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Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial

Dear Editor, Emergence from anaesthesia and deep sedation is the transition from unconsciousness to the return of awareness and airway reflexes. The chief patterns of...

Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae infections among hospitalised children in Singapore

Dear Editor, Mycoplasma pneumoniae has become the leading cause of paediatric community-acquired pneumonia in countries where pneumococcal vaccination is included in the national immunisation programme,...

Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations

Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus...

Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series

Dear Editor, Thrombosis is an unexpected complication of COVID-19 initially reported in 3 patients from China.1 These patients tested positive for immunoglobulin (Ig) A anticardiolipin...

Evaluation of a health screening protocol for recovered COVID-19 patients before “return-to-play” and strenuous physical activity

Dear Editor, We conducted a prospective, single-centre cohort study to develop guidance for military personnel returning to strenuous activities following SARS-CoV-2 infection. The patients underwent...

Case Series of Bronchoscopic Removal of Tracheobronchial Foreign Body in Six Adults

Gustav Killian reported the first case of bronchoscopic removal of foreign body (FB) from the trachea in 1897. Since then, rigid bronchoscopy under general...

Bronchoscopy in the Intensive Care Unit (ICU)

Flexible fibreoptic bronchoscopy (FFB) has become an indispensable tool in the optimal management of intensive care unit (ICU) patients with both diagnostic and therapeutic...

Combined High-frequency Ventilation (CHFV) in the Treatment of Acute Lung Injury—A Case Report

The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The...

Contributions of Respiratory Care Practitioners to Intensive Care: A Review

The intensive care unit (ICU) is a complex environment in which multidisciplinary expertise has been shown to enhance clinical outcomes. For example, the availability...

Ventilatory Strategies for Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) was first described by Ashbaugh et al in 1967. The original authors detailed the presence of tachypnoea, hypoxaemia, decreased...

The Oxygen Delivery Debate—A Review

Multisystem organ failure occurs in a large proportion of critically ill patients and is a major cause of death in this group of patients....

Controlled Observations in Critical Care Medicine: The Therapeutic Trial

Central to the combined diagnostic and therapeutic approach to the critically ill subject is the evaluation of both the basal physiologic status and its...

Impact on Quality of Patient Care and Procedure Use in the Medical Intensive Care Unit (MICU) Following Reorganisation

Critical care is costly as it is labour intensive and involves expensive life support technology. In the United States, the intensive care units (ICUs)...

Intensivists for the Intensive Care Unit—Do They Make a Difference?

Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have...

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...

A Prospective Study of Infections with Atypical Pneumonia Organisms in Acute Exacerbations of Chronic Bronchitis

Chronic obstructive pulmonary disease (COPD) is a disease state characterised by the presence of airflow limitation that is generally progressive, partially reversible and caused...

Hospitalised Low-risk Community-acquired Pneumonia: Outcome and Potential for Cost-savings

Community-acquired pneumonia (CAP) is a common illness with nearly 4 million adults diagnosed each year in USA with more than 600,000 hospita1isations. The associated...

Long-term Outcome and Disease Control in Near-fatal Asthma

Rising trends in mortality in asthma have been reported from many countries, including Asian countries such as Hong Kong. Asthma deaths have been associated...

Rapid Mycobacterial Tuberculosis Detection in Bronchoalveolar Lavage Samples by Polymerase Chain Reaction in Patients with Upper Lobe Infiltrates and Bronchiectasis

Pulmonary tuberculosis (PTB), the incidence of which is rising, poses a major health problem. It is caused by <i>Mycobacterium tuberculosis</i>. The isolation of <i>Mycobacterium...

Beneficial Effect of Combination Therapy with Ozagrel and Pranlukast in Exercise-induced Asthma Demonstrated by Krypton-81m Ventilation Scintigraphy—A Case Report

Exercise is a common stimulus of bronchoconstriction in subjects with asthma. Exercise-induced asthma is a temporary increase in airway resistance that occurs after several...

Cardiopulmonary Exercise Testing in Patients with Chronic Obstructive Pulmonary Disease

Exercise intolerance is a hallmark of chronic obstructive pulmonary disease (COPD). Although exertional symptoms may be mild at the outset, exercise limitation is the...

Ethnic Differences in Genetic Susceptibility to Atopy and Asthma in Singapore

Twin studies have indicated that both asthma and atopy are largely regulated by genetic factors. However, the genetics is complex, involving an interaction of...

Human Genetic Susceptibility to Tuberculosis

The World Health Organization has declared that the recent resurgence of tuberculosis (TB) is a global emergency. Southeast Asia, which is seeing the greatest...

A Case Report of Aspergillus Hypersensitivity Syndrome with Obstructing Bronchial Aspergillosis

The spectrum of pulmonary aspergillosis includes saprophytic colonisation, hypersensitivity syndromes and invasive lung disease. There has been a tendency to classify these syndromes as...

Upper Airway Resistance Syndrome—Report of Three Cases

Sleep-related breathing disorders are widely recognised as important causes of morbidity and mortality over the past 3 decades. The obstructive sleep apnoea syndrome (OSAS)...

Audit of Oxygen Therapy in Acute General Medical Wards Following an Educational Programme

The rational basis for supplemental oxygen (O<sub>2</sub>) treatment is well established. Long-term O<sub>2</sub> therapy improves survival and quality of life in patients with chronic...

Active Management of a Patient with Endstage Pulmonary Emphysema Using Lung Volume Reduction Surgery and Intensive Rehabilitation

A 65-year-old Chinese man with a 30-pack year history of cigarette smoking was referred to our institution for further management of chronic obstructive pulmonary...

Endobronchial Mass in a Patient with Burkholderia pseudomallei Infection

The diagnosis of Burkholderia pseudomallei infection is based on culture of clinical specimens such as blood or other body fluids, or serology using indirect...

Endobronchial Stenting in Patients Requiring Mechanical Ventilation for Major Airway Obstruction

Few things are as dramatic as respiratory arrest from major airway obstruction. Major airway obstruction frequently leads to well-defined clinical sequelae, namely shunt-associated hypoxaemia...

Clinical Update on Occupational Asthma

Occupational asthma is the most common occupational respiratory disease in the United Kingdom and also in Singapore. Recent estimates of the proportion of adult...

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...

Effect of Different Endotracheal Suctioning Systems on Cardiorespiratory Parameters of Ventilated Patients

Endotracheal suctioning is a routine procedure performed in the intensive care unit (ICU) to remove secretions from the tracheobronchial tree. This is to maintain...

The Role of Early Tracheostomy in Critically Ill Neurosurgical Patients

In medical history, tracheostomy is one of the oldest operations performed. There are indications that the Egyptians first employed this procedure more than 3500...

Effects of a Pulmonary Rehabilitation Programme on Physiologic and Psychosocial Outcomes in Patients with Chronic Respiratory Disorders

Pulmonary rehabilitation is a multi-disciplinary programme of care for patients with chronic respiratory impairment that is individually designed to optimise physical and social performance...

Recent Advances in the Obstructive Sleep Apnoea/Hypopnoea Syndrome

The past decade has seen a rapid increase in the number of patients being referred for investigation for the obstructive sleep apnoea/hypopnoea syndrome (OSAHS)....

All that Wheezes is not Asthma—Broncholithiasis, a Forgotten Disease

Asthma is a very common condition which presents clinically with cough, shortness of breath and wheezing. However, ‘all that wheezes is not asthma’, is...

Asthma Disease Management: A Provider’s Perspective

The burden of asthma appears to be increasing worldwide, especially in societies undergoing rapid urbanisation, and both morbidity and mortality from asthma have increased...

Emergency Department Asthma: Compliance with an Evidence-based Management Algorithm

Attendance at the emergency medicine department (EMD) for acute exacerbation is an important milestone in the natural history of patients with asthma. It is...

Four-month Chemotherapy in the Treatment of Smear-negative Pulmonary Tuberculosis: Results at 30 to 60 Months

Patients with active pulmonary tuberculosis (PTB) are usually treated with a 6-month regimen in which chemotherapy is administered daily, intermittently or as a combined...

Bacteriologically-negative Pulmonary Tuberculosis—The Singapore Tuberculosis Control Unit Experience

The management of a patient as for pulmonary tuberculosis (PTB) in the setting of negative bacteriology would have to take into account not only...

Asthma in Light of Patient Documents. A Factor Analytic Study

The lack of uniform criteria for asthma handicaps the diagnosis, the systematic documentation of cases and the consistent reporting of studies addressing asthma. It...

Malignant Mesothelioma: Experience at the Singapore General Hospital

Malignant mesothelioma is a rare tumour and is typically associated with asbestos exposure. In endemic areas, it has an estimated incidence as high as...

Pulmonary Hypereosinophilia

Eosinophilic lung diseases encompass a heterogenous spectrum of lung disorders defined by increased eosinophils in blood and/or tissue. In 1952, Crofton et al proposed...

An Unusual Cause of Pulmonary Haemorrhage in a Patient with Rheumatoid Arthritis

Strongyloides stercoralis is an intestinal nematode which causes a chronic but usually asymptomatic infection in humans. However, in immunocompromised patients, parasitic larvae can develop...

A Case Report of Occupational Asthma due to Gluteraldehyde Exposure

Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been...

The Haze and Health: A Blog About the Fog

The haze is an atmospheric phenomenon where pollutant particles accumulate in the air and obscure the normal clarity of the sky. In Singapore, this...

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...

SARS: How to Manage Future Outbreaks?

Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV), which crossed from wild animals at live markets to man in mid-November...

Guidelines on Cardiac CT in Singapore (2006)

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

The Clinical Predictors of Hypertension and Sleepiness in an Asian Population with Sleep-disordered Breathing

Sleep physicians have only recently began to learn much about the epidemiology of sleep-disordered breathing (SDB) from large, well conducted prospective community-based studies. These...

Sarcoidosis with Granulomatous Hepatitis and Autoimmune Endocrine Involvement

Sarcoidosis is a systemic granulomatous disease of unknown aetiology. It emerges in the form of hiler adenopathy and interstitial pulmonary disease in most cases. This...

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...

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...

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...

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...

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...

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...

Obstructive Sleep Apnoea in Singapore: Polysomnography Data From a Tertiary Sleep Disorders Unit

Overnight attended polysomnography (PSG) in the sleep laboratory has been the gold standard to confirm the presence and severity of obstructive sleep apnoea (OSA)....

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....

Impact of the Singapore National Asthma Program (SNAP) on Preventor-Reliever Prescription Ratio in Polyclinics

According to the World Health Organization/Global Initiative on Asthma (WHO/GINA) report on the global burden of asthma, Singapore is an intermediate-risk country for asthma...

T Lymphocyte Activation Profiles in Peripheral Blood of Long-Versus Short-Term Residents of Kuwait: Comparison with Asthmatics

The Gulf Wars of 1991 and 2003 exposed the residents of Kuwait and several neighbouring countries to high levels toxicants with the capacity to...

Lung Cancer: Recent Advances

Lung cancer is the leading cause of cancer related mortality in the world. It accounts for almost a million deaths annually and resulted in...

Difference in Asthma Control Test™ (ACT) Scores in Three Different Clinical Practice Settings

The prevalence of asthma ranges from 1% to 18% worldwide and it remains a significant cause of morbidity and economic burden despite advances in...

Clinical Features of Allergic Rhinitis and Skin Prick Test Analysis Based on the ARIA Classification: A Preliminary Study in Malaysia

Allergic rhinitis (AR) is a common disease worldwide and is known to cause serious implications to the physical and mental health status of the...

Off-pump Coronary Artery Bypass is a Safe Option in Patients Presenting as Emergency

Percutaneous coronary intervention (PCI) is the preferred therapy strategy for revascularisation in the case of an acute coronary syndrome (ACS) or acute myocardial infarction...

Inadvertent Haemodialysis in a Pulmonary Tuberculosis Patient with Hypercalcaemia

Malaysia is a country with an intermediate burden of tuberculosis (TB) with a prevalence of 121 cases per 100,000 population per year. TB usually...

Sir John Wenman Crofton

Sir John Crofton, a world famous expert on the treatment of tuberculosis died in Edinburgh at the age of 97. John Crofton was born...

Rapidly Vanishing Pulmonary Pseudotumour

A 51-year-old male ex-smoker with a history of pulmonary tuberculosis was referred for exertional dyspnoea for 5 days. He had no fever, cough or...

Demographic Determinants of Survival in Osteosarcoma

The treatment of osteosarcoma has seen tremendous improvements over the last 3 decades of the twentieth century. Over the last decade it appears that...

Plasma IP-10 could identify early lung disease in severe COVID-19 patients

Dear Editor, The global pandemic of SARS-Coronavirus-2 (SARS-CoV-2) infection has imposed tremendous strain on healthcare resources worldwide, as a significant proportion of patients require...

Outcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study

Despite its widespread adoption, rapid response systems (RRS) and rapid response teams (RRT) vary significantly in composition and set-up.1-3 While implementation of RRSs appear...

An Unusual Cause of Severe Pulmonary Hypertension in a Young Woman

Dear Editor, A 25-year-old Cambodian lady diagnosed with pulmonary hypertension in her native country came for second opinion on the further management of her condition....

Cognitive Aspect of Diagnostic Errors

It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were...

Heterogeneity of non-cystic-fibrosis bronchiectasis in multiethnic Singapore: A prospective cohort study at a tertiary pulmonology centre

Bronchiectasis is a chronic lung disease of significant morbidity and mortality. The pathological hallmarks of the disease are abnormal dilatation of airways resulting from...

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...

Impact of pulmonary rehabilitation in patients with interstitial lung disease in Singapore

Interstitial lung diseases (ILD) encompass a heterogeneous group of lung parenchymal disorders. ILD-related symptoms impact significantly on quality of life (QoL). Dyspnoea is the...

Radiological changes on chest CT following COVID-19 infection

COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution...

The Novel Coronavirus (SARS-CoV-2) Pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and...

Controversies in Sepsis Management—What is the Way Forward?

Sepsis is a common and life-threatening medical condition which has high incidence and mortality rates. Health care professionals are increasingly familiar with this syndrome,...

Emergency airway management in a Singapore centre: A registry study

Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to...

Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection

In this report, we describe a patient who developed acute respiratory distress syndrome (ARDS) with rapid clinical deterioration. Unfortunately, not much is known about...