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Development of immediate and chronic spontaneous urticaria following mRNA COVID-19 vaccination: Tolerability of revaccination and immunological study

Dear Editor, Coronavirus 2019 (COVID-19) vaccination remains one of the key public health measures against the SARS-CoV-2 infection, significantly reducing illness severity and mortality...

Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally...

Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome

A spectrum of immune dysregulation has been described following SARS-CoV-2 infections—from the cytokine storm in the acute phase, to hyperinflammatory syndromes that occur after...

Sepsis, cardiovascular events and short-term mortality risk in critically ill patients

Sepsis is defined as “life-threatening organ dysfunction caused by a dysregulated host immune response to infection”.1 It is one of the most common conditions...

Sepsis and cardiovascular events: The story so far

Sepsis is a state of life-threatening organ dysfunction that results from a dysregulated host immune response to infection.1 Sepsis is a common condition that...

Circular RNAs in the pathogenesis of sepsis and their clinical implications: A narrative review

Sepsis is a condition with life-threatening organ dysfunction, resulting from abnormal responses of the host to various infections.1 The underlying pathogenic mechanisms include an...

Circular RNAs and sepsis: New frontiers in diagnostics and therapeutics?

Circular RNAs (circRNAs) are a group of endogenous RNAs characterised by their covalently closed-loop structures. These molecules are part of a large class of...

Planning and Design of a Surgical Intensive Care Unit in a New Regional Hospital

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

Management Training in Critical Care Medicine

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

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...

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...

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...

Contributions of Respiratory Care Practitioners to Intensive Care: A Review

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

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...

Ventilatory Strategies for Acute Respiratory Distress Syndrome

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

The Oxygen Delivery Debate—A Review

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

Severity Scoring Systems in the Modern Intensive Care Unit

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

Controlled Observations in Critical Care Medicine: The Therapeutic Trial

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

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...

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....

Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery

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...

A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)

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...

Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia

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

Use of Central Venous Lines in Paediatrics—A Local Experience

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 Requiring Intensive Care

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

Patients Admitted to an Intensive Care Unit for Poisoning

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

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. This article...

Diabetes Insipidus in Neurosurgical Patients

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

Outcome of Patients with Traumatic Brain Injury Managed on a Standardised Head Injury Protocol

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...

Predictors of Long-term Outcome in Severe Head Injury

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...

Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team

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

APACHE II and SAPS II are Poorly Calibrated in a Hong Kong Intensive Care Unit

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

Audit of 2431 Admissions to the Surgical Intensive Care Unit, Singapore General Hospital

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,...

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

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

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

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

The Role for Preoperative Localisation Techniques in Surgery for Hyperparathyroidism

Hyperparathyroidism is well recognised as a clinical problem that has a myriad of presentation. The classical presenting symptoms of hypercalcaemia have been well documented...

Lipid Disorders and Rheumatic Diseases

The relationship between lipid disorders and arthritis is manifold. Hyperlipidaemia may manifest clinically in the musculoskeletal system. In 1968, Khachadurian studied 14 families of...

Outcome of Tunnelled Central Venous Haemodialysis Catheters Inserted by Radiologists

In end-stage renal failure patients, maintaining adequate vascular access continues to be an ongoing challenge. Native arteriovenous fistulas or synthetic arteriovenous grafts are satisfactory...

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...

Renal Cell Carcinoma in Patients with Chronic Renal Failure

Dunnil and associates first described the association of renal cell carcinoma (RCC) with acquired cystic kidney disease (ACKD) and end stage renal disease. The...

Inferior Vena Cava Thrombectomy for Renal Cell Carcinoma with Thrombus

A characteristic feature of renal cell carcinoma is the development of tumour thrombus extending into the inferior vena cava (IVC). This takes place in...

Current Therapeutic Strategies in Glomerulonephritis

Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients...

Preliminary Results of Heart-beating and Non-heart-beating Donor Kidney Transplants—The Singapore Experience

End stage renal failure (ESRF) is the most common end stage organ disease treated with transplantation in Singapore. Though renal transplantation is the preferred...

Immunological Consequences of Trauma and Shock

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

The Role of Cytokines and Cytokine Gene Polymorphism in T-cell Activation and Allograft Rejection

Cytokines are peptide molecules that are responsible for intercellular signalling during immune activation events. Cytokines are responsible, in large part, for the regulation of...

Proteinuria and Angiotensin Converting Enzyme (ACE) Gene Polymorphism

Proteinuria is considered a marker of renal disease. Traditionally it has been thought that proteinuria is the result of diseased glomeruli. This article is available...

Genetics of Immunoglobulin A Nephropathy

Immunoglobulin (Ig) A nephropathy is the most common primary glomerulonephritis in various parts of the world, and it was detected in 25% of biopsy...

Minimal Change Nephrotic Syndrome—A Complex Genetic Disorder

Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia,...

Plasma Procalcitonin in Sepsis and Organ Failure

Although severe infection and sepsis are associated with high morbidity and mortality in the intensive care unit (ICU), the classification of severity or definition...

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...

Retinol Palmitate Counteracts Oxidative Injury During Experimental Septic Shock

Gram-negative bacteria induced septic shock, a condition with high mortality, is frequently seen in critical care medicine. The wall of gram-negative bacteria consists of...

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...

Pregnancy after Renal Transplantation: Experience in Singapore General Hospital

Successful renal transplantation significantly improves the sexual and reproductive functions of women with end-stage renal disease and offers the best hope for those who...

Thyroid Dysfunction in Elderly Patients

Symptoms and signs of thyroid dysfunction in the elderly tend to be atypical and may be mistakenly attributed to the ageing process. Currently, thyroid...

Seasonal Variations of Clinical and Biochemical Parameters in Chronic Haemodialysis

Seasonal variations in the general population in some body functions and diseases incidences have been well-established (e.g., vitamin D levels, allergic rhinitis, blood pressure,...

Molecular Adsorbent Recirculating System (MARS)

Liver failure is clinically heterogeneous in aetiology, pathophysiology, clinical severity and prognoses. It can be divided into the following categories: acute liver failure (ALF),...

Interleukin-2 Levels in Chronic Schizophrenia Patients

Autoimmune processes have been implicated in the pathogenesis of schizophrenia. Several pieces of indirect evidence point towards a role of autoimmune processes in at...

Hand-assisted Laparoscopic Living Donor Nephrectomy

Minimally invasive donor nephrectomy using laparoscopic techniques has become a very attractive method of procuring kidneys from live donors, compared to the traditional standard...

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...

3rd College of Physicians’ Lecture – Translational Research: From Bench to Bedside and From Bedside to Bench; Incorporating a Clinical Research Journey in IgA Nephritis (1976 to 2006)

In our quest to pursue knowledge regarding a patient’s illness or seek a cure for the disease, as doctors we have to derive the...

Commercial Renal Transplantation – Body Parts for Sale

A 45-year-old Singaporean was seen for review by a nephrologist at a restructured hospital. She had been on follow up by a private nephrologist...

Early Predictors of Mortality in Pneumococcal Bacteraemia

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

Angiotensin-Converting Enzyme Inhibitor versus Angiotensin 2 Receptor Antagonist Therapy and the Influence of Angiotensin-Converting Enzyme Gene Polymorphism in IgA Nephritis

Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ATRA) are both well established drugs utilised to help retard the progression of chronic...

Plasma Endotoxin and Immune Responses During a 21-km Road Race Under a Warm and Humid Environment

During intense exercise, immune disturbances can occur through an increase in plasma pro- and anti-inflammatory cytokines and lipopolysaccharide (LPS) concentrations, and post-exercise leukocytosis and...

In vivo Pro- and Anti-inflammatory Cytokines in Normal and Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by severe joint deformities due to bony erosions and tendon damage. The chronic inflammatory process...

Interleukin-18 Promoter Gene Polymorphisms in Chinese Patients With Systemic Lupus Erythematosus: Association With CC Genotype at Position –607

Systemic lupus erythematosus (SLE) is an autoimmune disease characterised by the production of high titres of autoantibodies and associated with a diverse array of...

Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis

Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis...

ANCA-negative Pauci-immune Crescentic Glomerulonephritis with Thrombotic Microangiopathy

Pauci-immune crescentic glomerulonephritis (Pauci-immune CGN) is the most common cause of CGN. Thrombotic microangiopathy (TMA) defines a clinicopathological syndrome consisting of intraluminal platelet thrombosis...

Urotensin 2 and Retinoic Acid Receptor Alpha (RARA) Gene Expression in IgA Nephropathy

IgA nephropathy (IgAN) is the most common primary glomerulonephritis in Singapore1 and in many parts of the world, contributing significantly to the pool of...

Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure

Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have...

Novel Trends in Haemodialysis: Where Are We Heading?

Despite advances in haemodialysis technology over the past 40 years and rapid proliferation of clinical guidelines over the last decade promoting evidence-based practices, the...

Triplicate Ureter with Contralateral Duplicate Ureter

What do you see in this intravenous urogram? 1. Left lower ureteric calculus with proximal hydroureteronephrosis 2. Left duplicated ureter with lower ureteric calculus 3. Right triplicate...

Profile of Hospitalisation and Death in the First Year after Diagnosis of End-stage Renal Disease in a Multi-ethnic Asian Population

End-stage renal disease (ESRD) is reaching epidemic proportions and is increasingly a public health issue due to the cost of providing care to these...

Primary Hyperoxaluria

An 18-year-old male presented with complaints of abdominal pain. He had history of previous episodes of renal colic and passage of stones in urine....

The Golden Hours in Paediatric Septic Shock—Current Updates and Recommendations

Sepsis in children is a global health issue. The Global Health Observatory estimates that 58% of deaths in children under 5 years old are...

Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan

Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer...

Prevalence of Chronic Kidney Disease in Adults with Type 2 Diabetes Mellitus

According to the National Health Survey, the percentage of Singapore residents with diabetes mellitus (DM) aged between 18 and 69 years has risen from...

Dietary Protein Intake in a Multi-ethnic Asian Population of Healthy Participants and Chronic Kidney Disease Patients

Clinical practice guidelines recommend different amounts of dietary protein intake for chronic kidney disease (CKD) patients. The recommended daily protein intake varies according to...

Avulsed Tip of a Systemic Iceberg

An 18-year-old male presented to the emergency department of Khoo Teck Puat Hospital with knee pain and swelling while playing basketball. He was unable to bear weight....

Immunomodulator use in paediatric severe sepsis and septic shock

Paediatric sepsis is one of the main causes of childhood mortality.1 Globally, paediatric severe sepsis and septic shock accounts for 6.2% to 23.1% of...

How to Feed the Critically Ill—A Review

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

Controversies in Sepsis Management—What is the Way Forward?

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