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Comparison of planned-start, early-start and deferred-start strategies for peritoneal dialysis initiation in end-stage kidney disease

Peritoneal dialysis (PD) is a well-established long-term dialysis modality for patients with end-stage kidney disease (ESKD).1 It is recommended that a PD catheter should...

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...

Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation

In-hospital cardiopulmonary resuscitation (CPR) for chronic kidney disease (CKD) patients is shown to have lower survival1 and a higher proportion of survivors on maintenance...

Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis

End-stage renal failure (ESRF) is a major cause of morbidity and mortality worldwide, including Asia.1 In Singapore, incidence of chronic kidney disease (CKD) stage...

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...

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,...

The Profile of Hospitalised Patients with Parkinson’s Disease

Prevalence studies in various parts of the world have shown that Parkinson’s disease (PD) is relatively common among the aged in all countries. Crude...

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...

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....

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...

Malaria Requiring Intensive Care

Malaria is an important and common infectious parasitic disease globally. It is associated with significant morbidity and mortality, especially in endemic areas. This article is...

Diabetes Insipidus in Neurosurgical Patients

Diabetes insipidus (DI) is a syndrome characterised by the excretion of abnormally large volumes of dilute urine. It occurs uncommonly in neurosurgical patients, but...

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...

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...

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...

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...

Ethnicity, Obstructive Sleep Apnoea and Ischaemic Heart Disease

Obstructive sleep apnoea (OSA) is a condition whereby there is snoring associated with complete or partial cessation of breathing during sleep, associated with nocturnal...

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...

Extended Resection of Locally Advanced (T4) Stomach Cancer

Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years,...

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...

Adverse Operative Risk Factors for Perforated Peptic Ulcer

Although there has been a significant decline in elective surgery for peptic ulcer disease with the introduction of H-2 blocker, the incidence of peptic...

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...

Critical Role of Functional Decline in Delayed Discharge from an Acute Geriatric Unit

In the last decade, many countries have experienced alarming transformation in their demographic patterns, with the elderly population emerging as the fastest growing segment...

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...

Catheter-related Infection: Diagnosis, Prevention and Treatment

Intravascular catheters are indispensable for patient care. Despite advances in catheter technology and patient care, catheter infection remains a significant clinical problem. This article is...

Quality of Life in Long-Term Survivors of Intensive Care

Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying...

Limitation of Life Support in the Critically Ill: The Hong Kong Perspective

Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly...

The Practice of Foregoing Life Support in the Critically Ill “Old Old”: A Singapore Perspective

Studies on the foregoing of life support (FLS) in North America, Europe and Australia have shown diversity in terms of the incidence, decision-making process...

Abdominal Complications after Cardiac Surgery

Despite intensive therapeutic efforts, both the incidence and mortality of gastrointestinal complications after cardiac surgery employing cardiopulmonary bypass (CPB) have not decreased during the...

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...

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...

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...

Influenza in Singapore: Assessing the Burden of Illness in the Community

Influenza is a major cause of morbidity and mortality worldwide. Morbidity in the working age group gives rise to frequent doctor visits and considerable...

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...

Epidemiology of Beta-haemolytic Group G Streptococcal Bacteraemia in Singapore (1996 to 1998)

Human isolates of group G streptococci (GGS) that form large colonies are similar to group A streptococci (GAS) in terms of virulence and cause...

Osteoporotic Hip Fractures in Singapore—Costs and Patient’s Outcome

Singapore is facing a rapidly ageing population. Osteoporosis, which is an age-related illness, will become an increasing problem. Osteoporotic hip fracture, because of the...

Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations

It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in...

Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital

Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly...

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...

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....

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...

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...

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...

Deep Hypothermic Circulatory Arrest in Adults Undergoing Aortic Surgery: Local Experience

The use of deep hypothermic circulatory arrest (DHCA) as a method of cerebral protection during aortic surgery was first described in 1975. Its use...

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...

Severe Adult Chickenpox Infection Requiring Intensive Care

Chickenpox (varicella) in adults can be severe. It is frequently associated with pneumonia and immunosuppression as well as increased mortality rates. This article is available...

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...

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...

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...

Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Early Predictors of Mortality in Pneumococcal Bacteraemia

Streptococcus pneumoniae infection is the most common cause of community-acquired pneumonia worldwide.1 It has been associated with an approximately 10% rate of bacteraemia.2-4 Despite...

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...

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)....

Review of Children Hospitalised for Ingestion and Poisoning at a Tertiary Centre

Childhood ingestion and poisoning is an important problem in many countries,1-8 and accounts for a significant workload for emergency department consultations and hospital admissions.9,10...

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...

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the...

The case for better hospitalisation selection in cancer patients

Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been...

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...

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...

An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza Admitted to Singapore Hospitals from July to September 2009

On 17 April 2009, the US Centers for Disease Control (CDC) determined that febrile respiratory illness occurring in 2 children residing in adjacent counties...

Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009

The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas...

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...

Causes of Death in Hospitalised Human Immunodeficiency Virus (HIV)-infected Patients at a National Referral Centre in Singapore: A Retrospective Review from 2008 to 2010

The advent of the highly active antiretroviral therapy (HAART) era has greatly reduced the mortality and incidence of new diagnoses of acquired immune deficiency...

Antibiotic Therapy and Clinical Outcomes of Pseudomonas Aeruginosa (PA) Bacteraemia

Pseudomonas aeruginosa (PA) is a virulent nosocomial pathogen and PA bacteraemia is associated with high mortality ranging from 18% to 59%. It is ranked...

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...

A 10-Year Profile of Trauma Admissions Caused by Interpersonal Violence: A Major Trauma Centre’s Experience

The World Health Organization (WHO) has divided violence into 3 categories: interpersonal violence, self-directed violence, and collective violence. Violence is defined as “the intentional...

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...

Neonatal Outcome of the Late Preterm Infant (34 to 36 Weeks): The Singapore Story

Neonatologists were caught looking the other way in the early part of the millennium. While they were keenly following the progress of extreme preterms...

Epidemiology and Clinical Evolution of Liver Cirrhosis in Singapore

Cirrhosis is the common end result of chronic damage to liver parenchyma caused by a variety of liver diseases. It results in replacement of...

An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit

Over the past 30 years, different versions of severity of illness scoring systems and prognostic models have been developed for prediction of patient outcomes...

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...

Antibiotic stewardship algorithm to rationalise antibiotic use among hospitalised COVID-19 patients

As presentation of COVID-19 may mimic that of bacterial pneumonia, antibiotics are often prescribed. Concerns regarding overuse of antibiotics are now being raised particularly...

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...

Obesity in COVID-19: A Systematic Review and Meta-analysis

Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is established that increasing...

Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review

Coronavirus disease 2019 (COVID-19) has spread rapidly from China to other countries around the world, with the World Health Organization characterising it as a...

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...