Original Article
Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes
Sudden cardiac death in athletes during exercise is rare, with an estimated incidence of 1–2 per 100,000 people per year in young athletes,1 and...
Editorial
Improving electrocardiogram interpretation in Asian athletes: A call to action
The field of sports cardiology has evolved substantially over the past 2 decades due to improved understanding of the athlete’s heart, causes of sudden...
Letter to the Editor
Outcomes of selexipag for treatment of pulmonary arterial hypertension in an Asian population
Dear Editor,
Pulmonary arterial hypertension (PAH) is a progressive condition characterised by increased pulmonary arterial pressure and pulmonary vascular resistance, resulting in right ventricular dysfunction...
Letter to the Editor
Suboptimal adherence to medical therapy in patients undergoing lower limb angioplasty in Singapore
Dear Editor,
Chronic limb-threatening ischaemia (CLTI) is the advanced stage of peripheral arterial disease (PAD) and patients with this condition face a very high risk...
Commentary
Approach to bradyarrhythmias: A proposed algorithm
Bradyarrhythmias are common and occur in both physiological and pathological states. Bradycardia is defined as a heart rate of fewer than 60 beats per...
Review Article
Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis
Atrial fibrillation (AF) is a pertinent health condition that is seeing a sustained rise in global incidence and prevalence.1 In particular, paroxysmal AF (PAF),...
Editorial
Catheter ablation as first-line treatment for paroxysmal atrial fibrillation
Pharmacotherapy has been the mainstay of atrial fibrillation (AF) treatment. As AF progresses from paroxysmal to persistent, electrical and structural remodelling of the atria...
Letter to the Editor
Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders
Dear Editor,
Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based...
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...
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...
Original Article
Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation
The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and...
Original Article
Sex and ethnicity modified high 1-year mortality in patients in Singapore with newly diagnosed atrial fibrillation
Atrial fibrillation (AF) is the most common clinically significant arrhythmia and is associated with increased risks of stroke, dementia, heart failure (HF) and death.1...
Editorial
Different strokes for different folks
Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey’s observation of fibrillating auricles in open chest animal models in 1628. Willem Einthoven...
Original Article
Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction
Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to...
Editorial
Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction
With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction...
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...
Commentary
Cardiac sarcoidosis: Difficulties in diagnosis and treatment
Sarcoidosis is a multisystem, granulomatous disorder of unknown aetiology. It affects the lungs in 90% of cases, but is also known to affect other...
Editorial
Out-of-hospital cardiac arrest in Singapore: Can we do better?
Cardiac arrests are unpredictable events that frequently result in death or significant residual morbidity among survivors. These sudden events affect not only the individual,...
Editorial
Sepsis and cardiovascular events: The story so far
Sepsis is a state of life-threatening organ dysfunction that results from a dysregulated host immune response to infection.1 Sepsis is a common condition that...
Letter to the Editor
Previous history of hyperthyroidism in emergency department patients with atrial fibrillation does not increase the risk of thromboembolism and death
Dear Editor,
Atrial fibrillation (AF) is frequently encountered in the emergency department (ED) and is a major risk factor for thromboembolic events. The clinical decision...
Editorial
Pressures, indexes and peripheral arterial disease: Time to rethink our approach?
Most patients with peripheral arterial disease (PAD) are asymptomatic. Despite the absence of symptoms, these patients have a significantly increased risk of death and...
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
Drug Treatment of Hypercholesterolaemia
Serum cholesterol has been established as a major risk factor for coronary heart disease (CHD). There is a linear association between serum cholesterol level...
Original Article
Goldberger’s Triad in Dilated Cardiomyopathy—Can it Predict the Severity of Left Ventricular Dysfunction?
In 1982, Goldberger described a novel electrocardiogram (ECG) triad that was highly specific for patients with dilated cardiomyopathy and congestive heart failure (attributable to...
Others
Thyroid Storm Presenting as Jaundice and Complete Heart Block
Thyroid storm is defined as a severe and often life-threatening exacerbation of thyrotoxicosis which is usually characterised by hyperthermia, tachycardia, severe agitation and altered...
Others
Simultaneous Transcatheter Valvuloplasty and Amplatzer Septal Occlusion for Pulmonary Valvar Stenosis and Secundum Atrial Septal Defect
Congenital pulmonary valvar stenosis (PVS) and secundum atrial septal defect (ASD) are relatively common forms of congenital heart disease (CHD). Since the first successful...
Others
Electrocardiographic Abnormalities in Combined Hypercalcaemia and Hypokalaemia—Case Report
The electrocardiographic abnormalities in isolated hypercalcaemia and hypokalaemia have been well documented in the literature. However, electrocardiogram (ECG) findings in combined hypercalcaemia and hypokalaemia...
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....
Original Article
Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore
In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has...
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
A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)
Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill...
Original Article
Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia
Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously...
Original Article
Use of Central Venous Lines in Paediatrics—A Local Experience
Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique...
Review Article
Interventional Electrophysiology and its Role in the Treatment of Cardiac Arrhythmia
Cardiac arrhythmias are disorders of the electrical system of the heart which can present as benign ectopics or as life-threatening arrhythmias and sudden cardiac...
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...
Others
Incessant Ectopic Atrial Tachycardia and Tachycardia-related Cardiomyopathy: Therapeutic Options and Potential for Cure
Incessant ectopic atria tachycardia (IEAT) is a rare and insidious arrhythmia which is frequently misdiagnosed and if untreated, leads to ‘exhaustion’ of the myocardium...
Review Article
Intracoronary Brachytherapy: The Beginning of the End of Restenosis?
Restenosis remains a major clinical problem 20 years after the introduction of coronary angioplasty by Andreas Gruentzig in the treatment of coronary artery disease....
Original Article
Perinatal Drug Abuse in KK Women’s and Children’s Hospital
In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance...
Original Article
The Effect of Fenofibrate on Insulin Sensitivity and Plasma Lipid Profile in Non diabetic Males with Low High Density Lipoprotein/Dyslipidaemic Syndrome
Hyperinsulinaemia and insulin resistance have been postulated to relate directly to both hypertension and coronary artery disease in type II diabetes and possibly also...
Review Article
Homocysteine and Atherosclerotic Disease: The Epidemiologic Evidence
Homocysteine is a thiol-containing amino acid formed during the metabolism of methionine. The metabolic fate of homocysteine may be influenced by the alterations in...
Original Article
A Clinical Study of Seven Cases of Trichotillomania in Singapore
Trichotillomania was first described by a French dermatologist Hallopeau (1889) of a young man who pulled out his hair in tufts. The word trichotillomania...
Original Article
Parainfluenza Type 3 Viral Outbreak in a Neonatal Nursery
Parainfluenza viruses are relatively large RNA paramyxoviruses. Four serologic types cause disease in humans.
This article is available only as a PDF. Please click on...
Others
T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report
T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T...
Original Article
Trends in Mortality, Incidence, Hospitalisation, Cardiac Procedures and Outcomes of Care for Coronary Heart Disease in Singapore, 1991-1996
In line with trends in many high-income countries, Singapore has experienced some declines in mortality from coronary heart disease (CHD) since the 1980s. Whether...
Others
The Future of Medicine from the Standpoint of the Practising Paediatrician
From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had...
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...
Original Article
Bidirectional Cavopulmonary Anastomosis
Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to...
Original Article
Retinopathy of Prematurity in Very Low Birth Weight Infants
Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship...
Others
Echocardiographic Features and Management of Neonatal Ductal Aneurysm
Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few...
Original Article
Initial Experience With an Autocapture Pacemaker System
The longevity of a pacemaker generator varies directly with the total deliverable amount of electrical charge (Q, in coulombs) and inversely with the rate...
Original Article
Transaminitis in Duchenne’s Muscular Dystrophy
Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine...
Others
Twenty-four hour, Non-invasive, Neonatal Chromosome Analysis—Application in a Case of Mixed Gonadal Dysgenesis
Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but...
Others
The Differential Diagnosis of Supraventricular Tachycardia Using Clinical and Electrocardiographic Features
Noninvasive evaluation of the mechanism of the arrhythmia is important in the management of supraventricular tachycardia (SVT). It guides one in the choice of...
Others
Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies
Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of...
Others
A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block
The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is...
Original Article
Cardiac Marker Point-of-care Testing: Evaluation of Rapid On-site Biochemical Marker Analysis for Diagnosis of Acute Myocardial Infarction
In the present era of revascularisation therapy, rapid and accurate diagnosis of acute myocardial infarction (AMI) is important, as these patients may benefit from...
Others
Minimal Change Nephrotic Syndrome—A Complex Genetic Disorder
Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia,...
Others
Cardiovascular Disease: Genes and Public Health
The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is...
Others
Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months
Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay,...
Original Article
Incidence of Ischaemic Heart Disease and Stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study
Comparisons of disease frequency in different ethnic groups help to unravel the contributions of nature and nurture in their aetiology and to identify environmental...
Original Article
Technetium-99m Sestamibi for the Assessment of Myocardial Salvage Following Reperfusion Therapy in Acute Myocardial Infarction
Reperfusion therapy for acute myocardial infarction is feasible with thrombolytic therapy as well as acute percutaneous transluminal coronary angioplasty (PTCA). Both modalities of treatment...
Original Article
DNA Testing for Fragile X Syndrome in 255 Males from Special Schools in Singapore
Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It...
Others
Diagnosis of Pacemaker Lead Infection Using Transoesophageal Echocardiography: A Case Report
The expanding indications for permanent cardiac pacing mandate an awareness of the potential complications associated with device implantation. After failure of pacing and sensing,...
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...
Others
Isolated Non-compaction of Ventricular Myocardium: A Report of Three Cases
Non-compaction of ventricular myocardium is a rare morphogenic arrest of compaction of the ventricular myocardial fibres during intrauterine life. Usually, the left ventricle is...
Original Article
Diagnosing and Prognosticating Acute Meningitis in Young Infants within 24 Hours of Admission
Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which...
Original Article
Impairment of Endothelial Function—A Possible Mechanism for Atherosclerosis of a High-fat Meal Intake
The impairment of endothelial vasodilatory function has been considered an early event in atherogenesis. This has been studied in association with various cardiovascular risk...
Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...
Review Article
Enteral Nutrition of the Very Low Birth Weight (VLBW) Infant
Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely...
Original Article
A Case Series of Six Children with Primary Pulmonary Hypertension
Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of...
Others
2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore
When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think...
Others
Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome
Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the...
Original Article
The Use of Vigabatrin in Infantile Spasms in Asian Children
Infantile spasms are a form of age-dependent myoclonic epilepsy that is difficult to control. Agents such as adrenocorticotrophic hormone (ACTH) and prednisolone have been...
Original Article
A Preliminary Study of the Utility of Combined Cardiac Markers in the Evaluation of Patients Presenting Early with Suspected Acute Coronary Syndrome
The management of patients presenting with chest pain of recent onset can prove to be a diagnostic challenge. These patients vary from having atypical...
Original Article
Homocysteine, Folate and Vitamin B12 as Risk Factors for Acute Myocardial Infarction in a Southeast Asian Population
Since the beginning of the last decade, hyperhomocysteinaemia has been identified as a risk factor for acute coronary syndromes. A few large prospective studies...
Review Article
Paediatric Orthopaedics in Singapore
The name “Orthopaedic Surgery” is derived from the words “orthos” (meaning straight or to straighten) and “paido” (meaning child). Thus, it is not unexpected...
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...
Review Article
Rheumatic Heart Diseases in Pregnancy
Rheumatic heart disease comprises acute rheumatic fever following group A beta-haemolytic streptococcal infection of the tonsillopharynx, and its long-term sequelae of heart valve fibrosis...
Others
Allopurinol Hypersensitivity Syndrome and Acute Myocardial Infarction—Two Case Reports
Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe multiorgan disease. It usually begins 2 to 6 weeks (up...
Original Article
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous...
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...
Others
Bronchopulmonary Dysplasia and Chronic Lung Disease of Infancy: Strategies for Prevention and Management
Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal...
Others
Two Case Reports on Incessant Left Ventricular Tachycardia: Curative Therapy with Radiofrequency Ablation
Left ventricular tachycardia is a recognisable condition in patients with otherwise structurally normal heart. It may arise from various foci in the left ventricle.
This...
Review Article
Prevention of Restenosis after Percutaneous Coronary Intervention: The Continuing Challenge
Since Andreas Gruntzig first demonstrated its use in humans in 1977, the utilisation of percutaneous transluminal coronary angioplasty (PTCA) has grown tremendously throughout the...
Original Article
Intussusception: A Three-Year Review
Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into...
Others
Severe Newborn Encephalopathy Unrelated to Intrapartum Hypoxic Events: 3 Case Reports
Since Little’s article of 1862, it was popularly believed that brain damage in the majority of cases of cerebral palsy occurs during labour and...
Others
A Case Series of Pre-Viable Severe Twin-Twin Transfusion Syndrome
Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta.
This article is available only...
Others
Idiopathic Chronic Fetomaternal Haemorrhage Resulting in Hydrops – A Case Report
Small amounts (<0.1 mL) of fetal blood are commonly found in maternal circulation. Massive fetomaternal haemorrhage (FMH) involves fetal blood loss into the maternal...
Others
Imaging of Paediatric Mediastinal Masses
A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for...
Others
The Relationship Between Scoring Systems and Cytokine Levels in Neonatal Sepsis
In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm...
Others
A Case Series of Sotalol-induced Torsade de Pointes in Patients with Atrial Fibrillation – A Tale with a Twist
In the light of the Cardiac Arrhythmia Suppression Trial (CAST) which suggested that class I antiarrhythmics may be linked to an increase in mortality,...
Original Article
Clinical Characteristics of an Outbreak of Hand, Foot and Mouth Disease in Singapore
The enterovirus family causes a wide array of illnesses, some easily recognised clinically and others diagnosed as non-specific viral illnesses. This large family of...
Review Article
Perinatal Care at the Threshold of Viability—From Principles to Practice
One of the major challenges in neonatal-perinatal medicine in the new century is the optimal management of the mother and infant when delivery is...
Original Article
Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital
The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and...
Review Article
Long-term Follow-up and Outcome of Extremely-low-birth-weight (ELBW) Infants
With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great...
Review Article
Exogenous Surfactant Therapy in Newborn Infants
Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of...
Others
The Use and Abuse of Steroids in Perinatal Medicine
Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality....
Review Article
Mass Newborn Screening in Singapore—Position and Projections
Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome...
Others
Neonatology In Singapore: The Way We Were, The Way Forward
Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore....
Original Article
Chorioamnionitis and Outcome in Extremely Preterm Infants
Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is...
Editorial
Challenges in Perinatal Medicine
One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This...
Others
Predicting Significant Hyperbilirubinaemia and Early Discharge for Glucose-6-Phosphate Dehydrogenase Deficient Newborns
Glucose-6-phosphate dehydrogenase (G6PD) deficiency occurs in 2.5% of Singapore’s population, and affected newborns are at risk for severe neonatal hyperbilirubinaemia and kernicterus. In the...
Others
Autoimmune Liver Disease in Children
Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1)...
Others
HIV/AIDS in Children
The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major...
Original Article
Immediate and Mid-Term Safety and Efficacy of Single Lead VDD Pacemakers for Patients with Atrioventricular Block and Normal Sinus Node Function—A Single Centre Experience
In patients requiring a cardiac pacemaker for any indication, the ideal goal of therapy is to achieve atrioventricular (AV) synchrony. This replicates the normal...
Review Article
Adolescent Health Education Programmes: Theoretical Principles in Design and Delivery
Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually...
Review Article
Art and “the Language of Well-Being” in Adolescent Health Care
Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration....
Review Article
From Recreation to Creative Expression: The Essential Features of an Adolescent Inpatient Psychosocial Support Programme
In 1984, the Royal Children’s Hospital (RCH) in Melbourne, Australia opened a new ward specifically for adolescent inpatients. This initiative was the result of...
Original Article
Adolescent Admissions to a Tertiary Paediatric Hospital: A Dynamic Pattern
The nature of paediatric practice is changing worldwide. In developing countries, infant mortality from infectious diseases continues to fall with improved immunisation, medical care...
Review Article
Clinical Assessment, Management and Outcomes of a Group of Adolescents Presenting with Complex Medico-psychosocial Conditions
Increased sensitivity to biological change can make adolescents particularly vulnerable to non-organic symptomatic disorders. A variety of pains, headaches, dizziness and fatigue may remain...
Original Article
Adolescent Chronic Illness: A Qualitative Study of Psychosocial Adjustment
Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many...
Review Article
Strategies to Promote Better Outcomes in Young People with Chronic Illnesses
The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to...
Review Article
Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience
The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent...
Review Article
Sexually Transmitted Infections in Singapore Teenagers
Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and...
Review Article
Eating Disorders in Singapore: A Review
Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms...
Review Article
Youth Suicide and Parasuicide in Singapore
The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or...
Original Article
Five-Year Review of Adolescent Mental Health Usage in Singapore
The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in...
Others
The Perils of Puberty
Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such...
Editorial
Adolescent Health—A New Perspective in Singapore
In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field...
Images in Medicine
Torsades de pointes in a woman presenting with syncope
A 57-year-old woman presented with first onset syncope, which was witnessed by her family members. It occurred in the middle of a conversation and...
Others
MELAS: A Case Report
A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...
Original Article
Spironolactone Does Not Prevent Restenosis After Coronary Stenting in Humans
High restenosis rate, which has been documented to occur in approximately 30% to 50% of cases, still remains a major concern, although percutaneous transluminal...
Original Article
Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey
Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an...
Review Article
Nuclear Cardiology in Singapore: A Review
The past decade has witnessed significant advances and rapid growth in the field of nuclear cardiology. In Singapore, our experience has been similar to...
Review Article
Stem Cell Cardiomyoplasty: State-of-the-Art
Congestive heart failure (CHF) remains the most common diagnosis made in cardiology wards today. At present, no long-term therapeutic option for end-stage CHF is...
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...
Review Article
Coronary Artery Disease: Comprehensive Evaluation by Cardiovascular Magnetic Resonance Imaging
Coronary artery disease (CAD) is a major health problem worldwide. With advances in CAD intervention and improvements in treatment and management of CAD, there...
Review Article
Surgery for Atrial Fibrillation
Atrial fibrillation is the most common sustained cardiac arrhythmia. The overall prevalence of atrial fibrillation is 0.4%.
This article is available only as a PDF....
Review Article
Drug-eluting Stents: The End of Restenosis?
Percutaneous coronary intervention (PCI) is the preferred revascularisation approach for most patients with coronary artery disease because, with comparable clinical outcomes in selected patients,...
Original Article
Coronary Artery Ectasia: A Ten-year Experience in a Tertiary Hospital in Singapore
Coronary artery ectasia (CAE) is the abnormal dilatation of a segment of the coronary artery to a diameter of at least 1.5 times that...
Original Article
Pilot Survey of the Diagnosis and Management of Heart Failure in Primary Care: A Singaporean Perspective
Congestive heart failure is an increasingly common disorder and a major cause of morbidity and mortality in developed countries around the world. It is...
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...
Editorial
Cardiovascular Medicine and Surgery in Singapore: The Next Lap
Fourteen years ago, an editorial in the Annals announced the coming of age of cardiology in Singapore. Among the issues raised in that editorial...
Others
Clinical Indications for Positron Emission Tomography (PET) Scanning
The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their...
Review Article
Clinical Applications of Positron Emission Tomography in Cardiology: A Review
Ischaemic heart disease associated with depressed left ventricular function is a common clinical management dilemma. There is overwhelming evidence that such patients have a...
Editorial
Positron Emission Tomography – A Vital Component of Molecular Imaging
Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of...
Letter to the Editor
A Fatal Turkish Case of Campomelic Dysplasia
Paediatric Medicine (CD) is a rare form of congenital short-limbed dwarfism, classically characterised by campomelia (bowing of the long bones of the lower extremities)...
Original Article
Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore
Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase...
Others
Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome
Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first...
Others
Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article
Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital...
Original Article
Gender Disparity in Paediatric Hospital Admissions
Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories...
Original Article
Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience
Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an...
Original Article
Does Visual Turbidity Correlate With Serum Triglyceride Levels in Babies on Total Parenteral Nutrition?
Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles...
Original Article
Corticosteroids are not Present in a Traditional Chinese Medicine Formulation for Atopic Dermatitis in Children
Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have...
Original Article
Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore
Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the...
Others
16th Seah Cheng Siang Memorial Lecture – The Changing Face of Cardiology Practice, Training and Research in Singapore
Professor Seah Cheng Siang was one of the most illustrious physicians of his era. During his professional career, he held the following positions: Head,...
Original Article
The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004
Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8...
Editorial
Building Collaboration in Cardiac Imaging
Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery...
Others
A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia
Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an...
Others
Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis
Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this...
Editorial
Paediatrics to Geriatrics: The Continuum
In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it...
Original Article
Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore
Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection...
Others
Guidelines on Cardiac CT in Singapore (2006)
The heart is difficult to image because of its complex wall motion and variability of the cardiac cycle. Recent advances in 16 and 64-slice...
Original Article
Clinical Features Associated with Nasal Staphylococcus aureus Colonisation in Chinese Children with Moderate-to-severe Atopic Dermatitis
Atopic dermatitis (AD) is a common chronic relapsing disease in children. It was estimated that about 15% of children suffer from this disease.1-3 Bacterial...
Review Article
A Rotavirus Vaccine for Infants: The Asian Experience
Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20%...
Original Article
Phase II Trial of Gemcitabine and Cisplatin Sequentially Administered in Asian Patients With Unresectable or Metastatic Non-small Cell Lung Cancer
Lung cancer is the most common cause of cancer-related death worldwide. It ranks first among males and third among females in the incidence of...
Editorial
Therapeutic Hypothermia for Neonatal Hypoxic-Ischaemic Encephalopathy
Hypoxic-ischaemic encephalopathy (HIE) is an important cause of death and later neurological disability in full-term neonates worldwide. Perinatal asphyxia causes about 19% of the...
Others
Outcome of Organic Acidurias in China
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Others
Organising Services for IMD in Thailand: Twenty Years Experience
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Others
Newborn Screening in Pakistan – Lessons from a Hospital-based Congenital Hypothyroidism Screening Programme
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Others
Newborn Screening in Bangladesh
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Others
Newborn Screening in China: Phenylketonuria, Congenital Hypothyroidism and Expanded Screening
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Others
Minimising Harm from Newborn Screening Programmes
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Others
Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?
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Others
Financing Newborn Screening Systems: US Experience
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Others
Inborn Errors of Metabolism Presenting as Neonatal Encephalopathy: Practical Tips for Clinicians
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Others
Legal Issues in Neonatal Screening
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Others
Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening
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Others
External Quality Assurance Programme for Newborn Screening of Glucose-6-Phosphate Dehydrogenase Deficiency
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Others
Glucose-6-Phosphate Dehydrogenase Deficiency: Correlation between the Genotype, Biochemistry and Phenotype
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Others
Disorders of Vitamin B12 Metabolism Presenting Through Newborn Screening
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Others
Diagnosis of Tetrahydrobiopterin (BH4) Responsive Mild Phenylketonuria in Japan over the Past 10 Years
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Others
Fatty Acid Oxidation Defects
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Others
Disorders of the Carnitine Cycle and Detection by Newborn Screening
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Others
Spectrum of Inherited Metabolic Disorders in Malaysia
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Others
Establishing a Universal Newborn Hearing Screening Programme
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Others
Current Understanding of Auditory Neuropathy
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Others
A Multidisciplinary Approach to Paediatric Hearing Loss: Programme at the Centre for Hearing Intervention and Language Development, National University Hospital, Singapore
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Others
Early Intervention For Hearing Impairment: Appropriate, Accessible and Affordable
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Others
Impact of the National Hearing Screening Programme in China
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Others
Outcome of Early Cochlear Implantation
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Others
Eliminating Iodine Deficiency: Obstacles and Their Removal
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Others
Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism
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Others
Issues on Universal Screening for Galactosemia
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Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case
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Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: Supporting Arguments
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Others
My Early Experiences in Establishing Neonatal Screening and the Reason for Regional Meetings of the International Society for Neonatal Screening
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Others
Diagnosis and Management Support for an Expanded Newborn Screening Programme
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Others
Considerations in Choosing Screening Conditions: One (US) Approach
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Others
Clinical Applications of Molecular Genetics: The Model of Congenital Adrenal Hyperplasia
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Others
Newborn Screening in Japan: Restructuring for the New Era
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Others
Improved Health and Development of Children who are Deaf and Hard of Hearing Following Early Intervention
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Others
Towards Universal Newborn Screening in Developing Countries: Obstacles and the Way Forward
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Others
Improving Child Health – Newborn Screening for All?
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Editorial
Neonatal Screening – A Global Perspective
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Original Article
Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia
Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected...
Original Article
The Association of Smoking with Components of the Metabolic Syndrome in Non-diabetic Patients
Metabolic syndrome (MS) is conceptualised as a constellation of physiologic or anthropometric abnormalities. Typically, it includes excess weight, hyperglycaemia, elevated blood pressure, low concentration...
Original Article
Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis
Coronary artery disease (CAD), also called coronary heart disease, is the leading cause of death for both men and women. CAD is usually caused...
Letter to the Editor
Assessment of Medical Graduates Competencies
Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate...
Commentary
When Words Really Matter
I think a lot these days about doctors giving advice. Nobody taught me, back in medical school, how to give advice.
This article is available...
Review Article
Behavioural Sleep Disorders in Children and Adolescents
Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are...
Review Article
Cardiovascular Changes in Children with Snoring and Obstructive Sleep Apnoea
Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the...
Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a...
Review Article
Sleep Disorders in Children: The Singapore Perspective
Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in...
Review Article
Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children
Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share...
Review Article
The Scope of Paediatric Sleep Medicine
Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of...
Original Article
Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most...
Original Article
Inflammatory Cytokines and Childhood Obstructive Sleep Apnoea
Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway occlusion during sleep that are associated with daytime behavioural changes and abnormalities...
Original Article
Nasal Obstruction in Children with Sleep-disordered Breathing
Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in...
Original Article
Concomitant Coronary Artery Disease Among Asian Ischaemic Stroke Patients
Coronary artery disease (CAD) is the leading cause of mortality following ischaemic stroke. The annual risk for myocardial infarction following ischaemic stroke is approximately...
Original Article
Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative
Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms...
Original Article
Immunogenicity, Reactogenicity and Safety of a Diphtheria-Tetanus-Acellular Pertussis-Inactivated Polio and Haemophilus Influenzae Type b Combination Vaccine in a Placebo-controlled Rotavirus Vaccine Study
Singapore’s national immunisation programme for the 6 traditional Expanded Programme on Immunisation (EPI) vaccines (i.e. BCG, diphtheria, tetanus, pertussis, polio and measles) and hepatitis...
Images in Medicine
Transfusion-dependent Microcytic Anaemia in a 10-year-old Girl
A 10-year-girl from Bangladesh presented with a moderately severe anaemia (lowest recorded haemoglobin level of 5.6 g/dL) and a mild jaundice (latest serum bilirubin,...
Images in Medicine
Caudal Regression Syndrome
A white female with an uncomplicated history of birth delivery and a familial history of diabetes mellitus presented to the orthopaedic clinic at the...
Others
3rd College of Paediatrics and Child Health Lecture – The Past, the Present and the Shape of Things to Come…
In the post-war days of the 1950s, Singapore children were faced with problems of malnutrition and infectious diseases. There was poverty, overcrowded housing and...
Original Article
Auricular Anthropometry of Newborns at the Singapore General Hospital
Abnormalities of the external ear are described in many syndromes and genetic conditions. Melnick et al reported an incidence of 1 in 90 births...
Original Article
Risk Factor Profile and Treatment Patterns of Patients with Atherothrombosis in Singapore: Insight from the REACH Registry
Atherothrombosis is a global problem that affects every ethnic group. It can lead to ischemic stroke, myocardial infarction or vascular death.
This article is available...
Letter to the Editor
Non-compaction Cardiomyopathy Presenting with Classical Angina Pectoris
Non-compaction cardiomyopathy (NCC) is an unclassified cardiomyopathy, previously known as “spongy left ventricular myocardium”. It is characterised by prominent myocardial trabeculations and deep intertrabecular...
Letter to the Editor
A Case of Myopericarditis in a Patient with Methicillin-resistant Staphylococcus aureus Community-acquired Pneumonia
We described a healthy and physically active 41-year-old man who presented to a private practitioner with right axillary pain and fever. Physical examination revealed...
Others
Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation
Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations,...
Original Article
Screening Tools for Bacteraemia in a Selected Population of Febrile Children
Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from...
Original Article
The Relation Between Insulin Resistance Determined by Haemostatic Modelling and Slow Coronary Flow
Slow coronary flow (SCF) is a well recognised clinical entity, characterised by delayed opacification of coronary arteries in the presence of normal coronary angiogram....
Original Article
Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined
Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications...
Commentary
Improving Access to Outpatient Cardiac Care at the National Heart Centre – A Partnership Between Specialists and Primary Care
There is evidence that shows that the use of healthcare delivered by private providers, particularly procedures and hospital care, depends on supply. For example,...
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...
Letter to the Editor
Phaeochromocytoma the Great Mimicker: A Case Report
Phaeochromocytomas are catecholamine producing neuroendocrine tumours that can manifest a variety of symptoms which mimic other diseases. They are also known for their “rule...
Original Article
The Angiographic Aspects of Myocardial Bridges in Turkish Patients who have Undergone Coronary Angiography
Myocardial bridge, intramural coronary artery, coronary artery over bridging and myocardial loop are essentially the different terms used to designate the same phenomenon. Myocardial...
Images in Medicine
Paediatric perineal skin pit: More than skin deep?
A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth,...
Others
A New Method for the Removal of Safety Pins Ingested by Children
Foreign body ingestion is a relatively common problem, with an estimated incidence of 120 per 1 million population, resulting in approximately 1500 deaths each...
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...
Letter to the Editor
Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis
Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis...
Review Article
Management of Acute ST-Elevation Myocardial Infarction: Reperfusion Options
Cardiovascular disease is a leading cause of death globally. More than 920,000 myocardial infarctions (MI) are diagnosed annually in the United States. Of these,...
Letter to the Editor
A Case of Acute Myocardial Infarction 24 hours after Acute Ischaemic Stroke
It is well known that thrombolysis for acute myocardial infarction (AMI) may lead to disintegration of pre-existing intracardiac thrombi with subsequent cerebral embolisation. It...
Original Article
Morbidity of Parainfluenza 3 Outbreak in Preterm Infants in a Neonatal Unit
Parainfluenza type 3 virus (PIV-3) is an important nosocomial pathogen. It closely mimics respiratory syncytial virus (RSV) in its clinical presentations, and in infants....
Letter to the Editor
An Unexpected Outcome following Radial Head Excision for Jeffrey Type II Fracture-Dislocation of the Proximal Radius in a Child
We present a case of a 10-year-old child who sustained a traumatic fracture-dislocation of his proximal radius and subsequently underwent surgical removal of the...
Letter to the Editor
Temporary Tattoo Associated Type IV Delayed Hypersensitivity Dermatitis in a Child – A Case Report and Call for Parental Caution in Singapore
A 5-year-old, previously healthy French Caucasian boy was seen at a Paediatric Emergency Department for a skin rash over his left forearm.
This article is...
Editorial
The Growing Burden of Cardiovascular Disease: Role of the Arterial-Cardiac Interaction
World Heart Day was inaugurated to increase global awareness that cardiovascular disease (CVD) is the world’s leading cause of death, claiming, according to the...
Images in Medicine
A Case of Congenital Haemolytic Anaemia and Thrombocytopenia
A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to...
Images in Medicine
An Exanthem with An Annular Pattern in a 2-year-old Girl
A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the...
Letter to the Editor
Comparison of Cardiac Output Measurement by Arterial Waveform Analysis and Pulmonary Artery Catheter in Mitral Stenosis
Cardiac output (CO) is a vital measurement that influences clinical decision-making. Although thermodilution via a pulmonary artery catheter (PAC) is considered the gold standard...
Original Article
Clinical Features Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis
Causes of neonatal cholestasis (NC) are long and diverse but the responses of newborn liver, either physiological or anatomical, are limited. This is because...
Original Article
Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children
Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can...
Images in Medicine
Unusual Pacemaker Lead Placement in an Unsuspecting Heart
A 51-year-old man, with a negative cardiac medical history, presented with symptomatic 2:1 atrioventricular block. A permanent pacemaker was implanted.
This article is available only...
Letter to the Editor
Bannayan Riley Ruvalcaba Syndrome
Bannayan-Riley-Ruvalcaba syndrome (BRRS) classically presents with macrocephaly, subcutaneous and visceral lipomata, haemangiomata, hamartomatous intestinal polyps and pigmented macules involving the genitalia. This autosomal dominant...
Images in Medicine
Dyke-Davidoff-Masson Syndrome
An 8-year-old boy presented with uncontrolled seizures. He was born as the second child to non-consanguineous parents. He had significant perinatal asphyxia in the...
Letter to the Editor
Embolised Injection Needle Fragment to the Heart, Mimicking a Subcutaneous Charm Needle
Embolisation of a fragmented injection needle to the heart is rare, even in intravenous drug abusers. The presence of an embolised needle fragment to...
Review Article
Childhood Food Allergy: A Singaporean Perspective
Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the...
Original Article
Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?
Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of...
Original Article
Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients
The term “stroke” comprises all diseases in which a region of the brain is transiently or continuously affected by ischaemia or haemorrhage, and/or in...
Original Article
Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis
Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the...
Original Article
Risk Factors and Clinical Outcomes for Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients with Normal Serum Creatinine
Contrast-induced nephropathy (CIN) is a common complication post-percutaneous coronary intervention (PCI). CINis associated with increased morbidity, mortality, prolonged hospitalisation and long-term renal impairment.
This article...
Original Article
Brachial Approach for Coronary Angiography and Intervention: Totally Obsolete, or a Feasible Alternative When Radial Access is Not Possible?
The possible methods of reaching the coronary vasculature using a percutaneous technique are limitless: the radial, femoral, brachial, ulnar, subclavian and axillary arteries, and...
Commentary
2009 Pandemic Influenza H1N1: Paediatric Perspectives
The pandemic H1N1 influenza virus, containing genes from avian, human and swine influenza viruses, emerged in North America, and caused illness in more than...
Original Article
Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns
Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise...
Others
Angioplasty on an Infarct-related Anomalous Right Coronary Artery Arising from Posterior Coronary Sinus
A 60-year-old chronic smoker had delayed presentation (>18 hours) of acute inferior myocardial infarction with electrocardiogram showing 1.0 mm ST-segment elevation in leads II,...
Others
Complete Atrioventricular Block Complicating Acute Anterior Myocardial Infarction can be Reversed with Acute Coronary Angioplasty
Complete atrioventricular block (AVB) develops in more than 5% of patients with myocardial infarction (MI). These patients have poorer outcomes compared to those without...
Review Article
Acute Myocardial Infarction in Pregnant Women
Acute myocardial infarction (AMI) is an important cause of mortality and morbidity worldwide. It typically occurs in middle-aged or elderly people with cardiovascular risk...
Review Article
Risk Stratification for Sudden Cardiac Death after Acute Myocardial Infarction
In today’s modern era of evidence-based medicine and interventional cardiology, most patients who suffer an acute myocardial infarction (AMI) are started on medication with...
Review Article
Adjunctive Pharmacologic Agents and Mechanical Devices in Primary Percutaneous Coronary Intervention
Primary percutaneous coronary intervention (PPCI) has been shown to be superior to thrombolysis in patients presenting with ST-segment elevation acute myocardial infarction (STEMI), with...
Review Article
Management of Antiplatelet Therapy During Acute Percutaneous Coronary Intervention: New Strategies and Therapeutics
Platelet adhesion, activation, and aggregation are stimulated during an acute coronary syndrome (ACS), the result of intimal injury due to rupture of an atherosclerotic...
Review Article
Risk Assessment Models in Acute Coronary Syndromes and Their Applicability in Singapore
Strategies for managing cardiovascular disease are evolving rapidly. This evolution and improvement in care is responsible for reducing mortality especially in patients presenting with...
Review Article
Current Trends in Diagnostic Biomarkers of Acute Coronary Syndrome
Advances in our understanding of the pathophysiology of acute coronary syndrome (ACS) have led to the marked increase in development of biomarkers for diagnosis,...
Review Article
Update on Clinical Imaging of Coronary Plaque in Acute Coronary Syndrome
Acute coronary syndrome (ACS) encompasses the clinical spectrum of unstable angina (UA) and acute myocardial infarction (AMI). Most ACS are precipitated by luminal thrombi...
Review Article
Panic Attack and its Correlation with Acute Coronary Syndrome – More Than Just a Diagnosis of Exclusion
Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for...
Review Article
Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?
In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence...
Original Article
Clinical and Angiographic Findings of Complete Atrioventricular Block in Acute Inferior Myocardial Infarction
Complete atrioventricular block (AVB) complicates inferior wall myocardial infarction (MI) in 11% to 15% of cases. It usually clusters with conditions indicative of poor...
Original Article
Reperfusion Strategy and Mortality in ST-Elevation Myocardial Infarction among Patients with and without Impaired Renal Function
Randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fi brinolytic therapy in the treatment of ST-segment elevation myocardial...
Original Article
Gender Disparity in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes – Does it Still Exist in Contemporary Practice?
Globally, cardiovascular disease (CVD) is the single most common cause of death among women; and in parallel with an increasing life expectancy, the proportion...
Original Article
The Impact of Gender on the Outcomes of Invasive versus Conservative Management of Patients with Non-ST-Segment Elevation Myocardial Infarction
Recent studies have suggested differences in clinical outcomes between men and women following acute myocardial infarction (AMI). Some studies have indicated poorer survival of...
Original Article
Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction
Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study...
Editorial
Acute Coronary Syndrome: from Epidemiology to Treatment
The term “acute coronary syndrome” (ACS) was introduced a decade ago to describe a spectrum of conditions resulting in acute myocardial ischaemia. It comprises...
Letter to the Editor
Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the...
Letter to the Editor
Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than...
Original Article
Off-Pump versus On-Pump Coronary Artery Bypass Procedures: Postoperative Renal Complications in an Asian Population
To date, the major part of routine cardiac surgery is performed using extracorporeal circulation with cardioplegic arrest. Regardless the technique of cardioplegia, temporary renal...
Original Article
Dedicated Cytogenetics Factor is Critical for Improving Karyotyping Results for Childhood Leukaemias – Experience in the National University Hospital, Singapore 1989-2006
Acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) make up the bulk of childhood leukaemia cases. With risk stratified therapy being one of...
Original Article
Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007
Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is...
Original Article
Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study
The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health...
Images in Medicine
A Missed Bilateral Choanal Atresia
What do you see in the image?
a) Deviated posterior nasal septum
b) Nasopharyngeal tumour
c) Rhinolith with mucous plug
d) Bilateral choanal atresia
e) Nasal pyriform aperture stenosis
This...
Original Article
Health-related Quality of Life in Children with Cancer Undergoing Treatment: A First Look at the Singapore Experience
Health-related quality of life (HRQOL) has been progressively acknowledged as an essential health outcome measure in clinical trials and health services research and evaluation....
Images in Medicine
Catheter Entrapment During Cardiac Electrophysiology Study
A 50-year-old man underwent cardiac electrophysiology study for palpitations. Under fluoroscopic guidance, 1 deflectable decapolar and 2 quadripolar diagnostic catheters
were introduced smoothly into the...
Original Article
Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore
The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist...
Letter to the Editor
Treatment of Coronary In-stent Restenosis with Drug-eluting Balloon Catheter: Real-world Outcome and Literature Review
Dear Editor,
Currently, coronary stent implantation is employed in approximately 90% of percutaneous coronary intervention (PCI) cases. Despite the use of drug-eluting stents (DES), coronary...
Original Article
Electrocardiograph Changes, Troponin Levels and Cardiac Complications After Orthopaedic Surgery
Following orthopaedic surgery, approximately 5% of patients sustain cardiac complications which leads to increased morbidity and mortality. The mortality rate after hip fracture is...
Original Article
Short- and Long-Term Outcomes at 2, 5 and 8 Years Old for Neonates at Borderline Viability—An 11-Year Experience
Singapore was listed consistently among the top 3 countries in the world with the lowest infant mortality rate. In particular, Asia had seen its...
Original Article
Long-term Outcomes of Medical Therapy Versus Coronary Revascularisation in Patients with Intermediate Stenoses Guided by Pressure Wire
Although coronary angiography has been used as the “gold standard” imaging technique for the diagnosis of coronary artery disease, it is essentially a lumenogram...
Images in Medicine
Chest Pain, Something is Not Right…Or Left
A 46-year-old female was referred for evaluation of central chest pain unrelated to exertion. She was known to have diabetes mellitus, hypertension, and dyslipidaemia....
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...
Original Article
Improved door-to-balloon time for primary percutaneous coronary intervention for patients conveyed via emergency ambulance service
Early reperfusion of ST-segment elevation myocardial infarction (STEMI) has been shown to result in better outcomes,1-3 and guidelines for treatment of STEMI recommend a...
Letter to the Editor
Prevalence of vitamin D deficiency and insufficiency in Malaysian infants
Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either...
Letter to the Editor
Impact of true fetal mosaicism on prenatal screening and diagnosis
Over the past decade, the non-invasive prenatal test (NIPT) has increasingly been used as a method for prenatal screening for trisomy 21 (T21) and...
Commentary
Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging
Transthyretin amyloidosis (or ATTR amyloidosis) is an under-recognised multisystemic disorder, arising from misfolding of transthyretin proteins into insoluble amyloid fibrils. As amyloid fibrils deposit...
Original Article
New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore
Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown....
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...
Editorial
Medical management of PAD: Expand or consolidate?
In this issue of the Annals, a rapid review of adherence to evidence-based medical treatment highlights an important and underappreciated aspect of the management...
Letter to the Editor
Dynamic mitral regurgitation treated with MitraClip
The dynamic nature of mitral regurgitation (MR) has been well appreciated but clinically under-recognised. In addition, evidence on therapeutic options for dynamic MR has...
Letter to the Editor
Percutaneous paravalvular leak repair for severe aortic regurgitation after transcatheter aortic valve implantation (TAVI)
Paravalvular leaks (PVLs) are not uncommon after surgical valve replacement. The need for re-operation for clinically significant leaks is between 1 and 3%. Percutaneous...
Original Article
Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there...
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...
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...
Original Article
Epidemiology and risk stratification of minor head injuries in school-going children
Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports...