Letter to the Editor
HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?
Dear Editor,
Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles ...
Letter to the Editor
Knowledge, attitudes and practices of doctors on constipation management in Singapore
Dear Editor,
Constipation is a common gastrointestinal disorder, affecting about 15% of the global population and severely impacting patients’ quality of life.1 The global constipation treatment market is estimated to worth USD22.93 billion in 2025. Patients with functional constipation had the highest treatment dissatisfaction at 63.4%. Poor satisfaction was reported...
Commentary
Value the patient as a person: Answering the call for a person-centred model of care
There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....
Letter to the Editor
Script concordance test to assess diagnostic and management reasoning in acute medicine
Dear Editor,
Clinical reasoning, an essential skill for patient care, can be difficult to assess. We created and validated a script concordance test (SCT) to assess clinical reasoning in acute medicine. This tool was used to provide feedback and targeted remediation for Postgraduate-Year-1 (PGY1) doctors, guide teaching and learning, and...
Original Article
Treating acutely ill patients at home: Data from Singapore
Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations age, and hospitals are expensive to build and run.1 There is increasing recognition of the risk of hospitalisation from potent nosocomial infections2,3 (exacerbated by the...
Others
Mesothelial Splenic Cyst—A Case Report
Non-parasitic cystic lesions of the spleen are unusual. They are classified essentially as primary (true, epithelial) and secondary (pseudo, non-epithelial) based on the presence or absence of lining epithelium.
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Others
A Case Report of Heparin Resistance due to Acquired Antithrombin III Deficiency
Intravenous heparin therapy is used in the management of angina and myocardial infarct with increasing frequency in recent years. Those patients who have been on heparin therapy for several days may exhibit resistance to heparin given before cardiopulmonary bypass.
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Others
Cryptococcal Prostatic Abscess in an Immunocompromised Patient: A Case Report and Review of the Literature
Cryptococcosis is a well-recognised infection in immunocompromised patients, although its prevalence varies with the type of immune defect. We report a patient with myasthenia gravis (MG) on steroid therapy and non-insulin dependent diabetes mellitus (NIDDM) who developed cryptococcal meningitis and in whom a search for a persistent focus by...
Others
Cutaneous Polyarteritis Nodosa: A Case Report and Literature Review
Cutaneous polyarteritis nodosa (CPN) is an uncommon form of vasculitis of the small-and medium-sized arteries in the reticular dermis and subcutaneous tissue. It remains limited and runs a chronic, benign course.
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Others
Sezary Syndrome: A Case Report and a Review of the Molecular Pathomechanism and Management
Our patient is a 64-year-old Malay man who first presented in July 1993 with a history of rash starting on the hands 1½ years earlier progressing to generalised eczema 5 months prior to consultation. He was diagnosed to have generalised exfoliative dermatitis (GED).
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Others
A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia
Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy.
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Others
Pericardial Injury Following Severe Sepsis from Faecal Peritonitis—A Case Report on the Use of Continuous Cardiac Output Monitoring
The intermittent manual bolus thermodilution method is the most common means of determining cardiac output in critically ill patients. Although widely used, there are many factors which may affect the accuracy of this technique such as the volume, temperature and timing of the injectate.
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Others
Creutzfeldt-Jakob Disease Presenting with Visual Blurring, Diplopia and Visual Loss: Heidenhain’s Variant
The electroencephalographic pattern is distinctive in many but not in all patients with Creutzfeldt-Jakob disease (CJD). Often, it is one of diffuse and non-specific slowing in the background with stereotypical generalised periodic high-voltage slow and sharp wave complexes.
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Others
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 anaesthesia by the cardiothoracic surgeon has remained the procedure of choice for FB removal in the airways, failing which thoracotomy and bronchotomy is performed.
This article...
Editorial
Academic Medicine in Singapore
Academic medicine is currently grappling with the problem of whether the triple-threat academician is a species threatened with extinction in the 21st century, given the extraordinary growth of knowledge during the past decades. Academicians, by this definition, were expected to be original and productive investigators, inspiring teachers and outstanding...
Others
Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case
A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians.
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Others
Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case
A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians.
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Others
Pelvic Spleen Masquerading as an Ovarian Neoplasm
A 53-year-old Caucasian woman, a receptionist in a general practice, was referred to the gynaecology outpatient clinic with an 18-month history of heavy, irregular menses and a pelvic mass on an abdominal ultrasound arranged by her General Practitioner (GP). She was otherwise asymptomatic.
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Others
Repair of Complex Ureterovaginal and Vesicovaginal Fistulas with Ileal Cystoplasty and Ureteric Reimplantation into an Antireflux Ileal Nipple Valve—A Case Report
Urogenital fistulas are a known but uncommon complication of gynaecological surgery, especially those involving a malignant process. Its incidence does not exceed 2%.
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Others
A Case Report—Delayed Vesicocutaneous Fistula After Radiation Therapy for Advanced Vulvar Cancer
To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer.
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Others
Sudden Profound Hypoxaemia in the Intensive Care Unit—A Case Report
Significant arterial hypoxaemia is defined as a partial pressure of oxygen (PaO2) that is less than 60 mmHg or a percentage of oxyhaemoglobin (% HbO2) that is less than 90%. The immediate response in acute situations is to rapidly exclude or treat common conditions such as airway obstruction, pneumothorax...
Others
Hyperthyroidism with Gynaecomastia as the Initial Complaint: A Case Report
Gynaecomastia is not a commonly recognised feature among the myriad symptoms and signs associated with hyperthyroidism. A review of the literature disclosed only eight reported cases of gynaecomastia as a presenting feature in thyrotoxicosis, and herein we describe an additional case.
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Others
Rosai-Dorfman Disease with Primary Cutaneous Manifestations—A Case Report
In 1969, Rosai and Dorfman first described a newly recognised benign systemic histioproliferative disease characterised clinically by bilateral striking cervical lymphadenopathy, fever, leukocytosis, and pathologically by enlarged lymph nodal sinuses containing large histiocytes with intact phagocytosed lymphocytes (emperipolesis). They dubbed the entity “sinus histiocytosis with massive lymphadenopathy” (SHML or...
Others
The Alien Hand Sign–Case Report and Review of the Literature
The alien hand sign or “strange hand sign”, first coined by Brion and Jedynak in 1972, refers to a feeling that the hand is foreign, together with autonomous activity which is perceived as independent of voluntary control, as if the hand is driven by an external agent.
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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 clinical application of transcatheter balloon dilation of PVS in 1982, the latter has become the treatment of choice for children with PVS who have significant...
Others
A Case of Metastatic Nasopharyngeal Carcinoma in Benign Nasal Polyps
Our patient was a 39-year-old Chinese man with nasopharyngeal carcinoma (NPC) presenting initially with right upper cervical lymphadenopathy. He was treated primarily with a course of radiotherapy, following which he was examined three monthly and was found to be free of disease in the nasopharynx and the neck.
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Others
A Case Report of Atasoy Antenna Procedure
The hook nail deformity is a relatively common problem after fingertip amputations. It is usually ignored but can be quite disabling.
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Others
Thoracoscopic Thymectomy for Myasthenia Gravis: A Case Report
Total thymectomy is the established surgical therapeutic method for generalised myasthenia gravis. Several approaches are used for the surgical removal of the thymus and these include the transcervical approach, partial sternotomy, median sternotomy and a combination of the transsternal and transcervical approaches.
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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 have rarely been described.
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Others
A Case Series of Ocular Disease as the Primary Manifestation in Sarcoidosis
Sarcoidosis is an idiopathic, systemic, non-caseating, granulomatous disease with protean clinical manifestations. Although the first description of sarcoidosis was attributed to Hutchinson, its ocular features received little attention until 1936 when Heerfordt’s syndrome of uveitis, salivary gland enlargement and cranial nerve palsies was recognised as a sign of sarcoidosis.
This...
Others
A Case of Pseudohyperkalaemia and Thrombocytosis
Hyperkalaemia is a common biochemical derangement in the intensive care unit reflecting a diversity of systemic perturbations such as acute renal failure, rhabdomyolysis, extracellular ionic shift from acid-base anomalies and tissue trauma. We report a rare and erstwhile unencountered cause of serum hyperkalaemia in our intensive care unit (ICU),...
Others
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 optimum mode of support varies with individual patients, but none can reliably prevent progression of acute lung injury and high frequency ventilation (HFV) has been...
Review Article
Foregoing Life Support in Medically Futile Patients
The origins of withholding medical support are found in ancient times. More than two millennia ago, Hippocrates (460 to 361 BC) stated that the role of medicine was “to do away with the suffering of the sick, to lessen the violence of their diseases, and to refuse to treat...
Review Article
Nitric Oxide in Septic Shock: Directions for Future Therapy?
In 1980, Furchgott and Zawadzki demonstrated that the relaxation of isolated arteries to acetylcholine required the presence of endothelial cells. This response was mediated by a labile humoral substance termed endothelium-derived relaxing factor (EDRF).
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Review Article
Critical Care Medicine in the Western Pacific Region
The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and medical traditions. The Western Pacific Association of Critical Care Medicine (WAPCCM) includes countries from Japan in the north to Australia and New Zealand in the...
Review Article
Critical Care—The Worldwide Perspective
Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s. Prolonged hand ventilation, and positive or negative pressure ventilation, enabled maintenance of oxygenation until some patients developed sufficient recovery or compensatory processes to enable separation...
Original Article
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.
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Original Article
A Retrospective Study of Near-drowning Victims Admitted to the Intensive Care Unit
Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present.
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Others
A Case Series of Paget’s Disease of Bone: Diagnosing a Rather Uncommon Condition in Singapore
Sir James Paget’s description in 1877 of “a form of chronic inflammation of bones” which now bears his name was based entirely on clinical and pathological observations in patients with advanced disease. Today, more than a century later, advanced imaging techniques and biochemical tests have allowed us to identify...
Others
Systemic Sclerosis in DRw52-positive Silica-exposed Males: A Case Report
Familial scleroderma was first documented in 1953 by Rees and Bennett who described the occurrence of a localised disease in a father and daughter. The first documentation of familial systemic disease was by Orabona and Albano who reported its occurrence in two sisters some five years later.
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Others
Subclavian-oesophageal Fistula as a Complication of Foreign Body Ingestion: A Case Report
Ingested foreign bodies are a common condition in the practice of Otolaryngology. In particular, there is no doubt a greater tendency in the local community to consume fish without it being de-boned.
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Others
A Case Report of a Patient with Bronchial Carcinoid Tumour and Late Presentation of Cushing’s Syndrome
Cushing’s syndrome is usually easy to recognise clinically. Determining the cause of non-iatrogenic Cushing’s syndrome is, on the other hand, often a diagnostic enigma.
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Others
Traumatic Dislocation of the Testes
Traumatic dislocation of the testes is uncommon. The first case was reported by Claubry in 1818 in Paris, when a 20-year-old soldier was run over by a wagon resulting in bilateral suprapubic dislocation of his testes.
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Others
A Case of Accelerated Development of Proliferative Diabetic Retinopathy in a Woman with Type 2 Diabetes Mellitus after Pregnancy
Diabetic retinopathy is the leading cause of blindness in persons between the age of 24 and 64 years both in the US and the UK. Peak fertility and childbearing years correspond to the first half of this period.
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Others
Trilateral Retinoblastoma—A Case Report
Retinoblastoma is the third most common tumour in childhood. It is inherited genetically.
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Others
Recurrent Gigantic Pyogenic Granuloma Disturbing Speech and Mastication: A Case Report and Literature Review
Pyogenic granulomas are common benign fibrovascular growths of the oral cavity that are non-neoplastic in nature. They may also present as skin lesions.
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Others
Verrucous Haemangioma—A Case Report
Verrucous haemangioma is an uncommon congenital vascular malformation which may grow to large sizes. It has a characteristic hyperkeratotic and verrucous surface which resembles angiokeratoma circumscriptum.
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Original Article
Plasma Vitamins A, C and E in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3% Others) is dominated by non-communicable diseases. There have been increasing trends, though with recent declines, for coronary heart disease (CHD) and cerebrovascular disease.
This article is...
Others
A Case of Sulindac-induced Enteropathy Resulting in Jejunal Perforation
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of various rheumatic conditions including rheumatoid arthritis (RA). The adverse effects of NSAIDs on the upper gastrointestinal tract (GIT) are well known and well described.
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Others
Musculoskeletal Pain Clinic in Singapore—Sacroiliac Joint Somatic Dysfunction as Cause of Buttock Pain
Patient A, a 33-year-old male administrative coordinator presented with left buttock pain of 4 to 5 years duration which radiated down to the leg and lower back. There was no antecedent trauma.
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Others
Osteoid Osteoma after a Stress Fracture of the Tibia: A Case Report
A 24-year-old man complained of left leg pain following 3 months of infantry training 6 years ago. There was no previous complaint of pain over his left leg and there was no trauma.
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Others
Reconstruction of a Supinated Hypoplastic Thumb with Combined Huber Transfer and Derotation Osteotomy: A Case Report
A 6-year-old Chinese girl presented with a deformity of the left thumb since birth. Her father has a similar deformity.
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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 and result in tachycardia-related cardiomyopathy. Early strategies to manage this problem such as pharmacological therapy to either block the atrioventricular node or suppress the ectopic...
Others
A Case Report of Adult T-Cell Leukaemia/Lymphoma (ATLL)
Our patient was a 71-year-old Chinese man who presented with a 6-year history of recurrent papular erythematous eruptions to the dermatologist.
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Others
Haemorrhage into Non-functioning Adrenal Cysts—Report of Two Cases and Review of the Literature
Doran, in 1903, reported the first case of adrenal cyst described by Greiselius in 1670. It was not until 1966 that Foster reported the 220th case.
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Others
Chronic Subdural Haematoma Presenting with Transient Ischaemic Attacks— A Case Report
Transient ischaemic attacks (TIA) are commonly seen in neurologic practice. They are most commonly associated with cerebrovascular insufficiency, either from a thrombotic or embolic occlusion of a cerebral artery.
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Others
Chryseobacterium meningosepticum (Flavobacterium meningosepticum)—A Report of Five Cases in a Local Hospital
Chryseobacterium meningosepticum has been known to be a causative agent of meningitis particularly in the premature and newborn infants. The first case of human infection with this organism was reported by King in 1959.
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Others
Bullous Dermatomyositis Associated with Nasopharyngeal Carcinoma —A Case Report
Bullous dermatomyositis is a rare variant of dermatomyositis and has been reported in the literature. It is believed to be strongly associated with the presence of a malignancy.
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Others
Case Reports of Linear IgA Bullous Dermatosis of Childhood
Linear IgA bullous dermatosis of childhood (LADC) is an acquired subepidermal blistering disorder of young children which is characterised by the unique finding of linear deposits of IgA along the dermoepidermal junction. It usually occurs acutely in pre-school children and has been described in association with a variety of...
Others
Atypical Mycobacterium Infection with Sporotrichoid Spread in a Patient with Human Immunodeficiency Virus
Mycobacteria other than tubercle bacilli (MOTT) were shown to be agents of human disease in the 1950s. They are also known as atypical, environmental or opportunistic mycobacteria.
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Others
Midface Distraction Osteogenesis in Cleft Patients: A Case Report
The aetiology of midfacial hypoplasia in patients with cleft lip and palate has been attributed in the literature to the surgical procedures used for the primary correction of these deformities. Ross reported that approximately 25% of patients developed maxillary hypoplasia that was refractory to orthodontic management alone.
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Others
A Case Report of a Vital Replanted Tooth with Unfavourable Extra-alveolar Condition: A 10-Year Follow-up
Tooth avulsion, frequently of the maxillary central incisors, occurs most often in children from 7 to 9 years of age, when the periodontium surrounding the immature erupting teeth is loosely structured, providing minimal resistance to extrusive forces. Falls against hard objects, including those incurred during sports activities, are one...
Others
Odontoameloblastoma: Report of a Case
Ameloblastoma is a benign but locally invasive tumour that affects the jaws. Although it is commonly regarded as a homogeneous group of tumours, detailed investigations have proven its clinicopathologic diversity.
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Others
Oral Manifestations of Schimmelpenning Syndrome: Case Report and Review of Literature
Schimmelpenning syndrome (SS) is characterised by specific skin manifestations, skeletal defects, and central nervous system abnormalities, such as mental deficiency and seizures. Happle has shown that a clinical entity known as “epidermal nevus syndrome”, formerly used as an alternative term to SS, does not exist.
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Others
Selective Laser Sintering: Application of a Rapid Prototyping Method in Craniomaxillofacial Reconstructive Surgery
The value of computed tomography (CT) in craniofacial trauma is now well established with progress in imaging modalities. Three-dimensional (3-D) CT has changed the way craniofacial surgery is planned and its valuable contributions and limitations have been studied.
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Others
Disseminated Penicillium marneffei Infection: A Report of Five Cases in Singapore
Penicillium marneffei is a dimorphic fungus that can cause infection in immunocompromised hosts. Reports on infection with this organism were initially uncommon, but after the first report of disseminated P. marneffei infection in a HIV-infected individual from Bangkok in 1989, the incidence has increased markedly, almost exclusively in patients...
Others
Extraarticular Villonodular Synovitis of the Tendoachilles: A Case Report
Pigmented villonodular synovitis is a progressive synovial lesion of uncertain aetiology associated with synovial-lined tissues of the joints, tendon sheaths and bursae. The incidence was 1.8 patients per million population.
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Others
Embolisation of a Leaking Pseudoaneurysm of the Main Artery Supplying a Replanted Arm: A Case Report
Pseudoaneurysms are conventionally treated by surgery. In recent years, non-surgical methods are being considered, including embolisation with wires, coils or gelfoam and anticoagulation.
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Others
Selective Serotonin Reuptake Inhibitor Discontinuation Symptoms
Selective serotonin reuptake inhibitors (SSRIs) are a new class of antidepressants which are effective, better tolerated with less side effects and more specific in receptor activity than the older tricyclic antidepressants. However, like tricyclic antidepressants and other groups of antidepressants such as the monoamine oxidase inhibitors (MAOIs) and the...
Others
Palatal Myoclonus—A Case Report
Palatal myoclonus is a rare movement disorder characterised by rhythmic recurring jerky movements of the soft palate, pharynx, larynx and rarely diaphragm, trunk and limb muscles. It usually develops secondary to brainstem or cerebellar disease (symptomatic palatal myoclonus) interrupting the central tegmental tract or dentato-olivary fibres.
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Others
Soft Tissue Chondroma in the Finger: A Case Report and Review of the Literature
Chondromas are the most common bony tumours in the hand. However, soft tissue chondromas are relatively uncommon entities.
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Others
The Use of Magnesium Sulphate in the Intensive Care Management of an Asian Patient with Tetanus
A 29-year old Thai construction worker, previously well, was admitted to our Orthopaedic Department for sudden onset of lower back pain. Physical examination showed severe tenderness in the lumbar region, limited straight leg raising but no neurological deficit.
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Others
Life-threatening Perineal Gangrene from Rectal Perforation Following Colonic Hydrotherapy: A Case Report
Alternative medicine has become widely publicised throughout the world. Alternative medicine practitioners (AMPS), which include Oriental medicine doctors, traditional Chinese medicine practitioners, naturopaths and Ayurvedic medicine practitioners, tout the ability to heal many diseases using treatments which are unconventional and of questionable scientific basis.
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Others
A Case Series of Falciparum Malaria-induced Acute Renal Failure
Predominantly a disease of hot and humid climates, malaria affects 270 million people worldwide annually, and has a mortality rate of 1%. The increasing morbidity and mortality attributable to malaria in recent years follows the loss, in the early 1970s, of the impetus and impact of the initial WHO...
Others
Eccrine Porocarcinoma: A Case Report
Porocarcinoma is a rare malignant tumour, arising from the intra-epidermal ductal portion of the eccrine sweat gland, also known as “acrosyringium”.’ According to the histological typing of skin tumours, it is an eccrine carcinoma that may arise de nova or develop in eccrine poroma, its benign counterpart, as an...
Others
Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report
A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior release approach and posterior instrumentation. Preoperative assessment revealed good effort tolerance.
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Others
Bilateral Caudate Infarct—A Case Report
The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply is from the deep penetrators from the middle cerebral and anterior cerebral arteries.
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Review Article
Intravital Microscopy for the Study of the Microcirculation in Various Disease States
It is more than 150 years ago when the first detailed description of intravital microscopy was given by Waller, demonstrating in the frog tongue the passage of leukocytes (at that time interpreted as “mucous and pus globules”) through microvessels. Later, the mesentery was acknowledged as the most suitable object...
Others
Acute Mercury Vapour Poisoning in a Shipyard Worker—A Case Report
Despite improvements in industrial working conditions, mercury remains second only to lead as a cause of heavy metal poisoning. Cases of poisoning by inhaled mercury vapour, though rare, are well documented in the literature.
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Others
Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children
Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease.
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Others
Radial Nerve Injury after Intravenous Cannulation at the Wrist—A Case Report
A 44-year-old male, right-handed and ASA 1 bus driver presented for elective mastoidectomy under general anaesthesia. Preoperative venous cannulation with a 20G cannula (Angiocath™) was first attempted on the dorso-lateral aspect of the right wrist at the base of the anatomical snuffbox.
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Others
Case Report: Percutaneous Balloon Dilatation and Ureteral Stenting for Tuberculous Renal Infundibular and Ureteral Strictures
The management of the non-functional tuberculous kidney is controversial and ranges from surgical intervention to conservative treatment. Intra-renal scarring with stricture formation is common in the late stages of renal tuberculosis and results in greater loss of renal function than direct involvement by tuberculosis alone.
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Others
Extensor Pollicis Longus Paralysis Following Thoracoscopic Sympathectomy
A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla.
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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 years. It has been noted as an incidental finding in autopsy, echocardiography and angiography, but can present with symptoms of cough, dyspnoea, hoarseness of voice...
Others
An Unusual Tumour Metastasis to the Cervix
A 55-year-old Chinese lady had a left mastectomy in April 1995 for an invasive lobular carcinoma of the breast. Axillary lymph node metastases were present.
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Others
Perioperative Wheezing—A Report of Three Cases
Perioperative “wheezing” can be due to upper or lower airway obstruction. The signs and sounds of upper airway obstruction are typically worse during inspiration, whereas those of lower airway obstruction are worse in expiration.
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Others
Retroperitoneal Castleman’s Disease in the Perinephric Space—Imaging Appearance: A Case Report and a Review of the Literature
Castleman’s disease (CD) was first proposed by Castleman in 1954. It is usually found in the mediastinum, but other sites have been described.
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Others
A Case Report: Persistent Acantholytic Dermatosis in Chronic Renal Failure
A 70-year-old Chinese man with end-stage renal failure (ESRF), who has been on continuous ambulatory peritoneal dialysis for 6 months, was referred by the renal physician for pruritic rashes over the scalp and chest. The rashes were first noted about 3 months ago.
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Others
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 minutes of strenuous exercise, usually after the exercise has ceased.
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The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report
A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral functional endoscopic sinus surgery for mild obstructive sleep apnoea and chronic sinusitis respectively. He weighed 109 kg, all his four upper incisors were missing and...
Others
Primitive Neuroectodermal Tumour of the Chest Wall—A Report of Two Cases and Review of Literature
Tumours of the chest wall are uncommon and are usually sarcomatous in nature. Primitive neuroectodermal tumours (PNETs) are rare and are thought to arise from neuroepithelial cells, possibly derived from the peripheral intercostal nerves. They could also arise from the neural crest cells, which have migrated alongside the peripheral...
Others
Squamous Cell Carcinoma arising in a Cutaneous Epidermal Cyst—A Case Report
Epidermal cysts are common benign subcutaneous lesions. Malignant transformation in epidermal cysts is a rare but recognised occurrence.
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Others
Otogenic Lateral Sinus Thrombosis—A Case Report
A 16-year-old boy, with a background history of beta-thalassaemia intermedia, splenectomy and hypogonadotrophic hypogonadism, was referred to our otolaryngological clinic for right otalgia following an episode of upper respiratory tract infection (URTI). He had hearing loss with tinnitus in the right ear, nasal obstruction with greenish nasal discharge and...
Others
Case Reports: The Use of Intermaxillary Screws to Achieve Intermaxillary Fixation in the Treatment of Mandibular Fractures
The mandible is a unique bone in the human skeleton and occupies a prominent position in the craniofacial region. Traumatic injury to the face, especially in the lower third, may result in fractures of the mandible.
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Others
Pseudomembranous Tracheobronchitis Caused by Aspergillus in a Patient after Peripheral Blood Stem Cell Transplantation
Pseudomembranous tracheobronchitis caused by Aspergillus is a rare and lethal variant of invasive aspergillosis. It has been reported in a few series of immunocompromised patients.
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Others
Treatment of Chronic Urticaria with Thyroxine in an Euthyroid Patient with Thyroglobulin and Microsomal Antibodies
Chronic urticaria is defined as daily outbreaks of urticaria of at least 6 weeks duration. Despite being a common disorder, the cause of chronic urticaria is often obscure and not easily treatable.
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Others
Hard Metal Lung Disease—The First Case in Singapore
A 38-year-old Chinese man and lifetime non-smoker, who had previously been well, was referred for investigation of bilateral reticulonodular infiltrates noted on his chest roentgenogram. He had experienced progressive dyspnoea on exertion associated with cough productive of whitish sputum for 6 months preceding this evaluation in April 1998.
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Others
A Case Report of the Use of Magnesium Sulphate during Anaesthesia in a Patient who had Adrenalectomy for Phaeochromocytoma
Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells of the body derived from neural crest tissue. They may secrete both adrenaline and noradrenaline in varying proportions.
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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 G<sub>M2</sub> gangliosides, particularly in the neuronal cells. The infantile form, similar to Tay Sach’s disease, may present in the first year of life with an...
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 the commonest of these disorders, and a leading cause of heart block in newborns.
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Others
Subcutaneous Emphysema and Pneumomediastinum after Endotracheal Anaesthesia
Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes.
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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, India.
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Others
An Unusual Case of Cutaneous Vasculitis
A 49-year-old Chinese man presented at the Tan Tock Seng Hospital with painful gangrene of the right second and left third and fourth toes for 6 weeks, purple discolouration of the toes for 3 months and arthritis of the left knee for 3 months.
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Others
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 separate entities but clinical overlap occurs.
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Others
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) and the sleep hypopnoea syndrome are well-known and well-described breathing disorders during sleep.
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Others
Muscle Dysmorphia in a Young Chinese Male
In 1891, Morselli described “dysmorphophobia” in 78 patients who were severely miserable, preoccupied and distressed by perceived deformities. The word “dysmorphia” in Greek means ugly. Body dysmorphic disorder appeared in DSM-III in 1987.
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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 anticancer activity has been demonstrated.
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Others
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 disease (COPD). Despite smoking cessation for 5 years, and pharmacological treatment with oral theophylline, inhaled ipratropium bromide and ventolin, his dyspnoea had progressed to the...
Others
Case Reports of Nocardiosis in Patients with Human Immunodeficiency Virus (HIV) Infection
Nocardiosis is an infection caused by a soil-borne aerobic filamentous bacterium in the genus Nocardia and the order Actinomycetales. Within the genus Nocardia, N. asteroides, N. brasiliensis and N. caviae are responsible for nearly all nocardial infections in man.
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Others
Neonatal Lupus Erythematosus: Our Local Experience
Neonatal lupus erythematosus (NLE) is related to the transplacental passage of anti-Ro antibodies from mother to foetus. The commonest manifestations involve the skin and the heart.
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Others
A Case Report of Total Finger Joint Replacement Arthroplasty After Traumatic Amputation
A 41-year-old Chinese man had his dominant thumb, index and middle fingers caught by a wood-cutting machine while at work. He sustained a near-amputation of his middle finger through the proximal interphalangeal joint (PIPJ), with an intra-articular comminuted fracture of the head of the proximal phalanx (Fig. 1a) and...
Others
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 haemagglutination (IHA) test and various antigen detection tests. Gram stain shows a bipolar “safety-pin” pattern or small gram-negative rods.
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Others
Lichen Amyloidosus: A Bullous Variant
Systemic amyloidosis, first reported in 1886, is characterised by deposits of amyloid in various organs including the skin, which may manifest as skin purpura, papules, nodules and occasionally bullae (termed bullous amyloidosis in the literature), predominantly distributed over the periorbital and intertriginous areas. In contrast, lichen amyloidosus is solely...
Others
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 in females.
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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, infection is the most frequent pacemaker-related complication, with reported rates of between 1% to 7% in older studies1 and <1% in more recent series.
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Others
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.
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Others
Human Immunodeficiency Virus Infection Presenting with Chronic Actinic Dermatitis: A Case Report
A 40-year-old Chinese man of skin phototype III (Table I), formerly a welder in a shipyard, presented with pruritic papules on his face, neck and arms of 3 years’ duration. He had noted sun-aggravation and had ceased working for 3 months.
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Others
Listeria Meningoencephalitis: Two Cases and a Review of the Literature
The general experience of local physicians and available data suggest that listerial infections of the central nervous system (CNS) are uncommon among adults in Singapore. This situation may change.
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Others
Histoplasmosis Presenting with Progressively Worsening Backache—A Case Report
A 55-year-old man presented with intermittent low back pain of 2 months’ duration which was progressively worsening, fever, anorexia and a 10-kg weight loss. He has travelled several times in the past few years to caves in Kuala Lumpur for worship.
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Others
Panhypopituitarism due to Pituitary Cyst of Rathke’s Cleft Origin—Two Case Reports
Rathke’s cleft cysts are non-neoplastic cystic epithelial lesions of the sellar and suprasellar region which are thought to originate from the remnants of Rathke’s pouch and are characteristically lined by a single layer of ciliated cuboidal or columnar epithelium with goblet cells. However, foci of squamous epithelium in Rathke’s...
Others
Two Cases of Medullary Thyroid Carcinoma
A 44-year-old Indian man was found to have a raised carcinoembryonic antigen (CEA) (49.5 μg/L) detected on routine medical examination in February 2000. His past medical history included asthma, chronic anal fissure and haemorrhoids, cervical spondylosis and mild hypercholesterolaemia.
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Others
Bilateral Synchronous Renal Oncocytoma: A Case Report and Review
Oncocytomas are neoplasms characterised by large epithelial cells with finely granular eosinophilic cytoplasm called oncocytes. They were first described by Zippel in 1942 and have subsequently been identified in the thyroid, parathyroid, salivary and adrenal glands.
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Others
Reduction Mammaplasty in the Surgical Management of a Giant Breast Hamartoma: Case Report
Large benign tumours of the breast cause gross enlargement with compression of normal breast tissue. Following removal of the tumour, the affected side has a large redundant skin envelope and the breast volume may be reduced or distorted compared with the normal side.
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Others
Case Report: Follicular Adenoma in a Thyroglossal Duct Remnant Arising Entirely within the Hyoid Bone
Thyroglossal duct remnant is one of the most common lesions of the anterior midline neck. It occurs in 7% of adults1 and carcinoma is found in less than 1%. The majorities are papillary and mixed papillary-follicular carcinomas, with follicular and squamous cell carcinomas occurring far less frequently.
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Others
A Case Report on the Treatment of Intractable Anal Pain from Metastatic Carcinoma of the Cervix
Unremitting pain remained a primary therapeutic challenge in cancer patients. Both opioids and non-opioids are often the main stay of therapy for many.
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Others
188Rhenium-TDD-Lipiodol in Treatment of Inoperable Primary Hepatocellular Carcinoma—A Case Report
Hepatocellular carcinoma (HCC) is one of the most malignant tumours. The lack of an effective treatment modality has stimulated the use of selective internal radiation therapy for the treatment of HCC.
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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 more compact and less trabeculated than the right ventricle.
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Others
Ossifying Lipoma of the Hand: A Case Report
Lipomata are one of the most common benign tumours in adults, occurring in almost any location of the human body, especially in the subcutaneous region. They are commonly found in the soft tissues of the neck, back and extremities.
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Others
A Rare Cause of Syncope in a Patient with Diabetes Mellitus—A Case Report
Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma or with symptoms caused by excess of counterregulatory hormones like catecholamines, such as palpitations, sweating and tremulousness. It is most commonly seen in patients with...
Others
Case Reports of Low Dose Cyclosporine A Therapy in Adult Minimal Change Nephrotic Syndrome
There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic syndrome (MCNS), including those who fail steroids and cyclophosphamide therapy or who are steroid dependent and frequent relapsers. We report 3 cases which demonstrate the...
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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 as there are so few books of medicine written and published in Singapore.
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Others
Mucinous Cystadenoma of the Appendix—An Unusual Cause of Intestinal Obstruction
Mucinous cystadenoma of the vermiform appendix is an uncommon entity. It is a benign lesion but may disseminate and lead to the development of pseudomyxoma peritonei.
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Others
Primary Anorectal Malignant Melanoma: Clinical Features and Results of Surgical Therapy in Singapore—A Case Series
Malignant melanoma arising from the anal canal was first described in 1857. It is uncommon, comprising only about 1% of all anal canal tumours.
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Others
46, XY Female—A Case Report
The phenotypic sex of an individual is usually male if that person’s genotype is 46, XY since the SRY gene on the Y chromosome, being the putative testicular determining factor (TDF) governs testicular gonadogenesis. Yet, there are distinct situations where sexual differentiation proceeds along a female phenotype despite the...
Others
A Case Report of Primary Hyperparathyroidism with Severe Bony Involvement and Nephrolithiasis
Primary hyperparathyroidism is said to have evolved from a disease of “bones, stones and groans”, to one that is largely asymptomatic with a relatively benign course in the majority of patients. In a 1981 study, the incidence of radiologically detectable bone disease was found in 24% of patients but...
Others
Case Report: Catheter-Related Epidural Abscess
Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to 12% and about 0.7% are reported to have central nervous system infection e.g. epidural abscess or meningitis.
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Others
A Case of Alpha-Fetoprotein-Producing Gastric Cancer
A 57-year-old accountant presented to her doctors in a neighbouring country in early October 1998 with problems of easy bruising, bleeding gums, one single episode of gross haematuria and 2 months of back pain. Investigations showed evidence of disseminated intravascular coagulation (DIVC) and compression fracture of T10 vertebra.
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Others
Case Report: Acute Tumour Lysis Syndrome
Acute tumour lysis syndrome (ATLS) is one of the most urgent of all oncological treatment-related complications. It has a broad impact on organ dysfunction, the most important and life threatening complication being acute renal failure. Early implementation of preventive measures can have a drastic impact on reducing the associated...
Others
Galeazzi-Equivalent Fracture in Children Associated with Tendon Entrapment—Report of Two Cases
A 12-year-old boy fell whilst running. On examination, there was swelling and deformity of the wrist and there was local tenderness of the distal third of the radius and the distal end of the distal ulna. Movement of all the fingers and thumb were limited by pain.
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Others
Melioidosis Splenic Abscess—An Unusual Presentation as Osteomyelitis of Rib
A 74-year-old Chinese gentleman first presented in February 1999 with an abscess over his left lower chest. He was treated for pulmonary tuberculosis in 1977.
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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 short arm of chromosome 20.
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Others
Sudden Death Due to Granulomatous Myocarditis: A Case of Sarcoidosis?
Granulomatous myocarditis and sarcoidosis are considered uncommon entities in our local community and sudden death due to either condition has not been described in local literature. Earlier local reports have alluded to the fact that sarcoidosis may be more common amongst Indian females and that more cases may be...
Others
Gemella Empyema Cured without Antibiotics: A Case Report
Gemella are gram-positive anaerobic bacteria that rarely produce serious human infections. We describe a case of thoracic empyema that occurred in an elderly Chinese male which, to our knowledge, is the first reported case out of Southeast Asia.
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Others
Double Omental Hernia—Case Report on a Very Rare Cause of Intestinal Obstruction
Internal hernia is defined as the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. This unusual cause of intestinal obstruction occurs in 4% of all cases of acute intestinal obstruction.
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Review Article
The Clinician Meets the Computer—Uneasy Bedfellows
Information technology has become a cornerstone of civilization as we know it. In its broadest definition, information technology encompasses all forms of technology required to create, archive, exchange and manipulate data.
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Review Article
Leveraging on Information Technology to Enhance Patient Care: A Doctor’s Perspective of Implementation in a Singapore Academic Hospital
Information technology (IT) has become truly pervasive in everyday life; however, in the field of medicine, we have yet to fully harness its full potential in the care of our patients. Most restructured hospitals in Singapore have been wired up with fast local area networks (LAN) and desktop personal...
Editorial
Internal Medicine
It has taken a long time to plan for this November issue in Internal Medicine. The topic is so wide and often neglected as the specialties take prominence.
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Commentary
General Medicine—Revisited, Rejuvenated, Revitalised and Reemphasised
“The irresistible swing towards medical specialisation has brought advantages for patients but arguably this has gone too far.” It is time to review the role of general medicine and general physicians in Singapore; with its own unique system of healthcare where patients can see any specialist and subspecialists without...
Others
A Case of Pulmonary Haemorrhage Following Jet Ventilation for Vocal Cord Surgery
Laryngospasm occurring at extubation is not an uncommon complication seen with use of endotracheal tubes and laryngeal mask airway. We report a case of laryngospasm on extubation of a Benjamin jet tube resulting in pulmonary haemorrhage.
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Others
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 an important adage not to be forgotten.
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Others
Subdural Block—From a Spinal? A Case Report
There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an epidural gone astray, and the lowest reported volume of local anaesthetic used was 3.5 mL.
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Others
A Countrywide Approach to the Control of Non-communicable Diseases—The Singapore Experience
In the area of health, the last two decades has seen a decline or eradication of deadly diseases, such as smallpox and polio, the introduction of the fatal disease, such as acquired immunodeficiency syndrome (AIDS), and a marked rise in chronic diseases, making them the leading worldwide public health...
Others
Causes for the Evolution of Case Management and the Development of a Working Model in an Acute Care Hospital in Singapore
In 1999, significant changes to the healthcare funding structure were introduced to public sector hospitals in Singapore. This was the advent of casemix-based funding for acute inpatient and day surgery episodes.
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Others
Evidence-based Medicine: The Key to Guidelines, Disease and Care Management Programmes
Health care in America and the rest of the industrialised world continues to reinvent itself at an ever-accelerating rate. The societal pressures for high quality, high value care that produces measurable improvement in quality processes and outcomes is increasing from the government and private sectors.
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Others
National Disease Management Plans for Key Chronic Non-communicable Diseases in Singapore
Like most other newly industrialised economies, Singapore has undergone a rapid epidemiological transition over the last 50 years. Chronic, non-communicable diseases have replaced infectious diseases as the dominant public health problems in Singapore today.
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Editorial
Chronic Disease Management: Challenges for Clinicians and the Way Forward
The healthcare, financial and social burden of chronic diseases, such as diabetes mellitus, coronary heart disease, asthma, chronic obstructive airway disease, hypertension, chronic depression, osteoporosis, end stage renal failure and stroke, are steadily on the rise. In the US alone, some 125 million people now suffer from at least...
Original Article
Measuring Health-related Quality of Life in Singapore: Normal Values for the English and Chinese SF-36 Health Survey
Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many chronic illnesses. With improvements in survival, patients’ perceptions of health are increasingly being recognised as an important outcome in clinical medicine, especially in illnesses where...
Others
Four Pregnancies in Two Patients with Essential Thrombocythaemia—A Case Report
Essential thrombocythaemia (ET) is a rare myeloproliferative disease which manifests with an elevated platelet count. It presents predominantly in the middle-aged population, occurring slightly more frequently in women than men.
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Others
The Course of Pregnancy in a Patient with Nail-Patella Syndrome
The nail-patella syndrome (NPS) is a rare autosomal dominant disorder defined by the association of nail dysplasia, bone abnormalities and, frequently, renal disease. We report the course of pregnancy in a patient with such a condition.
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Others
Case Report on Recombinant Coagulation Factor VIIa in the Treatment of Three Haemophilia A Patients with Inhibitors in Singapore
Development of inhibitors against factor VIII is one of the main complications in the treatment of haemophiliacs. Inhibitors block the procoagulant effects of factor VIII and prevent the successful arrest of bleeding episodes when administered to these haemophiliacs.
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Others
Unusual Endolaryngeal Extension of a Large Thyroglossal Duct Cyst
Thyroglossal duct cysts are the most common nonodontogenic cysts that occur in the neck. They can be complicated by infections and fistulae.
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Others
Visual Rehabilitation with New-Age Rigid Gas-Permeable Scleral Contact Lenses—A Case Series
Advanced primary corneal ectasia presents a difficult problem in terms of visual rehabilitation. Soft contact lenses do not address the astigmatic aberrations in these conditions and conventional rigid gas-permeable (RGP) corneal contact lenses though useful in less severe disease, are poorly tolerated by those with progressively worsening keratoconus and...
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 to 3 months) after starting allopurinol.
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Others
Adrenal Myelolipoma Presenting with Spontaneous Retroperitoneal Haemorrhage Demonstrated on Computed Tomography and Angiogram—A Case Report
Adrenal myelolipoma is a rare, benign tumour, usually an incidental finding. Spontaneous retroperitoneal haemorrhage resulting from this tumour is rare.
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Others
Anaesthetic Considerations for Lung Volume Reduction Surgery—A Case Report
Only until a few years ago, the only surgical alternative for patients with severe emphysema was lung transplantation. However, with transplantation, there are problems of rejection, infection, immunosuppression and declining donor pools.
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Editorial
Should Ethical Issues in Biotechnology Research be Decided by Physicians-Scientists or by Lawyers?
As with clinical practice, the practice of biomedical research is a moral activity. We have to think about what we should do, not just about what we can do, to modify life.
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Others
A Case Report of Neurologically Unstable Fracture of the Lumbosacral Spine in a Patient with Ankylosing Spondylitis
Ankylosing spondylitis is associated with progressive ossification of the spinal ligaments and ankylosing of the facet joints leading to a totally stiff spine. It is often associated with osteoporosis due to chronic inflammation and disuse.
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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.
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Others
Embolisation of a Renal Artery Pseudoaneurysm in a Patient with Renal Malrotation and Chronic Aortic Dissection
A 40-year-old Chinese male presented with severe right loin pain. He had a history of chronic abdominal aortic dissection of unknown aetiology. He was not hypertensive and there was no evidence of ankylosing spondylitis, Ehlers-Danlos syndrome or any connective tissue disorder.
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Others
Acute Embolic Occlusion of the Superior Mesenteric Artery: A Case Report and Discussion of Management
Acute ischaemia of the bowel is a devastating condition. Recently published figures on mortality range from 30% to 60%.
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Others
Giant Pericardial Lipoma: Unusual Cause of Intrathoracic Mass
Cardiac and pericardial lipomas are very rare tumours. They remain asymptomatic for a long time and produce symptoms, if at all, by the virtue of their size.
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Others
Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma – Case Reports
The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to control the haemodynamic fluctuations during phaeochromocytoma resection.
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Others
Intracerebral Schwannoma—A Rare Cause of Epilepsy
Schwannomas are extra-axial neoplasms derived from the nerve sheath of peripheral or cranial nerves. They represent approximately 8% of all intracranial tumours, arising predominantly from the vestibular nerve.
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Others
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 200 mL of blood after a severe bout of vomiting. She declined a oesophago-gastro-duodenoscopy (OGD) and was clinically diagnosed to have Mallory-Weiss syndrome.
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Others
Sweet’s Syndrome Associated with Mycobacterium chelonae and Herpes Simplex Virus Infections: A Case Report
Sweet’s syndrome is an acute febrile neutrophilic dermatosis. An association with malignancy is well recognised.
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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, attention has been turned towards the use of class III drugs for the management of both atrial and ventricular arrhythmias. While the adverse effects of...
Others
Unusual Case of Bowel Infarction with Invasive Aspergillus in an Immunocompromised Patient
The role of neoadjuvant chemotherapy for locally advanced breast cancer has been established and there has been a growing interest in its role in early and operable breast cancer.1 Most neoadjuvant chemotherapeutic regimes contain an anthracycline and are usually combined with cyclophosphamide, with or without 5-fluorouracil.
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Others
Intermittent Epoprostenol Infusions in Systemic Lupus Erythematosus Associated Pulmonary Hypertension—A Series of Three Cases
Pulmonary hypertension (PHT) is seen in 0.5% to 14% of systemic lupus erythematosus (SLE) patients and is associated with a grave prognosis. The overall 2-year mortality is more than 50% despite vasodilators, anticoagulants, systemic corticosteroids and cytotoxic drugs.
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Letter to the Editor
Patterns and predictors of sound levels in hospital rooms
Dear Editor,
Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also linked excessive sound levels with sleep disturbances and cardiovascular morbidity.2 While there have been data published regarding noise levels in the intensive care unit (ICU),3...
Others
Case Report of a Dermoid Cyst at the Floor of the Mouth
A 19-year-old Indian male with a past history of “Ludwig’s angina” was seen at the Accident and Emergency Department of National University Hospital complaining of an acute swelling at the floor of the mouth for 2 days. The patient was seen the day before in an outpatient clinic and...
Others
Difficulties in Diagnosing Lesions in the Floor of the Mouth – Report of Two Rare Cases
The floor of the mouth takes form as early as in the fourth week of gestation with the downward growth and subsequent degeneration of the ectoderm surrounding the peripheral of the tongue, forming the lingual sulcus separating the tongue and the floor of the mouth. The anterior boundary is...
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 multiple dental caries, phenytoin-induced gingival hyperplasia and severely worn-down and eroded dentition. He is under regular follow-up by the Paediatrics Department of the National University...
Others
Oral Pemphigus Vulgaris: A Case Report and Literature Update
Autoimmune blistering conditions are an uncommon cause of chronic ulceration of the oral mucosa. Nevertheless, it is important to diagnose these conditions early and institute treatment as soon as possible, as they can lead to serious involvement in other mucosal and cutaneous sites and even death.
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Others
Spontaneous Bone Regeneration after Mandible Resection in a Case of Ameloblastoma – A Case Report
Ameloblastoma is a true neoplasm of enamel organ type tissue which does not undergo differentiation to the point of enamel organ. This type of tumour occurs mostly in the mandible and grows slowly with variable clinical and histological characteristics, but it is histologically benign.
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Others
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 connective tissues, vessels and with an eosinophilic inflammatory component.
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Others
A Case of Recurrent Erythema Multiforme and its Therapeutic Complications
Recurrent erythema multiforme (EM) is a disabling condition with a specific diagnosis and certain diagnostic criteria. Systemic corticosteroid therapy is frequently used to treat this condition.
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Others
1st College of Physicians Lecture: The Role of Internal Medicine as a Specialty in the Era of Subspecialisation
It humbles me to accept the invitation to give this lecture, the First College of Physicians Lecture, titled “The Role of Internal Medicine as a Specialty in the Era of Subspecialisation”. I believe I am given this honour as I am one of the few of a seemingly dying...
Others
Standards and Revalidation or Recertification
In my Gordon Arthur Ransome Oration and other papers, I have described the nature and development of patient-centred professionalism, the key features of which are summarised in Figure 1.
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Others
Continuing Professional Development – a Surrogate for Recertification?
The Hong Kong Academy of Medicine is a statutory body set up in 1993 with the objectives of fostering the development of postgraduate medical education and continuing medical education, the study and practice of medicine and its specialties, and medical research. It is concerned with the standard of specialist...
Others
Teaching and Learning of Professionalism in Medical Schools
There is now worldwide consensus that the elements of medical professionalism need to be enhanced and explicitly taught in medical schools. Medical schools in the United Kingdom (UK) have recently published a model for a core ethics curriculum.
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Others
The Challenge of Teaching Professionalism
For the past 25 years, professionalisation, industrialisation, large-scale infusions of technology into the healthcare system and consumerism, to name a few factors, have definitely contributed to changes in the healthcare environment. At the same time, society has moved from modernity to post-modernity with the adoption of pluralism, relativism and...
Others
2004 Runme Shaw Memorial Lecture: Professionalism – A Concept in Need of Nurturing
It is a great honour to be invited to deliver the Runme Shaw Memorial Lecture. I am grateful to the Runme Shaw Foundation for their support of this lecture.
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Others
17th Gordon Arthur Ransome Oration: Patient-centred Professionalism
When sickness strikes we all need doctors. People everywhere know that the quality of medical care can affect the outcome and possible consequences of illness, and at times mean the difference between life and death.
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Others
Acute Isolated Sphenoid Sinusitis
Isolated infection of the sphenoid sinus is uncommon. It usually occurs in conjunction with infection of the other paranasal sinuses. Acute isolated sphenoid sinusitis is seen in fewer than 3% of all cases of sinusitis.
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Others
Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore
Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to 1.0 per million population. However, the incidence of CJD in the Singaporean population is not known. With a population of 4 million, an estimated 2...
Others
A Case of a Diaphragmatic Rupture Complicated With Lacerations of Stomach and Spleen Caused by a Violent Cough Presenting With Mediastinal Shift
Diaphragmatic rupture is a recognised consequence of high-velocity blunt trauma to the abdomen and chest and also has been reported in 0% to 5% of thoracoabdominal trauma patients. The diagnosis is often difficult and delay in diagnosis is implicated in increased morbidity and mortality.
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Others
Initial Experience of Macular Translocation in Singapore – One-year Results
Choroidal neovascularisation (CNV) is a devastating complication of macular degeneration and a major cause of irreversible vision loss in many developed countries. The most common cause of CNV is age-related macular degeneration but it may also occur secondary to a variety of other aetiologies such as pathological myopia, ocular...
Others
The Importance of High Resolution Chromosome Analysis in the Diagnosis of Birth Defects: Case Reports of Holoproscencephaly and Cystic Hygroma
Optimal chromosome preparation is a function of many factors. These include cell density culture initiation, optimal time for harvest, concentration and exposure duration to a mitotic arrestant, appropriate hypotonic treatment and adequate fixation with modified Carnoy’s fixative.
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Others
Cutaneous Mycobacterium haemophilum Infections in Immunocompromised Patients in a Dermatology Clinic in Singapore
Mycobacterium haemophilum is a nontuberculous mycobacterium (NTM) that is increasingly recognised as a cause of cutaneous, joint, or pulmonary infections in immunocompromised patients and lymphadenitis in children. To date, less than 100 patients with this infection have been reported worldwide.
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Others
Early Appendicitis – A Safe Diagnosis?
Appendicitis is the most common surgical condition of the abdomen. At laparotomy, an inflamed appendix is removed once it is found, and further exploration of the peritoneal cavity is not advised.
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Others
A Case of Nephrogenic Fibrosing Dermopathy
Nephrogenic fibrosing dermopathy (NFD) is a recently described and recognised fibrosing disorder occurring in patients with renal disease. The condition resembles scleromyxoedema clinically and histologically, and was originally termed “scleromyxoedema-like illness of haemodialysis”.
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Others
Littoral Cell Angioma of the Spleen
The littoral cells line the vascular channels of the red pulp of the spleen and have characteristics of endothelial and histiocytic cells. In 1991, Falk et al described and characterised the tumoural component.
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Others
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 the term “pulmonary eosinophilia” for disorders characterised by chest radiographic infiltrates and peripheral eosinophilia.
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Others
Refining Clinical Practice: Transforming Science Research into the Art of Medicine
I am humbled by the invitation given to me by Changi General Hospital to deliver this lecture at your 5th Annual Scientific Meeting with the theme “Frontiers of Medicine”. Thank you very much for the honour accorded me. Your CEO, Mr Udairam, and your CMB, Prof Fock Kwong Ming,...
Others
A Case of Right Loin Pain: Septic Ovarian Vein Thrombosis Due to Campylobacter fetus Bacteraemia
Septic ovarian venous thrombosis is an uncommon entity. Classically, it occurs as a postpartum complication with reported frequency of 1 in 600 to 2000 deliveries.
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Others
A Case of Ductal Carcinoma In situ of Breast with Poland Syndrome
We report a rare case of multi-focal ductal carcinoma in situ (DCIS) of the breast associated with Poland syndrome. A skin-sparing mastectomy of the left breast with immediate reconstruction using ipsilateral deep inferior epigastric perforator (DIEP) flap was performed.
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Others
Head and Neck Cancer After Foreign Body Ingestion
Foreign bodies ingested accidentally and lodged in the upper aerodigestive tract is one of the most common emergencies seen in the Otorhinolaryngology practice in Singapore. We present 2 cases which illustrate an unusual outcome of an otherwise usual occurrence.
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Others
Dapsone Hypersensitivity Syndrome Masquerading as a Viral Exanthem: Three Cases and a Mini-Review
Dapsone hypersensitivity syndrome (DHS) is a rare condition mostly occurring in leprosy patients on multidrug therapy. Dapsone is also combined with pyrimethamine as maloprim (Beacons Chemicals Pte Ltd, Singapore), a fairly effective chemoprophylactic agent in the management of malaria.
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Others
A Case of Cystic Leiomyoma Mimicking an Ovarian Malignancy
Uterine leiomyomas are the most common gynaecological tumour. Typical appearances of leiomyomas are easily recognised on imaging.
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Others
Supernumerary Testicle in a Case of Polyorchidism
The presence of more than 2 testicles is called polyorchidism. It is a rare anomaly.
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Others
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 rapidly and re-invade the host.
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Others
Plantar Dislocation of Lateral Tarsometatarsal Joint: A Case of Subtle Lisfranc Injury
Lisfranc fracture dislocations are uncommon injuries and the diagnosis may be easily missed. There are several variations and we present one such variant.
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Others
A Rare Case of Porphyria
Porphyrias are a rare and intriguing group of metabolic disorders. We report a case of congenital erythropoietic porphyria, one of the infrequent forms of porphyria.
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Others
A Case of Metastatic Squamous Cell Carcinoma of the Hypopharynx Manifesting as Acute Abdomen
T, a 23-year-old female, was previously well until November 2000 when she presented with 1-year history of sore throat associated with neck lumps for 2 months. Clinically, she had left cervical lymphadenopathy measuring 3 cm.
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Others
Uncommon Benign Intrascrotal Tumours
Leiomyomas of the urinary tract are exceedingly rare. They can, however, arise from almost any site within the genito-urinary tract, most commonly in the renal capsule and bilateral tumours are very rare.
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Others
A Case of Maffucci’s Syndrome With Pleural Effusion: Ten-year Follow-up
A 23-year-old male patient was admitted to Ataturk Chest Disease Hospital with non-productive cough, dyspnoea, chest pain and back pain. These complaints had begun 15 days before he was admitted.
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Original Article
Extended-spectrum Beta-lactamases in Clinical Isolates of Escherichia coli and Klebsiella spp. in a Singapore Hospital: Clinical Spectrum
Extended-spectrum beta-lactamases (ESBLs) in gram-negative bacillary pathogens are a growing and important problem in hospital practice and it is tied to extensive use of broad-spectrum antibiotics. The emergence of ESBLs has increased the possibility that traditional, empiric antimicrobial regimens may be ineffective.
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Original Article
Routine Microbiological Screening in Septic Patients in a Cardiac Surgical Intensive Care Unit
Compared to in-hospital patients, patients treated in an intensive care unit (ICU) have the highest risk of contracting an infection. The risk correlates well with underlying and accompanying diseases and invasive monitoring.
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Others
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 attributed to an occupational cause. Yet, only 3 cases were reported and confirmed in Singapore in the year 2000 – an incidence of only 0.14/100,000...
Others
Profunda Femoris Artery Pseudoaneurysm Presenting with Triad of Thigh Swelling, Bleeding and Anaemia
Pseudoaneurysms of the profunda femoris artery have been reported following blunt and penetrating trauma to the thigh, and orthopaedic procedures of the proximal femur. These pseudoaneurysms can present in various forms, such as a painful pulsatile mass, or even thigh compartment syndrome.
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Commentary
Medical Education in Asia: Is it a Time for Optimism?
Asia, the largest continent, is also an immensely diverse region with countries that vary in their socio-economic status, degree of urbanisation and health and disease profile. The objective of medical education is to create efficient and compassionate healers to serve indigenous society’s aspiration and priorities.
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Review Article
Issues and Priorities of Medical Education Research in Asia
Medical schools traditionally rest on the “three-legged stool” of research, education and service. Hence, medical teachers are sometimes referred to as “triple-threat academicians”.
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Original Article
Genital Herpes in a Sexually-transmitted Infection Clinic in Singapore: A 1-year Retrospective Study
Genital herpes simplex virus (HSV) infection is a commonly notified sexually transmitted infection (STI). Genital herpes can be caused by both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2), with HSV-2 being the predominant infection in genital herpes.
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Others
Lymphomatoid Papulosis Associated with Recurrent Cutaneous T-Cell Lymphoma
Lymphomatoid papulosis is a self-healing recurrent popular eruption often exhibiting a chronic course. It is associated with malignant lymphomas in 10% to 20% of cases.
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Others
Extensive Calcinosis Cutis in Relapsed Acute Lymphoblastic Leukaemia
Calcinosis cutis is characterised by the aberrant deposition of calcium salts in the skin. In metastatic calcinosis cutis, calcium salts are precipitated in normal tissue as a result of an underlying defect in calcium and/or phosphate metabolism.
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Others
Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association
The spinocerebellar ataxias (SCAs) are a rare group of neurodegenerative disorders that are clinically and genetically heterogeneous. Almost all SCAs are due to trinucleotide repeat expansions and 16 types of SCAs have been described.
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Others
Two Case Reports of Metastases from Colon Carcinoma to the Thyroid
Metastases to the thyroid are not as rare as previously believed and have been shown, in autopsy series, to be more common than primary thyroid malignancy. The overall incidence, not surprisingly, varies from 1.25% in unselected patient autopsy series to 24% in autopsy of patients with widespread malignant neoplasms.
This...
Others
Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context
Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44 per 100,000 in the year 2001.
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Others
Bile Duct Perforation in Children: Is it Truly Spontaneous?
Bile duct perforation (BDP) and biliary ascites in children is a rare clinical entity. The aetiopathogenesis is still elusive.
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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 described in 1961 and the phenotype was subsequently expanded in 1972.
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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 setting, such as nebulisers, water baths, dialysis machines and intravenous fluids.
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Others
Unravelling the Mystery in a Case of Persistent ACTH-independent Cushing’s Syndrome
A Malaysian Chinese male patient, CMO, first presented at the age of 22 years with a 2-week history of severe spontaneous low backache with no prior trauma or back injury. A lumbar spine X-ray showing marked osteopenia and compression fracture of the first lumbar vertebra led to findings of...
Editorial
Professionalism: Looking For Your Blind Spots
In 1996 a major breakthrough was reported in the medical literature. A 5-week ectopic pregnancy was re-implanted into the uterus via the cervix, and the fetus was successfully carried to term.
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Others
Neisseria meningitidis Keratitis in Adults: A Case Series
Neisseria meningitidis has been reported as a causative organism for conjunctivitis and endogenous endophthalmitis, more commonly in neonates and young children. A search of the literature on Medline revealed very few reports on infective keratitis caused by N. meningitidis.
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Others
Presumed Dapsone-induced Drug Hypersensitivity Syndrome Causing Reversible Hypersensitivity Myocarditis and Thyrotoxicosis
A 22-year-old Malay soldier doing his National Service was warded with a 6-day history of an itchy generalised rash associated with fever and lymphadenopathy. Prior to this episode, he was well and not known to have any major illnesses.
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Others
Visual Recovery Following Emergent Orbital Decompression in Traumatic Retrobulbar Haemorrhage
Acute retrobulbar haemorrhage is a potentially sight threatening condition that can occur spontaneously or following retrobulbar injections and trauma to the orbit. Visual loss results from central retinal artery occlusion or optic neuropathy from direct compression or from compression of optic nerve venous drainage.
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Review Article
Methodological Aspects of Traditional Chinese Medicine (TCM)
Traditional Chinese Medicine (TCM) has a long history but its efficacy is not as well-documented as one would hope. Proof of efficacy has to come from clinical trials, i.e., prospective experiments for assessing the results of medical interventions.
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Review Article
A Practical Way of Research in Chinese Medicine
Chinese medicine individualises its treatment plan and practice and refutes any general law. Therefore, Chinese medicine practitioners do not have the tradition of research.
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Editorial
Complementary and Alternative Medicine, and Traditional Chinese Medicine: Time for Critical Engagement
Practice outside of mainstream or conventional medicine has always been an important part of public healthcare in some countries, particularly in the developing world. Recently the use of complementary-alternative medicine (CAM) has grown in popularity worldwide.
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Others
Recurrent Non-immune Fetal Hydrops: A Case Report
The incidence of non-immune hydrops (NIH) has been reported to be 1/10001 and is associated with high perinatal morbidity and mortality at all gestational ages with an overall perinatal mortality rate (PNMR) of 86.6%. If the diagnosis is made before 24 weeks’ gestation, the PNMR is 95%, with 30%...
Others
Recombinant Tissue Plasminogen Activator (r-TPA) in Fibrin Dissolution due to Postoperative Endophthalmitis
Cataract surgery is one of the most successful surgical procedures performed. However, postoperative endophthalmitis, defined as severe inflammation involving both the anterior and posterior segments of the eye secondary to an infectious agent, is an uncommon but devastating complication.
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Commentary
Student Academic Committees: An Approach to Obtain Students’ Feedback
The shift of medical curricula from a traditional subject based to an integrated module-based system can be seen in many medical schools worldwide. The change in curricular design was introduced to encourage student-centred learning and equip students with essential skills for future practice.
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Review Article
Curricular Trends in Malaysian Medical Schools: Innovations Within
Medical educators continue to evaluate and introduce innovations into their curriculum with the objective of achieving appropriate outcomes for their graduates so that they can meet the healthcare needs of the society locally and globally. They sought to develop approaches to teaching and learning that would address the goals...
Original Article
A Problem-Based Learning Pathway for Medical Students: Improving the Process Through Action Research
Problem-based learning (PBL) is a student-centred, self-directed, integrated and contextual mode of learning. It has been widely perceived by many to confer advantages in promoting critical thinking, retention of knowledge, independent learning and interpersonal skills.
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Original Article
A Simple Instrument for the Assessment of Student Performance in Problem-based Learning Tutorials
Assessment can be done in a variety of ways, for many purposes, and for different populations. It can occur at the classroom level, programme level, college level or even national level.
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Original Article
An Online Evaluation of Problem-based Learning (PBL) in Chung Shan Medical University, Taiwan – A Pilot Study
The goal of problem-based learning (PBL) is to motivate students to develop self-learning skills in a small group. PBL embraces principles of good learning and teaching.
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Original Article
Evidence-based Medicine in Clinical Curriculum
Evidence-based medicine (EBM) is “the conscientious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients.” Considering the vast amount of medical knowledge available today through various media outlets with almost no boundaries, it is essential that our medical graduates should have...
Original Article
Leadership and Professionalism Curriculum in the Gross Anatomy Course
Healthcare delivery systems worldwide are currently undergoing significant changes to create resilient learning organisations that are able to adapt with ever-increasing speed to shifting business, regulatory, and competitive environments. The delivery of healthcare is no longer a single-provider responsibility; modern group practice organisations require a physician to be not...
Original Article
Constructing Multiple Choice Questions as a Method for Learning
Students in general and medical students in particular are often described as “strategic learners”, but in reality many become superficial learners out of necessity when faced with the seemingly boundless volume of material in today’s curriculum. The apparent enormity of the task might encourage rote learning and much of...
Original Article
Computer-based Versus Pen-and-paper Testing: Students’ Perception
Computer-based testing (CBT) has gained popularity as a testing modality, with large-scale professional examinations such as the United States Medical Licensing Examination (USMLE) adopting a CBT format since 1999, replacing the written pen-and-paper (PNP) format. Studies have found that testing format does not affect test scores, and that CBT...
Editorial
Curriculum TIPS For All of Us
Medical education is a lifelong learning process. Just as we remind our students and ourselves that the practice of medicine is a lifelong process in which we continually seek to improve our knowledge so that we give our patients the most effective care, so too with medical education.
This article...
Others
Surgically-induced Corneal Changes Following Macular Translocation with Punctate Retinotomies and Chorioscleral Infolding (Limited Macular Translocation)
Changes in corneal curvatures and astigmatism after retinal surgery are well documented. Although some of these changes are mild and transient, some have reported clinically significant irregular and asymmetric corneal changes.
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Others
Cutaneous and Subcutaneous Metastases of Adenocarcinoma of the Colon and Rectum
Cutaneous metastasis from colorectal adenocarcinoma is an interesting condition not only because of its rarity, it occurs in less than 4% of patients with colorectal cancers, but also because it implies a poor prognosis. We discuss 3 patients with rectal adenocarcinoma who subsequently developed cutaneous metastases.
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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 estimated incidence of 1 in 350,000 in a newborn screening programme.
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Others
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 (CHB) are the commonest cause. Hence, in Singapore where 4% of the population are hepatitis B carriers, when faced with acute hepatitis in a patient...
Others
A Hyperthyroid Patient with Measurable Thyroid-stimulating Hormone Concentration – A Trap for the Unwary
Free thyroxine (FT4), total tri-iodothyronine (T3) and thyrotropin (TSH) are the commonly measured biochemical indices in the assessment of thyroid function in a patient with suspected thyrotoxicosis. These indices give sufficient information regarding the functional status of the thyroid gland under most circumstances.
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Others
Abuse of Prescription Buprenorphine, Regulatory Controls and the Role of the Primary Physician
Buprenorphine is an opiate partial agonist that has been used for pain management, and in the past few years has been approved for the treatment of opioid dependence in Singapore and other countries. Buprenorphine is available in primary care clinics and can be prescribed by all licensed physicians who...
Review Article
Community-associated Methicillin-resistant Staphylococcus aureus: Overview and Local Situation
The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates from the community that are distinct from their archetypal healthcare-associated counterparts (HA-MRSA) marked a critical evolutionary milestone for the organism. In less than 2 decades, particularly in the last 3 years, this initially sporadic phenomenon of community-associated methicillin-resistant Staphylococcus...
Letter to the Editor
Translational Research – A Multidisciplinary Approach
Translational research aims to convert laboratory discoveries into therapeutic gains for patients – in oncology, drug development is a prime example. This multifaceted process is often complicated and requires huge investments in time, money and expertise.
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Others
A Complex, Contagious, Evolutionary Habit
Yawning is often noted in medical seminars and conferences – be they surgical, orthopaedic, gastroenterological, endocrinological or neurological. Yet, this condition receives little coverage by professors in medical schools.
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Commentary
Amendment of the Human Organ Transplant Act
Kidney transplants have been carried out in Singapore for more than 35 years, with the first cadaveric kidney transplant operation performed on 8 July 1970. However, prior to the commencement of the Human Organ Transplant Act (HOTA) in 1988, there was only a small number of kidney transplants; between...
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 entity became more frequent after the introduction of vasoactive drugs for intracavernosal injections.
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Others
Delayed Hypersensitivity Reaction After Intravenous Glucagon Administered for a Barium Enema: A Case Report
A 74-year-old Chinese woman presented with a 1-week history of an itchy rash on the trunk and legs. A barium enema was performed a day before the rash started.
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Others
Ethambutol-associated Optic Neuropathy
Tuberculosis (TB) has been present since ancient times. Around 460 BC, Hippocrates identified phthisis, which is the Greek term for consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor and long relentless wasting) as the most widespread disease of the times, which...
Others
Necrotising Fasciitis and Traditional Medical Therapy – A Dangerous Liaison
The first case was a 54-year-old lady, with a history of insulin-dependent diabetes mellitus and hyperlipidaemia, who presented with bilateral hand pain and stiffness of 4 days’ duration.
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Others
Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis
Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes and non-caseating epithelioid granulomas in affected organs.
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Others
Retrobulbar Alcohol Injection for Orbital Pain Relief Under Difficult Circumstances: A Case Report
The management of pain in the orbital region, whether ocular or orbital in origin, is complex and lies at the margins of several subspecialty interests. Because of this, and because of its rarity, it has received little attention in the literature.
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Others
Mycobacterium-related Ocular Inflammatory Disease: Diagnosis and Management
Tuberculosis (TB) is an ancient disease that has been detected in 3000-year-old Egyptian mummies. Robert Koch’s discovery of the tubercle bacillus as the aetiologic agent of this disease in 1882 led to the acceptance of “Koch’s postulates,” which remain the gold standard for linking a pathogen to a disease.
This...
Others
Interesting In- and Outpatient Attendances at Hogwarts Infirmary and St Mungo’s Hospital for Magical Maladies
With the return of “You Know Who” (YKW) and the rise of Death Eaters, injuries amongst both muggle and wizarding folk (MF and WF) have escalated. Muggle medicine, with its quaint dependence on potions and “technology”, is inadequate to deal with magical injuries, and has much to learn from...
Others
The Doctor’s Multi-instrument Tool of the Future?
It is just another day in 2020, except that the eyes of the medical world are eagerly awaiting the latest invention to be revealed: the ingenious multi-instrument pocket tool. Precision, quality, functionality and versatility are what this invention promises to deliver.
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Others
Intravitreal Triamcinolone Acetonide for the Treatment of Diffuse Diabetic Macular Oedema – A Case Report
Focal and grid laser photocoagulation are the primary surgical treatments for diabetic macular oedema. However, laser treatment of eyes with diffuse macular oedema has been disappointing.
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Others
Potentially Fatal Paracetamol Overdose and Successful Treatment with 3 Days of Intravenous N-acetylcysteine Regime – A Case Report
Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in a patient can be life threatening.
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Others
Postirradiation Sarcoma of the Sphenoid Bone – A Case Report
Radiation-associated tumours of the temporal and maxillary bone have been reported in patients treated with radiotherapy for nasopharyngeal carcinoma. There was no previously reported case of postirradiation sarcoma of the sphenoid bone after radiation therapy for nasopharyngeal carcinoma.
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Others
Septic Monoarthritis and Osteomyelitis in an Elderly Man Following Klebsiella pneumoniae Genitourinary Infection: Case Report
Despite improved antimicrobial therapy over the past 30 years, there has been little change in the incidence, outcome, or, causative organisms in septic arthritis. Staphylococcus aureus is the commonest cause of septic arthritis and various series reported rates of 17% to 80%.
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Original Article
Relationship Between Item Difficulty and Discrimination Indices in True/False-Type Multiple Choice Questions of a Para-clinical Multidisciplinary Paper
Multiple-choice questions (MCQs) are used more and more in departmental examinations or as comprehensive examinations at the end of an academic session. They may be used to determine progress or to make decisions regarding the certification of a candidate.
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Others
Fetus-in-fetu in the Pelvis: Report of a Case and Literature Review
Baby A was delivered at 37-week and 4-day gestation via elective caesarean section. His mother was a healthy 33- year-old with a previous uneventful pregnancy. There was no history of consanguinity and no family history of multiple pregnancies. In the current pregnancy, there was no maternal illness, history of...
Others
Beyond Ortner’s Syndrome – Unusual Pulmonary Complications of the Giant Left Atrium
The giant left atrium (GLA) is a complication of severe mitral regurgitation most commonly due to rheumatic heart disease. It causes morbidity by compressing adjacent intra-thoracic structures. Examples include Ortner’s syndrome due to compression of the left recurrent laryngeal nerve, and dysphagia from oesophageal compression. We report 2 unusual...
Others
Dural Sinus Thrombosis after Minor Head Injury in a Child
A healthy 4-year-old Chinese girl was admitted to the hospital after a fall from a one-metre-high chair. She sustained a minor head injury to her right temporal region. There was no loss of consciousness, visual disturbances or motor dysfunction after the fall. She had symptoms of vomiting a few...
Others
Periampullary Diverticulum: A Case of Bleeding from a Periampullary Diverticula
Duodenal diverticula were reported for the first time by Chomel in 1710. 1 They can be classified as either congenital or acquired and intraluminal or extraluminal. They typically occur in the periampullary region, along the medial aspect of the second and third part of the duodenum. Periampullary diverticula (PAD)...
Others
Inflammatory Tumour of the Retroperitoneum – A Case Report
First diagnosed as pulmonary tumours in the adult population, inflammatory myofibroblastic tumours (IMTs) are true neoplasms that are also known to occur in children in various extrapulmonary locations.1 Although abdominal IMTs have been reported, retroperitoneal tumours are exceedingly rare.1 Since needle biopsy and frozen section in these tumours are...
Others
Swallowed Foreign Bodies in Children: Report of Four Unusual Cases
Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating occasional immediate intervention to avoid serious complications.
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Others
A Case of Cystic Schwannoma of the Lesser Sac
Schwannoma or neurilemmoma (NL) is a well-defined, usually benign, tumour arising from the nerve sheath (Schwann cell). It may present as a solitary mass in any part of the body, but is more commonly seen in the head and neck, the extremities and on the trunk.
This article is available...
Others
Adult-onset Re-emergent Stuttering as a Presentation of Parkinson’s Disease
A 61-year-old right-handed man with no past medical history presented to our movement disorders clinic with a history of stuttering which had begun 5 years earlier, and appeared to worsen in the preceding year. He had stuttered briefly in childhood, from the age of 5 to 11, but had...
Others
Severe Upper Limb Complications from Parenteral Abuse of Subutex®
Subutex® (sublingual buprenorphine hydrochloride) tablets are prescribed by licensed physicians to alleviate symptoms of opiate withdrawal in addicts undergoing a cessation programme. It is increasingly used instead of methadone in cessation programmes, as it is effective, well tolerated and has fewer side effects.1-3 In Singapore, according to Institute of...
Others
Autosomal Dominant Familial Chronic Mucocutaneous Candidiasis Associated with Acne Rosacea
Chronic mucocutaneous candidiasis (CMC) is a rare disorder characterised by chronic and recurrent infections, predominantly caused by Candida albicans affecting the mucous membranes, nails and skin. Other species of the Candida genusare occasional causative agents. Infections with other bacteria and dermatophytes can also occur. The infection is usually localised...
Others
Gastric Pneumatosis after Endoscopic Argon Plasma Coagulation
Argon plasma coagulation (APC) is a major haemostatic modality for large surface bleeding areas.1 It effects thermal coagulation with limited and controlled tissue depth by using high-frequency monopolar electrosurgical current via an ionised argon gas stream. When used endoscopically, a flexible probe passed through the accessory channel provides non-contact...
Others
Impetigo Herpetiformis – A Rare Dermatosis of Pregnancy Associated with Prenatal Complications
Impetigo herpetiformis (IH) is a rare dermatosis of pregnancy that can present dramatically in the third trimester of pregnancy with widespread cutaneous pustulosis and serious systemic features, including fetal distress.1,2 Early recognition of this condition is of utmost importance as maternal and fetal well-being may be compromised due to...
Letter to the Editor
Towards a Global Educational Matrix for Tomorrow’s Health Systems
Society supports medical schools expecting them to produce physicians who can improve both the health of the population as well as the health system itself. This goal has not been achieved yet; deaths from tuberculosis (1.7 million, 2006) are but one of many examples that points to that failure...
Commentary
Harnessing the IT Factor in Medical Education
In this digital age, we are constantly inundated with breathtaking images worthy of an Ansel Adams photograph or a Zhang Yimou film. Is it any wonder, then, that we educationists feel compelled to “wow” our students, who may have become jaded by this daily barrage of digital wizardry to...
Others
False Positive F-18 Fluorodeoxyglucose Combined PET/CT Scans from Suture Granuloma and Chronic Inflammation: Report of Two Cases and Review of Literature
Postoperative surveillance for recurrence after curative colorectal cancer surgery has been enhanced with the use of F-18 fluorodeoxyglucose (FDG) combined positron emission tomography (PET)/computed tomography (CT) imaging that detect metabolic anomalies via differences in tissue glucose uptake and thus metabolic activity.1-3 This may occasionally pose a problem in distinguishing...
Others
Snakebite in a Child: Could We Avoid the Anaphylaxis or the Fasciotomies?
Snakebites have become uncommon in the metropolitan and densely populated city of Hong Kong.1-3 We recently reported a 10-year survey of snakebites in children in Hong Kong and concluded that children should be discouraged to play in areas where snakes may hide and that protective footwear should be worn.4...
Others
A Case of Lemierre’s Syndrome Presenting with Multiple Pulmonary Abscesses Associated with a Tension Hydropneumothorax Resulting in a Mediastinal Shift
Lemierre’s syndrome (LS) is a condition which follows an oropharyngeal infection, often in an otherwise healthy young adult. This usually progresses to septic thrombophlebitis of the internal jugular vein (IJV), leading to metastatic abscesses mainly of the lungs, but organs such as the liver, bones, joints and kidneys can...
Commentary
A Systems Approach to Teach Core Topics across Graduate Medical Education Programmes
Core curricula including Ethics, Medico-legal issues, Socioeconomics, and Quality Improvement (QI) are relevant and significant for graduate medical education programmes, regardless of specialty. A lack of faculty expertise in these content areas is a frequently cited concern among specialty programmes in graduate medical education.
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Others
Post-poliomyelitis Syndrome: Case Report and Review of the Literature
Postpoliomyelitis syndrome (PPS) is characterised by the delayed appearance of new neuromuscular symptoms in patients many years after their acute poliomyelitis paralysis. PPS occurs 30 to 40 years after an acute poliomyelitis attack and is observed in approximately 25% to 28% of patients.1 It is still unclear, at this...
Commentary
World Federation for Medical Education Policy on International Recognition of Medical Schools’ Programme
There is an increasing need for international quality assurance of medical education. However, there are no present mechanisms for international recognition of medical educational institutions and programmes.
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Others
Parathyroid Carcinoma: A Case Series
Parathyroid carcinomas account for 1% to 3% of patients with primary hyperparathyroidism (PHPT).1 Patients usually present with a severe form of hyperparathyroidism at diagnosis, such as bone disease, renal disease, or hypercalcaemic crisis, in contrast to the relatively asymptomatic presentation of benign parathyroid disease.2 Problems encountered include difficulty in...
Original Article
Quality Management of Medical Education at the Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Germany
In Germany, medical education is an undergraduate programme for which the students applying at the “Zentralstelle für die Vergabe von Studienplätzen” (ZVS); the final admission is primarily based on the grades of the “Gymnasium”. The number of applying students is about 4 times higher than the number of university...
Others
Recurrent Prostatic Stromal Tumour of Uncertain Malignant Potential (STUMP) Presenting with Urinary Retention 6 Years after Transurethral Resection of Prostate (TURP)
Prostatic stromal tumour of uncertain malignant potential (STUMP) is a rare lesion, with fewer than 100 cases reported worldwide. It is considered a neoplastic lesion possessing relatively high recurrence and progression rates. We report a case of this neoplasm, manifesting initially with gross haematuria and haematospermia, and subsequent acute...
Original Article
Supporting Learners who are Studying or Training Using a Second Language: Preventing Problems and Maximising Potential
Travel and immigration are vibrant aspects of the international medical and educational field. Patients are increasingly mobile and finding healthcare professionals in a foreign country who can bring additional insights to help address their cultural and language needs can only benefit their care.
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Original Article
Development of a Tool to Evaluate Health Science Students’ Experiences of an Interprofessional Education (IPE) Programme
A shortage of healthcare professionals and resources in rural areas is well documented. These workforce shortages necessitate new models of healthcare in rural areas that focus on increased collaboration and communication to optimise patient care.
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Original Article
Step-2 Thai Medical Licensing Examination Result: A Follow-up Study
The Center for Evaluating and Accrediting Medical Competency of the Thai Medical Council has established the regulation that Thai medical graduates matriculated as of 2003 have to pass the Medical Licensing Examination of Thailand (MLET) to qualify for medical practice. There are 3 steps in this national test.
This article...
Original Article
Does Team Learning Motivate Students’ Engagement in an Evidence-based Medicine Course?
Team-based learning (TBL) is a well-defined instructional strategy that has generated considerable interest within the medical education community because of its potential to promote active learning with a limited number of faculty facilitators. This mode of learning was originally developed more than 20 years ago for college business and...
Original Article
A Survey of Medical Students’ Perceptions of the Quality of their Medical Education upon Graduation
Founded in 1934, Tehran University of Medical Sciences School of Medicine (TUMS-SoM) is the oldest modern medical school in Iran. It has the most number of academic staff and research productivity in the country, as well as the highest number of both undergraduate and postgraduate students enrolment per year.
This...
Original Article
The Learning of 7th Year Medical Students at Internal Medical – Evaluation by Logbooks
In 1945, Taihoku (Taipei) Imperial University was renamed the National Taiwan University and the Japanese teaching system was replaced with a system implemented by the Ministry of Education of the Republic of China. The 7-year curriculum in the School of Medicine, College of Medicine and the National Taiwan University...
Original Article
Use of Knowledge-sharing Web-based Portal in Gross and Microscopic Anatomy
The extensive use of and the rate at which medical technology is becoming an integral force in medicine has impacted on the way in which physicians are being trained to practise within this new environment. Medical informatics and the era of interacting over web-based systems require competencies that need...
Original Article
Assessment of Psychometric Properties of a Modified PHEEM Questionnaire
In Sri Lanka, after a 5-year medical undergraduate curriculum, graduates from the medical faculties undergo a one year mandatory internship or housemanship, 6 months each in 2 selected disciplines of clinical medicine, surgery, paediatrics, obstetrics & gynaecology and paediatric surgery in a recognised government hospital. After successful completion of...
Editorial
Medical Education in a Flat World
In 2005 Thomas Friedman published the international best-seller The World is Flat: A Brief History of the Twenty-First Century. He asserted that as the world becomes more connected, it becomes a level playing field, in which all players have equal opportunities.
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Letter to the Editor
Objective Structured Clinical Evaluation Should Not Only Be a Test of Clinical Skill
The Objective Structured Clinical Examination (OSCE) was originally a test (or summative assessment) specifically of clinical skills, using standardised patients (SP), anatomical models and itemised checklists3 for scoring medical students. However, if OSCE was restricted to a test, as with any other test, many students would learn tricks for...
Others
5th College of Physicians Lecture – A Physician’s Odyssey: Recollections and Reflections
Allow me to thank you Mr President and your Council for asking me to deliver the 5th College of Physicians Lecture. Your President has suggested that with over 50 years of association with Medicine, the title be “In the Service of the Medical Profession”.
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Others
Fungal Pan-sinusitis with Severe Visual Loss in Uncontrolled Diabetes
Fungi are known opportunistic organisms, which potentially invade and infect a host with depressed immunity. Fungal pan-sinusitis complicated with orbital apex syndrome or cavernous sinus syndrome has been described in immunosuppressed patients.
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Review Article
Standard Setting in Student Assessment: Is a Defensible Method Yet to Come?
To validate any “adjective”, be it for living or non-living, a criteria or standard is needed. Globalisation, mobility of doctors and the rising number of medical institutions make it imperative to have comparable standards in medical teaching learning and assessment.
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Original Article
Innovative “Case-Based Integrated Teaching” in an Undergraduate Medical Curriculum: Development and Teachers’ and Students’ Responses
In Asia, the challenges facing medical education are similar across different countries. The learning process is still problematic with large classes, and most of the curriculum time being spent on traditional lectures.
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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 medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...
Others
Metastasis to the Sinonasal Tract from Sigmoid Colon Adenocarcinoma
A 52-year-old female was diagnosed with well-differentiated adenocarcinoma of the sigmoid colon in 1999. An anterior resection was performed followed by adjuvant chemotherapy for 6 cycles.
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Original Article
Evidence-based Medicine (EBM) for Undergraduate Medical Students
The practice of evidence-based medicine (EBM), which integrates individual clinical expertise with the best available evidence from systematic research, demands a set of skills. These skills help clinicians retrieve, appraise and apply the current best evidence.
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Original Article
Transudates in Malignancy: Still a Role for Pleural Fluid
According to Light’s criteria, an exudate is defined by at least one of the following: a total protein pleural fluid to serum ratio greater than 0.5, an lactate dehydrogenase (LDH) pleural fluid to serum ratio greater than 0.6, or an absolute pleural fluid LDH greater than 2/3 of the...
Others
An Unusual Presentation of a Giant Frontal Sinus Mucocele Manifesting with a Subcutaneous Forehead Mass
A mucocele is an epithelium-lined mucus-containing sac which usually develops when the ostium of a paranasal sinus becomes obstructed by chronic sinusitis, polyps or bone tumours. Mucoceles can erode through the surrounding bone and spread both intraorbitally and intracranially.1-4 We report an unusual case of a patient with intracranial...
Others
Cavitating Cryptococcal Pneumonia in the Immunocompetent Host
Three immunocompetent male patients with cryptococcal pneumonia presented to our hospital between June 2000 and November 2001. They had varied presentations, as shown in Table 1. All 3 patients were previously well, without any underlying diabetes mellitus, renal or hepatic diseases, and none was on any immunosuppressants. None of...
Others
Cyclosporin-induced Sebaceous Hyperplasia in Renal Transplant Patients
There are several reports in the literature of sebaceous hyperplasia being induced by cyclosporin in immuno-suppression of organ transplant patients. The condition was only found in male transplant patients and not seen in children with renal transplant. Two Chinese renal transplant recipients who developed sebaceous hyperplasia while on cyclosporin...
Others
Artificial Urinary Sphincter in Adult Male with Neurogenic Stress Urinary Incontinence: A Rare Indication
The artificial urinary sphincter (AUS) is an established modality for the management of stress urinary incontinence. It is usually used in adults with post-radical prostatectomy incontinence1 and in children with neurogenic voiding dysfunction usually secondary to spinal dysraphism.2 However, it is rarely used in adults with neurogenic stress incontinence...
Others
First Branchial Cleft Anomalies have Relevance in Otology and More
The external ear canal is a derivative of the first branchial cleft. Anomalies of the first branchial cleft, therefore, often involve external ear canal structures which are normally managed in an Otology practice. However, in duplication anomalies, clinical features are varied and may include those seen in a typical...
Others
An Unusual Case of an Intramuscular Lipoma of the Pectoralis Major Muscle Simulating a Malignant Breast Mass
Intramuscular lipomas of the pectoralis major muscle are rare tumours.1 We describe an unusual case of a lipoma of the pectoralis major muscle which presented as a hard and progressively enlarging breast mass.
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Others
Development of Ipsilateral Adrenocortical Carcinoma Sixteen Years after Resection of an Adrenal Tumour Causing Cushing’s Syndrome
Adrenocortical carcinoma is a rare tumour, with an annual incidence of 0.5 to 2 per 1 million people. The overall 5-year survival rate ranges from 16% to 38%.1-4 Recurrence, even after seemingly complete resection, is common, occurring in 23% to 85% of patients.3,5,6 The reported mean disease-free interval ranges...
Others
Legal Issues in the Treatment of a Violent Manic Patient in a Non-Gazetted Setting: A Case Report
Mr X, a 68-year-old Indian, was the chairman of a big corporation. He had had a history of bipolar disorder for the past 40 years, with an episode of depression and mania that started 40 years ago, and then 3 episodes of mania in the past 6 years. About...
Others
Rapid Cystic Development in Relation With an Impacted Lower Third Molar: A Case Report
There are many conditions affecting the jaws that present with a cystic, radiographic appearance. Odontogenic cysts and tumours have the potential to reach considerable sizes in the jaw. Unicystic ameloblastoma often presents as a large unilocular radiolucency in young individuals, typically at the posterior mandible, and is usually associated...
Others
Caesarean Scar Pregnancy: A Diagnosis to Consider Carefully in Patients with Risk Factors
A uterine scar pregnancy is a gestation separated from the endometrial cavity and completely surrounded by the myometrium and the fibrous tissue of the scar. The most probable mechanism through which this can occur is invasion of the myometrium through a microscopic tract. The tract is believed to develop...
Others
Tuberculosis Post-Liver Transplantation: A Rare but Complicated Disease
Tuberculosis (TB) is a serious opportunistic infection in transplant recipients, with an incidence in organ transplant recipients ranging from 0.35% in developed countries to 15% in endemic areas.1 It carries a mortality rate of as high as 40%.2 The majority of TB infection have occurred within 12 months of...
Others
Vision Restoration Therapy: New Hope for Stroke Patients with Visual Field Loss
Patients suffering from visual field defects caused by optic nerve or post-chiasmatic injury commonly experience many limitations in their daily activities. The generally accepted paradigm that nothing can be done leaves little hope for such patients as restoration was once considered impossible.
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Others
Placental Calcification in Pseudoxanthoma Elasticum
Pseudoxanthoma elasticum (PXE) is an inherited multisystem disorder of the elastic tissue leading to skin disease as well as ocular and cardiovascular complications. Although earlier literature on pregnancy in PXE contained reports of severe complications, most patients show no serious complications during pregnancy.
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Others
Effects on the Contralateral Eye After Intravitreal Bevacizumab and Ranibizumab Injections: A Case Report
Vascular endothelial growth factor (VEGF) is recognised as an important mediator in the pathogenesis of age-related macular degeneration (AMD) and retinal neovascularisation. Anti-VEGF therapies such as pegaptanib (Macugen, EyeTech/OSI Pharmaceuticals) and ranibizumab (Lucentis, Genentech) are Food and Drug Administration (FDA)-approved in the US for the treatment of neovascular AMD.
This...
Review Article
Self-directed Learning in Health Professions Education
More than 600,000 new citations were published in MEDLINE in 2005; this raised the total number of indexed citations to more than 14 million citations. In a study be Williamson et al, 2 out of 3 primary care physicians described the volume of literature as unmanageable, and 1 out...
Commentary
Sir Gordon Arthur Ransome (1910-1978) – His Teaching Style and His Legacy
Sir Gordon Arthur Ransome was born in Salop, England, in 1910.1 He came to Singapore in 1938, where he taught and practised medicine for 33 years before his retirement in 1971.
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Commentary
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 a “counterculture” to the disease-and-body-part focus of the hospital specialties in the 1960s.
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Letter to the Editor
Erysipelothrix rhuseopathiae Septicaemia with Prolonged Hypotension: A Case Report
Erysipelothrix sp. is a gram-positive, non-spore forming bacterium that was first isolated by Robert Koch. It has the unusual ability to infect a large variety of vertebrate and invertebrate animals, including various species of domestic and wild animals, mainly swine, cattle, fish and birds.
This article is available only as...
Others
Pathological Pulmonary Hernia in a Patient With Metastatic Breast Cancer
Pulmonary hernia is a rare and uncommon clinical entity that has been defined as a protrusion of pleural membranes or lung parenchyma through the defect in the thoracic enclosure. According to aetiology, pulmonary hernias can be congenital (due to rib or intercostal hypoplasia or agenesis) or acquired (traumatic, pathological...
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, especially among children. The severity of the envenomation is related to haemodynamic and cardiorespiratory alterations, with cardiac failure and cardiogenic pulmonary oedema being the major...
Commentary
The Hospitalist Movement – A Complex Adaptive Response to The Hospitalist Movement – A Complex Adaptive Response to Fragmentation of Care in Hospitals
Healthcare systems are complex adaptive systems. They are capable of self organisation through interacting agents that adapt to changes to the internal and external environment.
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Commentary
Medication Use in the Transition from Hospital to Home
Hospital discharge can be a complex and challenging time for physicians and patients alike. Patients are being discharged sooner, often in the process of convalescence rather than at baseline health status. This requires physicians to more effectively communicate instructions for post discharge care to patients, family members, and outpatient...
Commentary
Family Medicine Education in Singapore: A Long-standing Collaboration between Specialists and Family Physicians
In the US, Canada and Australia, the postgraduate training of family physicians (FPs) involves the attachment of family medicine (FM) trainees to specialist departments, similar to the model currently employed in Singapore. Unlike Singapore, however, FM training outside these hospital attachments is largely administered by senior FPs with minimal...
Editorial
Bridging the Gap between Primary and Specialist Care: Formidable Challenges Ahead
The strong guiding hand and deep pockets of the state have brought about the growth of hospitals and national specialist centres while leaving the primary care sector largely to free market forces. Thus, it is not surprising that the evolution of Singapore’s healthcare system has largely favoured specialisation and...
Others
Thoracic Complications of Radiofrequency Ablation of Recurrent Hepatoma
Radiofrequency ablation (RFA) intended to produce complete thermal necrosis of unresectable primary or secondary hepatic malignancies have gained widespread availability and acceptance over the past 5 years.
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Others
An Unexpected Presentation of Endometriosis – A “Parasitic” Cyst of the Bowel in a Menopausal Woman on Hormone Therapy
Endometriosis commonly affects women during their reproductive years and may involve any organ. Although rare, endometriosis has been reported in postmenopausal women and is often associated with hormone replacement or tamoxifen.
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Original Article
Clinical Skills in Final-year Medical Students: The Relationship between Self-reported Confidence and Direct Observation by Faculty or Residents
In clinical medical education, instructors train students in their medical knowledge and clinical skills. Medical educators also aspire to develop students’ self-confidence in medical practice.
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Others
Suprascapular Nerve Neuropathy Secondary to Spinoglenoid Notch Ganglion Cyst: Case Reports and Review of Literature
Shoulder pain and dysfunction have long been the bane of both the young and old alike. Common causes include local conditions such as rotator cuff tears, impingement syndromes, tendonitis, bursitis, adhesive capsulitis, acromioclavicular joint osteoarthritis, as well as cervical pathology such as disc disease and spondylosis. Suprascapular nerve neuropathy...
Others
A Case Report of Endovascular Stenting in Salmonella Mycotic Aneurysm: A Successful Procedure in an Immunocompromised Patient
Mycotic aortic aneurysm carries a high mortality and morbidity rate. Traditionally, such cases are treated with open surgery, including extra-anatomical or in-situ graft repair. A growing number of authors have reported the use of endovascular stenting as treatment for mycotic aneurysms. To our knowledge, this is the first case...
Others
Managing Breast Cancer Diagnosed in First Trimester Pregnancy: A Case Report
Cancer complicates approximately 1 per 1000 pregnancies and accounts for one third of maternal deaths during gestation.1,2 The reproductive system is affected by malignant growth more frequently than any other systems during pregnancy. Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy, lactation or 1-year postpartum. The...
Others
Tetanus in an Injecting Buprenorphine Abuser
Problems with parenteral drug abuse with opioids and infectious complications have been well-described in medical literature.1-3 Substitution drugs such as buprenorphine (Subutex) have been used as an adjunct to manage intractable opioid dependence. Buprenorphine, a partial opioid agonist, has been shown in previous trials to reduce heroin use, with...
Others
EUS-FNA of the Left Adrenal Gland is Safe and Useful
The occurrence of an adrenal mass in patients with an underlying malignancy may represent distant metastases, precluding curative surgical resection of the primary malignancy. On the other hand, it may simply represent a benign adrenal adenoma with no prognostic implications. In a cohort of lung cancer patients, an isolated...
Others
Late Complications Following Tetralogy of Fallot Repair: The Need for Long-term Follow-Up
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease with an incidence of approximately 0.5/1000 live births (5% to 7% of congenital heart lesions). In Singapore with a live birth of over 37, 000 per year,1 the expected number of new TOF cases will be approximately...
Others
Clear Cell Carcinoma of Minor Salivary Gland – Case Report
Clear cell carcinoma is a rare low-grade carcinoma that occurs almost exclusively in the intra-oral minor salivary glands.1-11 Occasional cases have been reported in other sites.3,10-14 Various terms applied to this tumour reflect its histological diversity.1-3,9 The recognition and consequent reporting of this neoplasm increased significantly after the report...
Others
Peripartum Acute Anterior ST Segment Elevation Myocardial Infarction: An Uncommon Presentation of Acute Aortic Dissection
Reperfusion therapy in the form of primary angioplasty or thrombolytic therapy is the cornerstone of management in patients presenting with acute ST segment elevation myocardial infarction (STEMI).1 Thrombosis of the atherosclerotic coronary artery is by far the most common cause of acute myocardial infarction. In patients without traditional risk...
Others
Arteriovenous Fistula Aneurysm – Plicate, Not Ligate
Arteriovenous fistulae (AVF) are created for haemodialysis in patients with end-stage renal failure. While AVF is a lifeline for these patients, its creation is not without complications.1 One complication is that of aneurysmal dilatation, which can cause rupture and potentially fatal haemorrhage.
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Others
Cluster of Staphylococcus aureus and Dengue Co-infection in Singapore
In recent years, Singapore has seen a resurgence of dengue fever despite the seemingly successful implementation of a nationwide Aedes mosquito control programme,1 culminating in 9459 clinical and laboratory-confirmed dengue cases in 2004 and up to 13,653 cases in its 2005 dengue epidemic.2
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Others
Neurogenic Pulmonary Oedema Misdiagnosed as Acute Myocardial Infarction in a Comatose Patient
Neurogenic pulmonary oedema (NPO) is a well recognised complication of subarachnoid haemorrhage (SAH) and severe traumatic brain injuries (TBI).1 The incidence of NPO was reported to be 6% in a series of 457 patients with SAH.2 However, the diagnosis of NPO can be challenging when it occurs without abnormal...
Others
Avoiding Dialysis in Tumour Lysis Syndrome: Is Urate Oxidase Effective? – A Case Report and Review of Literature
Tumour lysis syndrome (TLS) is frequently associated with lymphoproliferative malignancies. It is the result of massive spontaneous or chemotherapy-induced cytolysis, leading to the release of intracellular metabolites. Hyperuricaemia from breakdown of large amount of nucleic acids in lysed tumour cells causes renal dysfunction from precipitation of uric acid leading...
Others
POEMS Syndrome – A Case for More Aggressive Treatment
POEMS syndrome is a rare, multisystem disorder originally characterised by the presence of polyneuropathy, organomegaly, endocrinopathy, monoclonal or M-protein and skin changes. Bardwick proposed the acronym in 1980.1 With a wide array of features, this condition can present to a variety of medical subspecialties. We report a patient who...
Others
Case Report: Induction of Immune Tolerance to Factor VIII Inhibitor after a Major Operation
Mr ZBH was a 30-year-old man with a history of severe haemophilia A with 0% factor VIII (FVIII). He was initially supported with cryoprecipitate but was switched to FVIII concentrate in 1995. He first developed FVIII inhibitor in 1995 and his inhibitor level fluctuated between 0.3 and 2 BU....
Others
Ovarian Carcinoma Presenting With Isolated Contralateral Inguinal Lymph Node Metastasis: A Case Report
Ovarian carcinoma is the most frequent cause of death from gynaecological malignancies in the United States. Rates for ovarian carcinoma in Singapore fall between those of Western Europe and those of the rest of Asia, accounting for 5.4% of all female cancers diagnosed between 1998 and 2002 in Singapore.1...
Letter to the Editor
Thalidomide-associated Arterial Thrombosis: Two Case Reports
Thalidomide was used as a sedative in the 1950s and was withdrawn from the market after initial reports of teratogenicity in 1961. In 1998, the US Food and Drug Administration (FDA) approved the drug as a treatment for erythema nodosum leprosum. The finding of increased angiogenesis in myeloma, coupled...
Others
Lessons Learnt from Two Women with Morbidly Adherent Placentas and a Review of Literature
Pathologically adherent placenta occurs when there is a defect of the decidua basalis, resulting in abnormally invasive implantation of the placenta into the substance of the uterus. As a result, there is no clear plane between the placenta and the underlying uterus to which it is implanted. The extent...
Others
Pars Plana Vitrectomy and Internal Limiting Membrane Peeling for Macular Oedema Secondary to Retinal Vein Occlusion: a Pilot Study
Macular oedema is a major cause of visual impairment in a number of ocular conditions such as diabetic retinopathy, retinal vein occlusion, Irvine-Gass syndrome and uveitis.1 In one study, cystoid macular oedema contributed to 37.9% of low vision in patients with retinal vein occlusion.2 Persistent macular oedema may lead...
Others
Is There a Place for Placebo in Management of Psychogenic Movement Disorders?
The term “placebo” is derived from St Jerome’s Latin Psalm, placebo domino in regione vivorum (I shall please the Lord in the land of the living).1 Placebos were fake substances or rituals used by medieval physicians to “please” patients for whom no cure was available. Arguably, acceptable uses for...
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 year. Toddlers form the most vulnerable group. Swallowed objects may be true foreign bodies such as coins, plastic toys, bones, pins and disc batteries.1,2 The...
Others
Paradoxical Orthodeoxia in a Patient with a Large Thoracic Aortic Aneurysm
We report an unusual case of “paradoxical orthodeoxia” in a man with a large asymptomatic thoracic aneurysm of the ascending aorta, arch and proximal descending aorta. He was found to have arterial deoxygenation when supine, that improved in the erect position.
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Others
Case Reports of Transient Loss of Vision and Systemic Lupus Erythematosus
In 1999, the American College of Rheumatology (ACR) research committee defined 19 specific neuropsychiatric systemic lupus erythematosus (SLE) syndromes to achieve a consensus in defining this broad disease spectrum which accounts for 4% to 16% of SLE mortality and may affect as many as 90% of SLE patients.1 They...
Others
Angioedema and Systemic Lupus Erythematosus – A Complementary Association?
Systemic lupus erythematosus (SLE) is an autoimmune multi-system disease of unknown aetiology with protean clinical and laboratory manifestations and a variable course and prognosis. We report angioedema as the initial presentation that led to a diagnosis of SLE in a middle-aged female.
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Letter to the Editor
Symphysis Pubis Diastasis After Normal Vaginal Birth: A Case Report
The reported incidence of symphysis pubis diastasis following vaginal delivery is very low. The injury is more commonly caused by severe trauma from road traffic accidents and falls from heights. The reported incidence of peripartum pubic separation varies from 1 in 300 to 1 in 30,000 deliveries,1,2 although it...
Others
Successful Rehabilitation With Cochlear Implant in Post-irradiation Induced Hearing Loss in Nasopharyngeal Carcinoma Patient
Nasopharyngeal carcinoma (NPC) is a common disease in Asia.1 Radiotherapy is the mainstay of treatment. Following radiotherapy, complications like profound sensorineural hearing loss may occur. If functionally active auditory fibres survive and there are no signs of recurrent tumour, we believe that successful rehabilitation is possible with a cochlear...
Others
Emphysematous Gastritis: A Case Report and a Review of Literature
A 45-year-old Chinese lady, who is a known hepatitis B carrier, presented with increasing alpha fetoprotein levels and a palpable liver 6 cm below the costal margin. Computed tomography (CT) scan of the abdomen showed a large heterogeneous mass in the right lobe of the liver, and she underwent...
Others
Efficacy of Limited-Duration Spinal Cord Stimulation for Subacute Postherpetic Neuralgia
Peripheral and central sensitisation of the nervous system through prolonged pain is commonly believed to be a mechanism responsible for facilitating the development of chronic pain. This suggests the importance of suppressing the sensitisation at the earliest possible stages of the pain process.1 From this perspective, spinal cord stimulation...
Others
Metastatic Bladder Cancer Presenting as Duodenal Obstruction
Bladder cancer is the most common malignancy of the urinary tract. Peak incidence is in the 6th and 7th decades although recent trends have shown an increase among younger patients.1 The majority of patients present with lower urinary tract symptoms, the most frequent of which is painless haematuria. Presentation...
Others
Successful Preimplantation Genetic Diagnosis of Hb Bart’s Hydrops Fetalis in Singapore after Fresh and Frozen Embryo Replacement Cycles
Alpha-thalassaemia is one of the most common genetic disorders worldwide. It results from absent or reduced production of a-globin chains caused by mutations in the a-globin gene cluster. The a-thalassaemia mutations usually involve deletions of one (-a) or both (--) a-globin genes, and are prevalent within Southeast Asia. In...
Others
Food-dependent Exercise-induced Anaphylaxis – A Review of 5 Cases
Anaphylaxis is a severe, potentially fatal, systemic reaction that occurs suddenly after contact with an allergy-causing substance, typically involving 2 or more systems: skin/mucosal, gastrointestinal, cardiovascular or respiratory systems.1-4 It is an increasingly important emergency, notably in Western countries, especially among children.5,6 The age-sex standardised incidence of anaphylaxis was...
Others
Imaging Findings of Chronic Subluxation of the Os Odontoideum and Cervical Myelopathy in a Child with Beare-Stevenson Cutis Gyrata Syndrome after Surgery to the Head and Neck
Fractures of the odontoid typically involve the synchondrosis between the odontoid process and body of the axis in the paediatric age group. However, to our knowledge, a chronic subluxation of the os odontoideum resulting in cervical myelopathy has yet to be described in a child with the Beare-Stevenson cutis...
Others
Residual Neurovascular Function and Retinotopy in a Case of Hemianopia
Homonymous hemianopia is one of the most common forms of acquired visual field defects.1 It is typically produced by head injury, tumours or stroke that damage the occipital cortex, postgeniculate pathways or both.1 This leads to the impairment in basic functions, such as reading, visual search and navigation. Thus,...
Others
Primary Lymphoedema at an Unusual Location Triggered by Nephrotic Syndrome
Lymphatic system returns proteins, lipids and accompanying water from the interstitium to the venous circulation near the subclavian vein-internal jugular vein junction, bilaterally. Lymphoedema results from impaired lymphatic transport leading to the pathologic accumulation of protein-rich lymphatic fluid in the interstitium, most commonly in the extremities.1 Lymphoedema may be...
Others
Hepatocellular Carcinoma Peritoneal Metastases: Report of Three Cases and Collective Review of the Literature
Peritoneal dissemination of hepatocellular carcinoma (HCC) is a rare presentation, with an incidence of 2% to 6% detected during autopsy or laparoscopy. Although uncommon, the morbid and fatal complications associated with peritoneal metastases, especially in patients with liver cirrhosis and coagulation deficiencies, deserve renewed attention given recent advances in...
Others
Live or Let Die: Ethical Issues in a Psychiatric Patient with End-stage Renal Failure
Ms T was a single, 41-year-old Chinese female who had been diagnosed with schizoaffective disorder at the age of 21. Her illness was characterised by frequent relapses and admissions to hospital; the longest admission was for more than a year when she was 27 years old.
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Original Article
Evaluation of Intensive Care Unit-acquired Urinary Tract Infections in Singapore
Urinary tract infection (UTI) is one of the most common types of nosocomial infections encountered in the inpatient settings including intensive care unit (ICU). Amongst patients admitted to ICU, studies have revealed the incidence of nosocomial UTIs to range from 9% to 29%.
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Others
Inflammatory Tinea Capitis: Non-healing Plaque on the Occiput of a 4-year-old Child
Tinea capitis is a fungal infection of the hairs of the scalp. Although commonly described in children, it is uncommonly seen in Singapore.
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Editorial
Medical Professionalism in the Internet Age
Medical professionalism encompasses the conduct and practices of physicians, both as individuals and as a collective organisation. Professionalism enhances the trust and confidence of patients and society in doctors.
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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, II, and aVF on admission to hospital. Subsequently, he developed sustained complete atrioventricular block with no ventricular escape which necessitated temporary pacing.
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Others
Cardiac Rupture due to Fall: A Case Study
Studies have shown that cardiac ruptures due to blunt trauma are seen more often than expected. Isolated left ventricular injuries tend to be less common in blunt traumatic injuries, However, epicardial injuries and atrial ruptures are common findings in deaths due to falls. Literature reveals that cardiac injury should...
Letter to the Editor
Developing the “NUS Tummy Dummy”, A Low-Cost Simulator to Teach Medical Students to Perform the Abdominal Examination
Simulators may be used to provide adequate exposure to learning experiences that allow clinical skills to develop, that is, allow medical students and trainees to perform the steps of clinical examinations and to acquire diagnostic skills. To date, simulators have been developed for trainees to perform cardiac and respiratory...
Others
Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report
The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to the development of several intravitreal anti-angiogenic therapeutics. Ranibizumab (Lucentis, Genentech, San Francisco, USA) and pegaptanib (Macugen, OSI/Eyetech Pharmaceuticals, New York, USA) have been FDA-approved for...
Others
A Unique Pair of Monozygotic Twins with Concordant Clear Cell Renal Cell Carcinoma: A Case Report
Studies of monozygotic and dizygotic twins represent an important approach in estimating the relative contributions of genes and environment to the development of various cancers and disease in general. However, remarkably and almost curiously, there has been no monozygotic twin-pair concordant for clear cell renal cell carcinoma (ccRCC) reported...
Others
Radiological Outcome of Short Segment Posterior Stabilisation and Fusion in Thoracolumbar Spine Acute Fracture
The management of unstable thoracolumbar spine fractures remains controversial in spite of an improved knowledge of the morphometric, anatomic and biomechanical features of thoracolumbar vertebrae. The transpedicular short-segment construct represents an attempt to rebuild the anterior column without the need for anterior strut graft or plate fixation, hence, avoiding...
Others
Surgical Remodelling of Haemodialysis Fistula Aneurysms
The Kidney Disease Outcomes Quality Initiative (DOQI) guideline 3 recommends autogenous radiocephalic and brachiocephalic arteriovenous fistula (AVF) as the first and second choices of treatment for primary permanent vascular access in patients with kidney failure. A native arteriovenous fistula is now widely accepted as the vascular access of choice...
Review Article
Managing a Case of Extensively Drug-Resistant (XDR) Pulmonary Tuberculosis in Singapore
Extensively drug-resistant tuberculosis (XDR-TB) is defined as TB which is resistant not only to the 2 best first-line anti-TB medications, rifampicin and isoniazid (known as multidrug-resistant or MDR-TB), but also to at least 1 of 3 injectable second-line agents (amikacin, kanamycin or capreomycin) and to any fluoroquinolone. XDR-TB is...
Commentary
Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?
Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values.
—Louis D Brandeis
As a small island state with finite resources, Singapore’s healthcare philosophy is governed by pragmatism, rationing and cost-effectiveness (see Appendix 1 for definition) with an unrelenting emphasis...
Review Article
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 constant distractions from the other
things he needed to attend to quickly. The patient, Madam Sumar was referred by her family doctor for chest pain with...
Original Article
Academic Medicine Education Institute (AM∙EI): Transforming the Educational Culture of Health Professionals
In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their individual strengths to become an integrated academic healthcare cluster. This new academic healthcare cluster has a mission to provide outstanding clinical service, discover and promote...
Letter to the Editor
Diagnosing Bacteraemia Early in Older Adults
Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop severe sepsis each year. Of this, more than 60% are patients older than 65 years. Morbidity and mortality remain high in spite of advances in...
Original Article
Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study
Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the readmissions considered preventable,3 early identification of the underlying risk factors can offer better management and discharge planning.4 Some risk factors of readmissions related to patient...
Editorial
Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions
Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue to increase given Singapore’s ageing population and growing chronic disease and multimorbidity burden, impacting care quality and patient/provider experience.2,4 While majority of admissions are clinically...