Dear Editor,In late February 2022, the Omicron BA.2.2 subvariant drove the outbreak of COVID-19 and rapidly spread through many parts of the world. Omicron-infected...

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

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

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

Dear Editor,Acute lower respiratory infections (ALRIs) are a leading cause of under-5 mortality globally—two-thirds could be attributable to respiratory viral infections (RVIs).1,2 The burden...

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

Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care,...

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

Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy....

The Changi General Hospital is a new regional hospital in the eastern part of Singapore catering to a population of about 750 000. Planning...

Critical care medicine as a specialty has grown rapidly, both clinically and academically, over the past 25 years. In the USA, certification of competence...

Hyperkalaemia is a common biochemical derangement in the intensive care unit reflecting a diversity of systemic perturbations such as acute renal failure, rhabdomyolysis, extracellular...

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...

The origins of withholding medical support are found in ancient times. More than two millennia ago, Hippocrates (460 to 361 BC) stated that the...

The last decade has seen a progressive change in the style of management of severe acute renal failure (acute renal failure which requires the...

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

In 1980, Furchgott and Zawadzki demonstrated that the relaxation of isolated arteries to acetylcholine required the presence of endothelial cells. This response was mediated...

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

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

The first major general severity adjustment system, the Acute Physiology and Chronic Health Evaluation (APACHE) system, was published in 1981. Since then, APACHE, the...

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

The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and...

Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s....

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...

Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill...

Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously...

Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique...

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

The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed...

Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present.This article...

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

Trauma is the fifth commonest cause of death in Singapore. In 1996, trauma contributed to 5.4% of mortality.This article is available only as a...

Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993.This article is available only...

Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute...

The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) scoring systems are widely used...

The Singapore General Hospital is a 1700-bedded tertiary hospital with subspecialty intensive care units (ICUs), i.e. Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU, Medical ICU,...

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

Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric...

In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists...

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

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

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

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

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

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...

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

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

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

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

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

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)...

The rational basis for supplemental oxygen (O₂) treatment is well established. Long-term O₂ therapy improves survival and quality of life in patients with chronic...

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

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...

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

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

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

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

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

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

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

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

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

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

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

Rapid urbanisation and increasing affluence have improved the socioeconomic status of Asians. This, however, has brought with it new socioeconomic and medical problems resulting...

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

Stroke is the fourth principal cause of death in Singapore, and the leading cause of long-term disability amongst developed countries. Due to the spiralling...

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

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

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

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

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

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

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

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

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

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 clinical syndrome of heart failure is recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses. Heart failure is the end-stage...

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

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

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

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

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

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

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

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

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

Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the...

Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a...

Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in...

Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share...

Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of...

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

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

Management of hip fractures is costly and continues to generate significant costs throughout the one-year period after discharge.1 They demand considerable resources from a...

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

The number of older adults in Singapore has been steadily increasing over the years and will continue to do so. In 2007, older adults...

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

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

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

Persisting disabilities from stroke lead to partial or total dependence for up to two-thirds of survivors. To improve mobility and to enable the recommencement...

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

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

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

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

Intermediate care, a range of services facilitating step-down care from the hospital to home, has become an integral part of the healthcare system. Community...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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