review Article
Current Management of Early Vulvar Cancer
Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although patient and physician delay remains common, an increasing number of patients are being diagnosed with early stage disease.
This article is available only as a PDF....
Others
Traumatic Dislocation of the Testes
Traumatic dislocation of the testes is uncommon. The first case was reported by Claubry in 1818 in Paris, when a 20-year-old soldier was run over by a wagon resulting in bilateral suprapubic dislocation of his testes.
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
Percutaneous Needle Aspiration in the Treatment of Hepatic Abscess: Factors Influencing Patients’ Outcome
Liver abscess traditionally has been treated by open surgical drainage, mortality rates being as high as 80% to 100% if left untreated. However, with the advent of modern non-invasive imaging techniques, percutaneous techniques performed under imaging guidance have, over the recent years, become increasingly acceptable as a suitable alternative...
Original Article
The Role of Multiple Segment Osteotomies in Orthognathic Surgery
Multiple segment osteotomy (MSO) orthognathic surgery serves to combine total or segmental maxillary and mandibular correction of dentofacial deformities with concurrent diastematic procedures to provide immediate repositioning of dental-osseous elements. In addition, splitting the palate may often be necessary to correct a functionally poor relationship of the maxilla to...
Others
Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children
Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease.
This article is available only as...
Original Article
Direct Mucosal Targeting of Colonic Receptors by Prokinetic Drugs in an Experimental Model
The direct intraluminal (IL) administration of drugs into the intestine may have an important regional action and therefore clinical implications in the effective management of functional bowel disorders. We have previously published findings in the anaesthetised in vivo pig, that cisapride and mebeverine when infused IL into the sigmoid...
Letter to the Editor
Graves’ disease after COVID-19 vaccination
Dear Editor,
Case 1 was a 41-year-old man with a history of primary hyperthyroidism. At the time of diagnosis, thyroglobulin antibodies were elevated although no thyrotropin receptor antibodies (TRAB) were available. The patient was treated with carbimazole for 20 months. At the time of cessation of carbimazole in May 2020,...
Letter to the Editor
Paediatric living-donor liver and kidney transplantation during COVID-19
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has impacted global healthcare including paediatric solid organ transplantation (SOT). We report our experience of resuming paediatric living-donor SOT during COVID-19, which took into account safety considerations for living donors, paediatric recipients and the transplant healthcare team. The US Centers for Disease...
Letter to the Editor
The evolution of severity of paediatric COVID-19 in Singapore: Vertical transmission and multisystem inflammatory syndrome in children
Dear Editor,
Coronavirus disease 2019 (COVID-19) arrived in Singapore in January 2020 as imported cases, followed by local transmission predominantly involving dormitories, with later spread within the wider community. Children still represent the minority of cases in Singapore, with around 8,000 paediatric cases as of 6 November 2021 out of...
Original Article
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 the fight against the disease. The safety and efficacy of these vaccines have been well demonstrated in clinical trials,1,2 and also against severe disease from...
Original Article
Incidence and risk factors of delirium in post-anaesthesia care unit
Post-anaesthesia care unit (PACU) delirium is defined as a disorder in thought processes that affect cognition in terms of memory, comprehension and attention.1 It has a strong association with postoperative delirium, which is present in up to 45% of patients after surgery.2-5 PACU is a wide-reaching problem, and especially...
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 control the haemodynamic fluctuations during phaeochromocytoma resection.
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Letter to the Editor
Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study
Dear Editor,
The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response.
We present our qualitative study, guided by...
Letter to the Editor
Pressure injuries related to N95 respirator masks among healthcare workers during the COVID-19 pandemic
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic outbreak, which started in 2019, has affected millions of patients globally.1 Singapore is not spared, being one of the first countries to import COVID-19 cases from China.2 Nosocomial transmission of SARS-CoV-2 had been reported in various cohort studies of healthcare workers (HCWs),...
Others
A Case of a Diaphragmatic Rupture Complicated With Lacerations of Stomach and Spleen Caused by a Violent Cough Presenting With Mediastinal Shift
Diaphragmatic rupture is a recognised consequence of high-velocity blunt trauma to the abdomen and chest and also has been reported in 0% to 5% of thoracoabdominal trauma patients. The diagnosis is often difficult and delay in diagnosis is implicated in increased morbidity and mortality.
This article is available only as...
Original Article
Infected Pancreatic Necrosis – An Evaluation of the Timing and Technique of Necrosectomy in a Southeast Asian Population
The management of necrotising pancreatitis has improved significantly over the last 2 decades, with a corresponding improvement in mortality rates. This improvement is largely attributed to advances in supportive therapy, diagnostic radiology and a better understanding of the pathophysiology of necrotising pancreatitis.
This article is available only as a PDF....
Original Article
The Relationship between Postoperative Complications and Outcomes after Hip Fracture Surgery
Hip fractures constitute a major health concern for older persons and are associated with significant morbidity and mortality, with 1-year mortality rates ranging from 14% to 36% in spite of advancements in anaesthesia, surgical techniques and nursing care.1,2 In addition, epidemiological studies have shown that the incidence of hip...
Original Article
Induction Concurrent Chemoradiotherapy Using Paclitaxel and Carboplatin Combination Followed by Surgery in Locoregionally Advanced Non-Small Cell Lung Cancer – Asian Experience
Lung cancer is the leading cause of cancer mortality in Singapore. The age standardised incidence rate is 45 per 100,000/year.
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Original Article
Surgical Training in Singapore: Will Patients Consent to Trainee Surgeons Performing Their Operations?
Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future.1 In most hospitals, trainee surgeons play a substantial role in providing healthcare and surgical services, under the supervision of a consultant. The Departments of Hand Surgery and Orthopaedic Surgery...
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 degenerative impingement of the spinal cord and nerve roots by osteo-cartilagineous elements, is managed by conservative or surgical methods.1 While surgery is often performed in...
Original Article
An End to “See One, Do One and Teach One” Residency Training Programme – Impact of the Training, Education, Surgical Accreditation and Assessment (TESA) Programme on Medical Care and Patients’ Safety†
The delivery of good medical care and the safety of patients are of utmost importance in all healthcare systems. Indeed, healthcare providers need to rely on one anothers’skills to minimise risk and decrease the number of medical errors.1 This is of particular concern in the practice of obstetrics and...
Original Article
From a “Generalist” Medical Graduate to a “Specialty” Resident: Can an Entry-level Assessment Facilitate the Transition? Assessing the Preparedness Level of New Surgical Trainees
Undergraduate medical education is considered a continuum leading into postgraduate training and ultimately medical practice.1 To this effect, it has been suggested that measures of performance of medical students and practising doctors should be aligned and the transition should be a smooth one. However, studies show a poor correlation...
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, the outcome for high-grade glioma has been disappointing. The first reported case of glioma resection was performed by Rickman Godlee in 1884.1 More than a...
Images in Medicine
Beware the anterior lying recurrent laryngeal nerve in a retro-oesophageal goitre
A 36-year-old woman presented with a 4-month history of right neck lump. She had mild shortness of breath, but no dysphagia or voice changes. Clinical examination found a firm right thyroid mass that moved with swallowing, consistent with a right thyroid lesion. Ultrasound evaluation of the lump revealed a...
Letter to the Editor
Mohs micrographic surgery in Singapore: A long-term follow-up review
Dear Editor,
Mohs micrographic surgery (MMS) has become the treatment of choice for high-risk non-melanoma skin cancers (NMSC) worldwide.1 Unlike wide local excision, MMS enables precise microscopic removal of tumour foci while allowing maximal tissue preservation, thereby maintaining cosmesis and anatomical function.1 The MMS service in Singapore started in...
Editorial
The Annals: Welcoming the future of Medicine
What started as a cluster of cases of pneumonia in Wuhan, the capital city of China’s Hubei Province, in December 2019, has since evolved into a pandemic with devastating consequences to health and livelihoods.1 Hardly a day passes without the term COVID-19, the disease caused by the severe acute...
Others
5th College of Surgeons Lectureship: Surgery beyond Scalpels
The training of surgeons composed of two aspects: (1) Clinical skill and competence; (2) The ‘soft’ skill and ‘art’ of surgery. With the gradual introduction of residency programme into the surgical discipline, hopefully our clinical training will be more systematic, closely supervised, monitored, assessed and reassessed, and structured.
This article...
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 revised version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma has further sub-divided melanoma metastatic sites to 3 specific categories;...
Letter to the Editor
Renojejunal Fistula: An Extremely Rare Form of Renoenteric Fistula
Obstructive calculous disease of the kidney often results in infectious complications such as pyelonephritis and perinephric abscesses. Renojejunal fistula formation may occur as the inflammation becomes chronic.
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Review Article
Drug-induced Kidney Disease – Pathology and Current Concepts
Departing from the usual account of drug-induced renal disease according to the specific type of drug, we divide this discussion into 3 main areas - glomerular injury, vascular injury and tubulointerstitial changes. In doing so, more emphasis will be placed on morphological findings although functional toxicity (with little or...
Original Article
Submandibular Mass Excision in an Asian Population: A 10-year Review
Submandibular masses are common presenting complaints in the outpatient setting. The differential diagnosis of a submandibular mass lesion can be salivary gland pathology, lymph nodal disease or soft tissue conditions. The more common submandibular gland pathologies include sialadenitis, sialolithiasis, pleomorphic adenoma, lymphoma and carcinomas.
This article is available only as...
Original Article
Early Outcome Following Emergency Gastrectomy
Emergency gastrectomy has been associated with high morbidity and mortality rates. These complications arise as a direct consequence following the procedure, such as duodenal stump leak and intra-abdominal collections, or more frequently, because of the resultant systemic complications.
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Letter to the Editor
Managing buccal space tumours
Dear Editor,
The buccal space is an infrequently addressed fascial space of the head and neck region. Intrinsic tumours of the buccal space are rare and hence present a management challenge. In a recent systematic review of 217 patients, 4 main surgical approaches were identified (intraoral, extended parotidectomy/rhytidectomy, transcutaneous...
Letter to the Editor
Plasma IP-10 could identify early lung disease in severe COVID-19 patients
Dear Editor,
The global pandemic of SARS-Coronavirus-2 (SARS-CoV-2) infection has imposed tremendous strain on healthcare resources worldwide, as a significant proportion of patients require intensive care. Although the majority have mild infections, up to 20% are estimated to become critically ill from severe disease.1 Age, concurrent comorbidities, more severe...
Original Article
Adverse reactions and safety profile of the mRNA COVID-19 vaccines among Asian military personnel
The COVID-19 pandemic has led to significant changes in the way of life for many around the world.1,2 After more than a year, many countries continue to struggle with rising infection rates, and economic and social impact of the pandemic.3-5 COVID-19 vaccines have become available since the end of...
Original Article
Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study
Since the first case of coronavirus disease 2019 (COVID-19) was reported in China in late December 2019, the pandemic has spread throughout the world, with the World Health Organization (WHO) reporting over 206 million cases and over 4 million deaths globally as of 15 August 2021.1 To contain the...
Original Article
Get “Real” with Hysteroscopy Using the Pig Bladder: A “Uterine” Model for Hysteroscopy Training
Hysteroscopy is an important surgical component of any training programme in gynaecology. Traditionally, surgical training in hysteroscopy occurred in the operating room where trainees first observe their senior performing the procedure, and then take on increasing roles in surgical cases under direct supervision. Often, hysteroscopic skills
are acquired via a...
Original Article
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 AF,1 which increases with age, is 8% in people aged over 80. About three-quarters of the cases are non-valvular AF. The risk for stroke in...
Images in Medicine
A maxillary sinus mass
A 55-year-old Chinese woman presented to the ear, nose and throat clinic with a 6-month history of left-sided blood-stained mucus. It was dark brown with no epistaxis. There was no mucopus, nasal obstruction, facial pain or fever. She denies any history of hypertension, trauma, head and neck cancer, anticoagulation...
Images in Medicine
Rapidly progressive ulcer in an older woman
A fit and well 78-year-old woman with no significant past medical history presented to the Emergency Department with large painless perianal ulcers. It started as an erythematous patch that developed into pruritic perianal blisters, and rapidly evolved into a necrotic ulcer over 2 days. She denied any prior injury...
Letter to the Editor
Joint preserving surgery for osteoarthritis of the big toe using a cartilage-like implant
Dear Editor,
Osteoarthritis of the big toe (hallux rigidus) is a common arthritic condition of the first metatarsophalangeal joint (MTPJ), beginning with stiffness, pain and inflammation. This subsequently progresses to restriction of movements especially dorsiflexion.1 Articular surface degeneration and formation of periarticular osteophytes may be seen on radiographs.2 Common...
Original Article
Safety and side effect profile of Pfizer-BioNTech COVID-19 vaccination among healthcare workers: A tertiary hospital experience in Singapore
The newly emerged coronavirus virus 2019 (COVID-19) disease was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on 30 January 2020, and subsequently designated a pandemic on 11 March 2020.1 Globally, over 209 million cases have been reported, with more than 4.4 million...
Letter to the Editor
The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown
Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties in the care of patients with communicable diseases like COVID-19. PPE is also worn by ancillary staff such as security personnel, porters, medical transport crew...
Commentary
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 as abnormal platelet activation, impaired fibrinolysis, and endothelial dysfunction in COVID-19 patients, resulting in thrombosis. The lungs are thought to be the epicentre of thrombosis,...
Letter to the Editor
Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 Panel for early diagnosis of COVID-19
An effective response to the SARS-CoV-2 that has caused the coronavirus disease 2019 (COVID-19) pandemic1 requires rapid and accurate diagnostic testing. We evaluate the QIAstat-Dx® Respiratory SARS-CoV-2 Panel—a multiplex real-time polymerase chain reaction (RT-PCR) assay—against an E-gene RT-PCR assay2 that successfully identified cases at the start of the COVID-19...
Letter to the Editor
Antibiotic stewardship algorithm to rationalise antibiotic use among hospitalised COVID-19 patients
As presentation of COVID-19 may mimic that of bacterial pneumonia, antibiotics are often prescribed. Concerns regarding overuse of antibiotics are now being raised particularly as we learn of the low rates of bacterial and fungal co-infection. To limit unnecessary antimicrobial exposure, we posit an algorithm for antibiotic guidance.
This article...
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, but this is impaired during general and/or neuraxial anaesthesia. Inadvertent peri-operative hypothermia is defined as a core temperature of <36C, the prevalence of which can...
Letter to the Editor
Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore
The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during COVID-19-related lockdowns. Notably, there have been reports that patients with acute emergencies such as strokes and heart attacks are either not seeking treatment, or are...
Letter to the Editor
Radiological changes on chest CT following COVID-19 infection
COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution computed tomography (HRCT) features of the lungs during the onset of COVID-19; however, few studies have described the radiological changes and outcome of residual lesions...
Letter to the Editor
Stress and resilience of paediatric healthcare workers during COVID-19
The coronavirus disease 2019 (COVID-19) pandemic has caused multiple changes in healthcare systems as governments implement measures to boost acute services. Healthcare workers (HCWs) across different specialties are reported to have decreased quality of life and increased stress, further aggravated during the pandemic.
This article is available only as a...
Review Article
Severe COVID-19 and coagulopathy: A systematic review and meta-analysis
Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications. Our understanding of the pathophysiology of the disease process is still evolving. As part of the host response to viraemia, it has been postulated that...
Editorial
Estimating the impact of COVID-19-induced coagulopathy
The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...
Letter to the Editor
Pilot study of single-session radiofrequency ablation of benign thyroid nodules in Singapore
Radiofrequency ablation (RFA) has been shown to be safe and efficacious in the treatment of benign thyroid nodules. Ion agitation during RFA generates high temperatures between 60 and 100 degree Celsius to cause tissue damage and size reduction.
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Letter to the Editor
Impact of COVID-19 on mental health and occupational burnout in a surgical unit in Singapore
In this study, we assessed the impact of COVID-19 on the psychological well-being and burnout among staff who manage critically ill general surgery and trauma patients as part of the Acute Care Surgery (ACS) service at the Singapore General Hospital, Singapore. The ACS team may be exposed to COVID-19...
Commentary
Optimum early orthopaedic surgery in COVID-19 patients
Multiple guidelines have been established regarding the management of COVID-19 patients. However, there remains a paucity regarding specific guidelines on the optimal timing for surgeries in COVID-19 patients requiring early orthopaedic surgery. This paper aims to provide evidence-based recommendations regarding the timing to proceed with early orthopaedic surgeries in...
Original Article
Vulnerability to rumours during the COVID-19 pandemic in Singapore
The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found to be elevated among healthcare workers and the general population. Others have reported a higher incidence of stress-related symptoms or post-traumatic stress disorder. These findings...
Original Article
Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore
In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community transmission began early in the outbreak, the government started emphasising the role that individuals had to play by adopting health-preventive behaviours.
This article is available only...
Editorial
The impact of COVID-19 pandemic on global mental health: From the general public to healthcare workers
The COVID-19 pandemic began in late 2019 and was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. To decrease the spread of the virus and demand on the healthcare system, governments globally executed multiple public health measures including lockdown, social distancing, significant closure of...
Review Article
Living with COVID-19: The road ahead
The COVID-19 pandemic has made an unprecedented impact on global morbidity, mortality and healthcare measures to contain the infection.1 Multiple waves of infections in 2020 and 2021 have resulted in significant disruptions to healthcare, economies and societies globally, with few countries able to avoid major epidemics. In the initial...
Editorial
The Novel Coronavirus (SARS-CoV-2) Pandemic
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and was reported to the World Health Organization (WHO) on 31 December 2019. An outbreak of unknown aetiology was suspected because many early cases were linked...
Review Article
Precautions When Providing Dental Care During Coronavirus Disease 2019 (COVID-19) Pandemic
Coronavirus disease 2019 (COVID-19) is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported to the World Health Organization (WHO) as pneumonia of unknown aetiology in the Chinese city of Wuhan on 31 December 2019. Since then, COVID-19 has spread across the globe and...
Original Article
Impact of Chronic Kidney Disease on Outcomes in Transcatheter Aortic Valve Implantation
With improvements in device technology as well as increasing experience, transcatheter aortic valve implantation (TAVI) has replaced open surgical aortic valve implantation as the treatment of choice in severe symptomatic aortic stenosis (AS) patients who have prohibitive and high surgical risks. TAVI has also gained increasing uptake in patients...
Commentary
Autism Spectrum Disorder and COVID-19: Helping Caregivers Navigate the Pandemic
The coronavirus disease 2019 (COVID-19) pandemic has disrupted societies globally. As of 11 May 2020, 53 children have been infected with COVID-19 in Singapore (Ministry of Health, Singapore, unpublished data). Children generally have mild disease, although there is emerging literature on paediatric multisystem inflammatory syndrome temporally associated with COVID-19....
Letter to the Editor
Cross-reaction of Sera from COVID-19 Patients with SARS-CoV Assays
SARS-CoV-2 is a new zoonotic coronavirus (CoV) that emerged in Wuhan, China, which was first reported to the World Health Organization (WHO) on 31 December 2019. This coronavirus disease (COVID-19) causes mild to moderate respiratory illness in the majority of patients, but can cause serious complications in the elderly...
Review Article
COVID-19 and Singapore: From Early Response to Circuit Breaker
The COVID-19 pandemic first broke out in Wuhan, China, in December 2019, where a cluster of pneumonia cases was reported and the novel coronavirus later identified. Since then, the virus has spread rapidly across the world, registering a total of 85000 reported cases across 53 countries/territories by 29 February...
Original Article
Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children
Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...
Review Article
Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre
As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...
Review Article
Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months
Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...
Original Article
Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore
Since the first cases of coronavirus disease 2019 (COVID-19) in pregnancy were described, significant concerns have been raised about the potentially increased susceptibility of pregnant women to severe disease, and the unquantified risk of mother-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the fetus and neonate....
Letter to the Editor
Resuming otolaryngology services following a COVID-19 lockdown in Singapore
When the COVID-19 outbreak first occurred, we tweaked our department workflows to cope with the various demands of our practice and the pandemic. When Singapore’s Multi-ministry Taskforce on COVID-19 deemed that it was safe to begin reopening the economy in 3 phases,3,4 our department adopted a gradual resumption of...
Letter to the Editor
COVID-19: Lessons from Thailand
The COVID-19 pandemic has massively disrupted the social and economy of many countries. Thailand has been successful in controlling the spread of the disease and treating COVID-19 patients. We discuss Thailand’s strategy in containing the disease, management of severe COVID-19 patients, as well as future perspectives of COVID-19.
This article...
Commentary
Videoconsultation to overcome barriers during COVID-19
Since February 2020, Government Restructured Hospitals in Singapore began deferring non-urgent outpatient appointments. This aimed to facilitate physical distancing and reallocate healthcare resources to combat the pandemic. As the pandemic becomes increasingly prolonged, this strategy is unsustainable. There is increasing interest in using videoconsultations to ensure that patients receive...
Letter to the Editor
Positive RT-PCR detected in patients recovered from COVID-19
Positive real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acid following 2 consecutive negative RT-PCR tests have been reported in China and Korea. This has led to speculation regarding “persistent carrier states”, “re-infections” or “re-activations” and raises questions about using negative RT-PCR as part of de-isolation criteria. We...
Letter to the Editor
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 coagulation, especially in patients with severe COVID-19 infection. Nauka et al. provided vital insight that thrombotic complications can happen in a patient with non-critically ill...
Letter to the Editor
Decrease in emergency department attendances during COVID-19 especially in school-going children
Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with minor ailments, but these observations have yet to be evaluated in Singapore. We investigated ED attendances during the coronavirus disease 2019 (COVID-19) pandemic in Singapore.
This...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...
Review Article
Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review
Coronavirus disease 2019 (COVID-19) has spread rapidly from China to other countries around the world, with the World Health Organization characterising it as a global pandemic on 12 March 2020. The number of fatalities owing to COVID-19 is escalating rapidly. COVID-19 is caused by the Severe Acute Respiratory Syndrome...
Review Article
Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review
The World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern on 30 January 2020. To control the outbreak, many countries have implemented nationwide lockdowns and social distancing measures, which have brought challenges to accessibility of healthcare services and continuation of long-term medical care,...
Review Article
Obesity in COVID-19: A Systematic Review and Meta-analysis
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is established that increasing age and comorbidities such as cardiovascular diseases are associated with risk of infection, more severe disease and adverse outcomes. Obesity is an epidemic globally, causing...
Commentary
Mental Health Strategies to Combat the Psychological Impact of Coronavirus Disease 2019 (COVID-19) Beyond Paranoia and Panic
On 30 January 2020, the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) an international public health emergency after the number of cases soared across 34 regions in Mainland China and surpassed that of severe acute respiratory syndrome (SARS) in 2003. The virus was believed...
Original Article
Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection
In this report, we describe a patient who developed acute respiratory distress syndrome (ARDS) with rapid clinical deterioration. Unfortunately, not much is known about the clinical features and risk factors for ARDS and critical illness even as the number of COVID-19 cases continues to climb at an alarming rate...