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Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

Dear Editor, The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an...

Sedation in gastrointestinal endoscopy in Singapore

Dear Editor, I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use...

Non-anaesthesiologists administering propofol in the Singapore context

Dear Editor, Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid...

Sedation by non-anaesthesiologists in gastrointestinal endoscopy

Dear Editor, We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy...

Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore

Functional gastrointestinal (GI) disorders, such as colic, gastroesophageal reflux (GER) and constipation, are common in infants under 1 year. They are a frequent cause...

Gastroesophageal reflux disease in Asian infants: Similar condition, different perceptions

Gastroesophageal reflux disease (GERD), a common problem in infancy, may lead to troublesome symptoms or complications such as oesophagitis or oesophageal stricturing in a...

Are Antacids Necessary as Routine Prescriptives with Non-steroidal Anti-inflammatory Drugs?

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic or anti-inflammatory properties in musculoskeletal pain. However, they are not without adverse effects, such...

9th Seah Cheng Siang Memorial Lecture: Gastric Cancer—Where are we now?

The last two decades have witnessed dramatic changes in the understanding of gastric cancer: a rapid decline in global incidence, its association with Helicobacter...

Diagnosing and Managing Faecal Incontinence

Faecal incontinence is the inability to control the passage of gas, liquid or solid through the anus. Its severity varies from infrequent passage of...

Magnetic Resonance Cholangiopancreatography: Value of Using the Half-Fourier Acquisition Single-Shot Turbo Spin-Echo (HASTE) Sequence

Direct cholangiopancreatography has long been considered the standard of reference for assessment of the biliary tree and is generally safe, reliable and widely available....

Standard Oesophageal Manometry in Healthy Adults in Singapore

Although standard oesophageal manometry has been widely used in the West for many years, normal manometric values that have been well described for healthy...

A Practical Technique of Colour Image Analysis: Applications in Experimental Research

Colour image analysers have been extensively used in medical research since 1970 for histomorphometric studies. Image analysis gives more information and a better understanding...

Tissue Microangiography Using a Simplified Barium Sulphate Cadaver Injection Technique

The understanding of blood supply is the cornerstone of successful tissue transfer in reconstructive surgery. This understanding has been derived largely from cadaveric dissections,...

Effect of Antiangiogenic Agents on Experimental Animal Models of Hepatocellular Carcinoma

Metastatic spread is the principal reason of treatment failure in solid tumours. Surgery, radiation therapy and chemotherapy have not manifestly altered the prognosis for...

Gut Barrier Dysfunction in Experimental Acute Pancreatitis

Bacterial infections are devastating and potentially lethal complications of acute pancreatitis, responsible for up to 80% of deaths in the condition. Pathogenetic studies of...

Experimental Models of Pancreatitis

From a historical perspective, the first experimental pancreatitis was induced by Claude Bernard in 1856 by the injection of bile and olive oil into...

Immunological Consequences of Trauma and Shock

Despite intensive research and intervention, trauma continues to be the leading cause of death during the first three decades of life in the USA,...

Murine Metastatic Tumour Models for Cancer Gene Therapy Research

In the evaluation of any new cancer treatment, the use of appropriate experimental animal tumour models to bridge the gap between in vitro discovery...

Experimental Models of Hepatic Fibrosis in the Rat

Hepatic fibrosis and cirrhosis of the liver are complex diseases which, in man, may be caused by such varied factors as alcohol, hepatitis, schistosomiasis,...

Regulation of Insulin Secretion by Nerves and Neuropeptides

The pancreatic islets of Langerhans were described by Paul Langerhans in 1869. They are distributed throughout the entire pancreas forming in adults approximately 1%...

An Animal Model for the Study of Hepatic Stellate Cell and Hepatocellular Carcinoma Interaction

Hepatic stellate cells (HSC) are mesenchymal cells that are prominent in various forms of liver injury, in particular with cirrhosis or carbon tetrachloride-induced fibrosis....

Establishment of Animal Models Using Experimental Rats for Allogeneic Tissue Transplantation and Quantitative Flow Cytometric Detection of Immunochimera

Allogeneic tissue and organ transplantation has long been an important medical issue, as it provides an effective treatment alternative for a broad spectrum of...

Experimental Study of Hypovolaemic Shock-Induced Gastric Mucosal Lesions in the Rat

Hypoxic tissue injury is not only caused by lack of oxygen as was previously believed. Now it is clear that tissue injury associated with...

The Role of Mast Cell Degranulation in Ischaemia-reperfusion-induced Mucosal Injury in the Small Intestine

Although a number of data support the notion that mast cell (MC) degranulation Is an important component of the tissue response elicited by ischaemia-reperfusion,...

Efficacy of Contraction Uncoupling by 2,3-Butanedione Monoxime during Initial Reperfusion versus Cardioplegic Arrest for Protection of Isolated Hearts

Despite the recent developments of minimally invasive surgery, most cardiac surgery procedures still include ischaemic cardioplegic arrest and cardiopulmonary bypass. For decades the efforts...

Synergistic Effect of Hepatitis B Virus and Aflatoxin B1 in Hepatocarcinogenesis in Tree Shrews

Primary hepatocellular carcinoma (HCC) is one of the commonest cancers in some parts of the world including several areas in China. The geographically distinct...

The Expression of Insulin-like Growth Factor II, Hepatitis B Virus X Antigen and p21 in Experimental Hepatocarcinogenesis in Tree Shrews

Hepatocarcinogenesis is a multistage and multifunctional process. Epidemiological studies indicate that contamination of food with aflatoxin B, (AFB,) and chronic infection with hepatitis B...

Nitric Oxide Synthase-Its Distribution and Alteration in the Intramural Ganglia of the Urinary Bladder in Normal and Urethra-obstructed Guinea Pigs

Nitric oxide (NO) has been recognised as a nonadrenergic noncholinergic (NANC) inhibitory neurotransmitter at various sites in the nervous system. Its function as a...

Radionuclide Studies of Articular Cartilage in the Early Diagnosis of Arthritis in the Rabbit

Osteoarthritis is a common joint disease that involves destruction of articular cartilage. Magnetic resonance imaging (MRI) provides a sensitive imaging modality for the diagnosis...

The Effect of Storage at -70°C and -150°C on the Torsion Properties of the Canine Femur

Allograft transplantation of bone has been established as a viable and useful reconstructive procedure when limb salvage is the option of choice. For bone...

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...

The Viability of Liver Graft for Transplantation After Prolonged Warm Ischaemia

Liver transplantation (LTx) is the treatment of choice for many patients with end stage liver disease. However liver allograft availability prevents its widespread application. This...

Use of Titanium Prosthesis to Bridge a Vertebral Gap in the Spine—A Preliminary Experimental Study

Bridging a vertebral gap in the spine is one of the commonest problems facing the spine surgeon after dealing with a tumour, infection or...

A Simple Method of Blood Pressure Measurement in the Pig Using a Neonatal Cuff

Blood pressure is an important parameter commonly measured in experimental studies using animal models. Various non-invasive techniques to monitor blood pressure have been described...

The Results of Autogenous Tibial Periosteal Transplants for Full Thickness Cartilage Defects in the Knee Joints of Pigs

Articular cartilage injuries to the knee are commonly seen by team doctors, sports physicians and orthopaedic surgeons. Despite many clinical as well as experimental...

Microvascular Lung Tissue Oxygenation—A Methodological Study in the Pig

Although the lung is mostly referred to as a respiratory organ it also exhibits a variety of metabolic functions, e.g. uptake, storage and/or synthesis...

The Philosophical Basis of the Experimental Method

The application of the experimental approach to Science and Medicine has its roots in the 16th century. William Harvey (1578-1657), who demonstrated the passage...

Antineutrophil Cytoplasmic Antibodies (ANCAs) in Patients with Inflammatory Bowel Disease Show No Correlation with Proteinase 3, Lactoferrin, Myeloperoxidase, Elastase, Cathepsin G and Lysozyme: A Singapore Study

The diagnostic tests currently employed to diagnose inflammatory bowel disease (IBD) and to differentiate between Crohn’s disease (CD) and ulcerative colitis (UC) are both...

Pseudomembranous Colitis in a Patient Treated with Paclitaxel for Carcinoma of the Breast: A Case Report

Paclitaxel was discovered in 1963 as a crude extract from the bark of the pacific yew Taxus brevifolia. Since its development, a range of...

Early Hepatocellular Carcinoma Presenting with Biliary Ductal Invasion—A Case Report

Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000...

Survival of Colorectal Cancer Patients in Singapore by Anatomic Subsite: A Population-based Study

Colorectal cancer incidence rates rank second in most developed countries and have been rising rapidly in urban societies of East Asia. Despite much effort...

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...

Shigella Septicaemia in Adults: Report of Two Cases and Mini-Review

Shigellosis is generally considered to be confined to the gastrointestinal tract. Septicaemic infections with Shigella species are extremely rare in adults. This article is available...

Psychiatric Illness, Personality Traits and the Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder seen by gastroenterologists and has been found to account for 50% of referrals...

Clinical Update on Helicobacter pylori

Helicobacter pylori is one of the commonest infections in human, affecting 30% to 50% of people worldwide. It is associated with the development of...

Perioperative Treatment with Bactericidal/Permeability-Increasing Protein (rBPI21) in Major Liver Surgery: A Concise Summary

Primary and secondary hepatic malignancies constitute a major health problem. Hepatocellular carcinoma accounts for 90% of all primary hepatic malignancies in the world. While...

Book Review

The third edition of this manual of gastroenterology by regional experts from Malaysia and Singapore consists of 27 short chapters packaged in 2 sections...

History of the Orthopaedic Specialty in Singapore

When the practice of orthopaedic surgery first began in Singapore, it was not a specialty in itself. There are no records as to when...

Current Status in the Surgical Management of Adult Polycystic Liver Disease

Adult polycystic liver disease (APLD) is a rare benign condition that is characterised by the growth of multiple cystic lesions in the liver. More...

Boerhaave’s Syndrome Presenting as a Right-sided Pleural Effusion

A 79-year-old Chinese woman with no significant past medical history was admitted to another hospital with symptoms of abdominal pain and haemetemesis of approximately...

Modern Management of Colorectal Polyps: Are They All Premalignant?

Polyps of the colon and rectum are relatively common lesions. Most colorectal polyps are either adenomas or hyperplastic polyps. This article is available only as...

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)...

Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

The practice of gastrointestinal (GI) endoscopy over the last 3 decades has seen both a rise in volume of routine procedures, and an increase...

The impact of deprescribing interventions on oral proton pump inhibitor utilisation in a Singapore tertiary hospital: A quality improvement initiative

The established efficacy of proton pump inhibitors (PPIs) in the treatment of upper gastrointestinal (GI) disorders, coupled with their perceived safety, have led to...

Ensuring safe sedation during gastroendoscopy

Gastrointestinal (GI) endoscopy started in Singapore in 1968 with diagnostic endoscopic gastric examination, using flexible fibre-optics GI endoscopy. Fibre-optic flexible sigmoidoscopy and colonoscopy were...

Inflammatory Fibroid Polyp of the Caecum in a Patient with Neurofibromatosis

Inflammatory fibroid polyp is an uncommon nonneoplastic lesion found in the gastrointestinal tract. It is a benign, non-encapsulated submucosal lesion, composed mainly of loose...

Axoglial Interaction via the Notch Receptor in Oligodendrocyte Differentiation

Oligodendrocytes (OLs) derived from the common neural progenitor cells in the central nervous system (CNS) ensheathe the nude axon to form the myelin that...

Appropriateness of the Use of Parenteral Nutrition in a Local Tertiary-Care Hospital

Parenteral nutrition (PN) is an important supportive and often life-saving therapy for patients with gut failure. However, it is expensive and carries significant complications...

A Bolt Out of the Blue: A Case of Unexpected Acute Liver Failure

Acute hepatitis could result from viral, autoimmune or drug-reaction causes, among others. In areas endemic with hepatitis B, acute exacerbations of chronic hepatitis B...

Does the Advent of Endoscopic Ultrasound (EUS) Sound the Death Knell for Endoscopic Retrograde Cholangiopancreatography (ERCP)?

Endoscopic retrograde cholangiopancreatography (ERCP) has been the primary method of diagnosing and treating many pancreatic and biliary diseases (PBD) over the last 3 decades....

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...

Ceftriaxone-resistant Salmonella spp. in Singapore

The utility of ceftriaxone for the treatment of Salmonella typhi bacteraemia was first demonstrated in Singapore as early as 1985. Since then, ceftriaxone has...

Ten-year Series of Splenic Abscesses in a General Hospital in Singapore

Splenic abscess is an uncommon clinical problem. Fewer than 800 cases have been reported in the literature. This article is available only as a PDF....

Translating the Family Medicine Vision into Educational Programmes in Singapore

The core of the Family Medicine (FM) vision is patient-centred care, requiring specific education and vocational training. Modern day FM began its existence as...

Charity Colonoscopy Event to Commemorate the 185th Anniversary of Singapore General Hospital

Colorectal cancer is now the cancer with the highest incidence in Singapore. Similar to many developed countries, individuals here have a moderate to high...

Rehabilitation for Traumatic Brain Injury in Children and Adolescents

Traumatic injury to the brain (TBI) can lead to multiple medical, cognitive and functional issues, both in the acute care setting as well as...

Liver Transplantation in Asia: Past, Present and Future

Liver transplantation is the best treatment modality for patients with end-stage liver diseases. It has been landmarked as one of the most important advances...

Guidelines for Endoscopic Ultrasonography

This guideline addresses the use of endoscopic ultrasound (EUS) as part of the diagnostic evaluation of certain conditions. In addition, issues of training and...

Diagnostic Challenge: A 79-Year-Old Woman with Calcified Lower Abdomen Mass

A 79-year-old woman presented with fever, diarrhoea, vomiting and abdominal pain for several hours. Her temperature was 39.2°C, pulse 102 beats/minute, respiratory rate 19...

Laparoscopic Common Bile Duct Exploration: Our First 50 Cases

Since its introduction a few decades ago, endoscopic retrograde cholangiopancreatography (ERCP) has brought about a significant change in the management of choledocholithiasis. With continual...

Peutz-Jeghers Syndrome: Data from the Singapore Polyposis Registry and a Shifting Paradigm in Management

Peutz-Jeghers Syndrome (PJS) is an uncommon autosomal dominant hamartomatous polyposis syndrome associated with mucocutaneous melanocytic macules. Melanin deposition occurs most commonly in the perioral...

Thrombocytopenia and its Related Factors: A Hospital-based, Cross-sectional Study

Thrombocytopenia is a common clinical problem found in laboratory results during health examinations. Blood platelets play an essential role in haemostasis, thrombosis and coagulation...

Current Technology in Navigation and Robotics for Liver Tumours Ablation

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the liver is the most common site of metastatic disease for intra-abdominal malignancies. Surgical...

Fasting during Ramadan and Associated Changes in Glycaemia, Caloric Intake and Body Composition with Gender Differences in Singapore

Muslim individuals worldwide participate in obligatory abstinence from oral consumption of medications, food and liquid during the fasting month of Ramadan. Fasting during Ramadan...

Assessment of Age in Ulcerative Colitis Patients with Ileal Pouch Creation—An Evaluation of Outcomes

A total proctocolectomy is considered the standard of care in patients with ulcerative colitis (UC). The indications for this operation in patients with UC...

Laparoscopic liver resection: Global diffusion and learning curve

Laparoscopic liver resection (LLR) is being utilised with increasing frequency worldwide, as initial concerns about the safety and feasibility of LLR, such as the...

Congenital adhesion band causing recurrent subacute intestinal obstruction in a virgin abdomen

Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB)...