Original Article
Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore
Within 3 weeks of the World Health Organization declaring the COVID-19 pandemic on 11 March 2020, the Society of Critical Care Medicine (SCCM) and...
Editorial
Challenges and considerations in delivering nutritional therapy in the ICU during COVID-19 pandemic
Coronavirus disease 2019 (COVID-19) has created unprecedented challenges for healthcare workers in Singapore and across the world. Providing clinical nutrition and metabolic care to...
Letter to the Editor
Evaluation of a health screening protocol for recovered COVID-19 patients before “return-to-play” and strenuous physical activity
Dear Editor,
We conducted a prospective, single-centre cohort study to develop guidance for military personnel returning to strenuous activities following SARS-CoV-2 infection. The patients underwent...
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...
Original Article
A Review of Patients with High-risk Carcinoma of the Cervix Treated with Combined Surgery and Postoperative Radiotherapy
It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness...
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 (%...
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...
Review Article
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...
Review Article
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...
Review Article
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....
Review Article
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...
Original Article
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...
Original Article
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)...
Editorial
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...
Original Article
Soft Tissue Cover in Compound and Complicated Tibial Fractures Using Microvascular Flaps
Compound tibial fractures are high-energy traumatic injuries, which are frequently associated with high incidence of complications like infection and failure of bony union leading...
Original Article
Excimer Laser Phototherapeutic Keratectomy for Recurrent Corneal Erosions
Recurrent cornea1 erosion (RCE) syndrome is a commonly encountered clinical condition which may be difficult to treat. Hansen first described it in 1872.
This article...
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...
Original Article
A Prospective Study of Infections with Atypical Pneumonia Organisms in Acute Exacerbations of Chronic Bronchitis
Chronic obstructive pulmonary disease (COPD) is a disease state characterised by the presence of airflow limitation that is generally progressive, partially reversible and caused...
Original Article
Hospitalised Low-risk Community-acquired Pneumonia: Outcome and Potential for Cost-savings
Community-acquired pneumonia (CAP) is a common illness with nearly 4 million adults diagnosed each year in USA with more than 600,000 hospita1isations. The associated...
Original Article
Long-term Outcome and Disease Control in Near-fatal Asthma
Rising trends in mortality in asthma have been reported from many countries, including Asian countries such as Hong Kong. Asthma deaths have been associated...
Original Article
Ethnicity, Obstructive Sleep Apnoea and Ischaemic Heart Disease
Obstructive sleep apnoea (OSA) is a condition whereby there is snoring associated with complete or partial cessation of breathing during sleep, associated with nocturnal...
Original Article
Rapid Mycobacterial Tuberculosis Detection in Bronchoalveolar Lavage Samples by Polymerase Chain Reaction in Patients with Upper Lobe Infiltrates and Bronchiectasis
Pulmonary tuberculosis (PTB), the incidence of which is rising, poses a major health problem. It is caused by <i>Mycobacterium tuberculosis</i>. The isolation of <i>Mycobacterium...
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...
Others
Cardiopulmonary Exercise Testing in Patients with Chronic Obstructive Pulmonary Disease
Exercise intolerance is a hallmark of chronic obstructive pulmonary disease (COPD). Although exertional symptoms may be mild at the outset, exercise limitation is the...
Others
Ethnic Differences in Genetic Susceptibility to Atopy and Asthma in Singapore
Twin studies have indicated that both asthma and atopy are largely regulated by genetic factors. However, the genetics is complex, involving an interaction of...
Others
Human Genetic Susceptibility to Tuberculosis
The World Health Organization has declared that the recent resurgence of tuberculosis (TB) is a global emergency. Southeast Asia, which is seeing the greatest...
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.
This article is available only as...
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...
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)...
Original Article
Audit of Oxygen Therapy in Acute General Medical Wards Following an Educational Programme
The rational basis for supplemental oxygen (O<sub>2</sub>) treatment is well established. Long-term O<sub>2</sub> therapy improves survival and quality of life in patients with chronic...
Original Article
The Predictive Value of Intraoperative ST-segment Monitoring as a Marker of Myocardial Injury
Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1...
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...
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...
Original Article
Endobronchial Stenting in Patients Requiring Mechanical Ventilation for Major Airway Obstruction
Few things are as dramatic as respiratory arrest from major airway obstruction. Major airway obstruction frequently leads to well-defined clinical sequelae, namely shunt-associated hypoxaemia...
Others
Clinical Update on Occupational Asthma
Occupational asthma is the most common occupational respiratory disease in the United Kingdom and also in Singapore. Recent estimates of the proportion of adult...
Original Article
Effect of Different Endotracheal Suctioning Systems on Cardiorespiratory Parameters of Ventilated Patients
Endotracheal suctioning is a routine procedure performed in the intensive care unit (ICU) to remove secretions from the tracheobronchial tree. This is to maintain...
Original Article
The Role of Early Tracheostomy in Critically Ill Neurosurgical Patients
In medical history, tracheostomy is one of the oldest operations performed. There are indications that the Egyptians first employed this procedure more than 3500...
Original Article
Effects of a Pulmonary Rehabilitation Programme on Physiologic and Psychosocial Outcomes in Patients with Chronic Respiratory Disorders
Pulmonary rehabilitation is a multi-disciplinary programme of care for patients with chronic respiratory impairment that is individually designed to optimise physical and social performance...
Review Article
Recent Advances in the Obstructive Sleep Apnoea/Hypopnoea Syndrome
The past decade has seen a rapid increase in the number of patients being referred for investigation for the obstructive sleep apnoea/hypopnoea syndrome (OSAHS)....
Others
A Review of Cutaneous Granulomas and Lupus Vulgaris Following BCG Vaccination in a Skin Hospital in Singapore
BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in...
Original Article
A Twelve-year Review of Radical Cystectomies in Singapore General Hospital
Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of...
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...
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...
Original Article
Problems Related to Epidural Analgesia for Postoperative Pain Control
Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with...
Original Article
Audit of Total Parenteral Nutrition in an Adult Surgical Intensive Care
Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to...
Others
Asthma Disease Management: A Provider’s Perspective
The burden of asthma appears to be increasing worldwide, especially in societies undergoing rapid urbanisation, and both morbidity and mortality from asthma have increased...
Original Article
Emergency Department Asthma: Compliance with an Evidence-based Management Algorithm
Attendance at the emergency medicine department (EMD) for acute exacerbation is an important milestone in the natural history of patients with asthma. It is...
Original Article
Four-month Chemotherapy in the Treatment of Smear-negative Pulmonary Tuberculosis: Results at 30 to 60 Months
Patients with active pulmonary tuberculosis (PTB) are usually treated with a 6-month regimen in which chemotherapy is administered daily, intermittently or as a combined...
Original Article
Bacteriologically-negative Pulmonary Tuberculosis—The Singapore Tuberculosis Control Unit Experience
The management of a patient as for pulmonary tuberculosis (PTB) in the setting of negative bacteriology would have to take into account not only...
Original Article
Asthma in Light of Patient Documents. A Factor Analytic Study
The lack of uniform criteria for asthma handicaps the diagnosis, the systematic documentation of cases and the consistent reporting of studies addressing asthma. It...
Original Article
Malignant Mesothelioma: Experience at the Singapore General Hospital
Malignant mesothelioma is a rare tumour and is typically associated with asbestos exposure. In endemic areas, it has an estimated incidence as high as...
Original Article
Transurethral Resection of Prostate (TURP) Through The Decades – A Comparison of Results Over the Last Thirty Years in a Single Institution in Asia
Over the last 70 years, transurethral resection of prostate (TURP) has been used in the surgical treatment of benign prostatic hyperplasia (BPH) and is...
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...
Original Article
Audit of Diagnostic and Interventional Craniocervical Catheter Angiographic Procedures at the Singapore General Hospital
Catheter angiography has long been considered the diagnostic standard by which the accuracy of other vascular imaging modalities are compared, given its superior contrast...
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...
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...
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...
Original Article
Spectrum of Dentofacial Deformities: A Retrospective Survey
Deformity refers to distortion of any part of the body. The term dentofacial is related to the dental arches and their effects on facial...
Commentary
The Haze and Health: A Blog About the Fog
The haze is an atmospheric phenomenon where pollutant particles accumulate in the air and obscure the normal clarity of the sky. In Singapore, this...
Others
Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids
Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE...
Commentary
SARS: How to Manage Future Outbreaks?
Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV), which crossed from wild animals at live markets to man in mid-November...
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...
Original Article
Carbon Monoxide Poisoning: A Five-year Review at Tan Tock Seng Hospital, Singapore
Carbon monoxide (CO) is an odourless, tasteless and toxic gas and is the most abundant pollutant in the lower atmosphere. It is produced largely...
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...
Original Article
The Clinical Predictors of Hypertension and Sleepiness in an Asian Population with Sleep-disordered Breathing
Sleep physicians have only recently began to learn much about the epidemiology of sleep-disordered breathing (SDB) from large, well conducted prospective community-based studies. These...
Letter to the Editor
Sarcoidosis with Granulomatous Hepatitis and Autoimmune Endocrine Involvement
Sarcoidosis is a systemic granulomatous disease of unknown aetiology. It emerges in the form of hiler adenopathy and interstitial pulmonary disease in most cases.
This...
Original Article
A Review of Clinical Pathway Data of 1663 Total Knee Arthroplasties in a Tertiary Institution in Singapore
Total knee arthroplasty (TKA) has been established as an effective treatment modality for patients with symptomatic knee arthritis. It provides predictable decrement in pain,...
Review Article
Cardiovascular Changes in Children with Snoring and Obstructive Sleep Apnoea
Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the...
Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a...
Review Article
Sleep Disorders in Children: The Singapore Perspective
Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in...
Review Article
Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children
Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share...
Review Article
The Scope of Paediatric Sleep Medicine
Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of...
Original Article
Obstructive Sleep Apnoea in Singapore: Polysomnography Data From a Tertiary Sleep Disorders Unit
Overnight attended polysomnography (PSG) in the sleep laboratory has been the gold standard to confirm the presence and severity of obstructive sleep apnoea (OSA)....
Original Article
The Relationship between Postoperative Complications and Outcomes after Hip Fracture Surgery
Hip fractures constitute a major health concern for older persons and are associated with significant morbidity and mortality, with 1-year mortality rates ranging from...
Letter to the Editor
Advanced Burkitt’s Lymphoma Presenting With Jejunal Perforation
Burkitt’s lymphoma (BL) is a high grade B-cell neoplasm under the umbrella of non-Hodgkin’s lymphomas. It is predominantly seen in children but may also...
Original Article
Impact of the Singapore National Asthma Program (SNAP) on Preventor-Reliever Prescription Ratio in Polyclinics
According to the World Health Organization/Global Initiative on Asthma (WHO/GINA) report on the global burden of asthma, Singapore is an intermediate-risk country for asthma...
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...
Original Article
Perforated Appendicitis in Children: Benefits of Early Laparoscopic Surgery
Despite perforated appendicitis (PA) being a common surgical emergency in childhood, controversy still exists with regard to its management in this era of minimal...
Letter to the Editor
Peritoneo-Cutaneous Fistula Secondary to Skin Excoriation from a Large Chronic Incisional Hernia
Incisional hernias are common complications following abdominal surgery with an incidence of 2% to 20% after midline laparotomy. Umbilical fluid discharge is, however, an...
Original Article
T Lymphocyte Activation Profiles in Peripheral Blood of Long-Versus Short-Term Residents of Kuwait: Comparison with Asthmatics
The Gulf Wars of 1991 and 2003 exposed the residents of Kuwait and several neighbouring countries to high levels toxicants with the capacity to...
Editorial
Lung Cancer: Recent Advances
Lung cancer is the leading cause of cancer related mortality in the world. It accounts for almost a million deaths annually and resulted in...
Original Article
Difference in Asthma Control Test™ (ACT) Scores in Three Different Clinical Practice Settings
The prevalence of asthma ranges from 1% to 18% worldwide and it remains a significant cause of morbidity and economic burden despite advances in...
Original Article
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...
Original Article
Clinical Features of Allergic Rhinitis and Skin Prick Test Analysis Based on the ARIA Classification: A Preliminary Study in Malaysia
Allergic rhinitis (AR) is a common disease worldwide and is known to cause serious implications to the physical and mental health status of the...
Letter to the Editor
Inadvertent Haemodialysis in a Pulmonary Tuberculosis Patient with Hypercalcaemia
Malaysia is a country with an intermediate burden of tuberculosis (TB) with a prevalence of 121 cases per 100,000 population per year. TB usually...
Original Article
Brachial Approach for Coronary Angiography and Intervention: Totally Obsolete, or a Feasible Alternative When Radial Access is Not Possible?
The possible methods of reaching the coronary vasculature using a percutaneous technique are limitless: the radial, femoral, brachial, ulnar, subclavian and axillary arteries, and...
Original Article
The Singapore National Healthcare Group Diabetes Registry – Descriptive Epidemiology of Type 2 Diabetes Mellitus
Diabetes mellitus is one of the most challenging global health problems in the 21st century. It is associated with excess mortality and significant morbidity...
Original Article
Functional Outcomes of Cancer Patients in an Inpatient Rehabilitation Setting
Cancer is the leading cause of death and the second most common cause of hospitalisation in Singapore. Cancer rehabilitation aims to help the patient...
Others
Sir John Wenman Crofton
Sir John Crofton, a world famous expert on the treatment of tuberculosis died in Edinburgh at the age of 97. John Crofton was born...
Images in Medicine
Rapidly Vanishing Pulmonary Pseudotumour
A 51-year-old male ex-smoker with a history of pulmonary tuberculosis was referred for exertional dyspnoea for 5 days. He had no fever, cough or...
Original Article
Clinical Outcome and Cost Comparison Between Laparoscopic and Open Appendicectomy
Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. The traditional operation of choice was the open...
Original Article
Neonatal and Paediatric Extracorporeal Membrane Oxygenation (ECMO) in a Single Asian Tertiary Centre
Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass technique (CPB) introduced by Bartlett in 1972, which provides life-saving support in patients with refractory yet...
Letter to the Editor
Plasma IP-10 could identify early lung disease in severe COVID-19 patients
Dear Editor,
The global pandemic of SARS-Coronavirus-2 (SARS-CoV-2) infection has imposed tremendous strain on healthcare resources worldwide, as a significant proportion of patients require...
Original Article
Outcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study
Despite its widespread adoption, rapid response systems (RRS) and rapid response teams (RRT) vary significantly in composition and set-up.1-3 While implementation of RRSs appear...
Letter to the Editor
An Unusual Cause of Severe Pulmonary Hypertension in a Young Woman
Dear Editor,
A 25-year-old Cambodian lady diagnosed with pulmonary hypertension in her native country came for second opinion on the further management of her condition....
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...
Original Article
Risk Factors for Severe Adenovirus Infection in Children during an Outbreak in Singapore
Human adenoviruses (HAdVs) are well known pathogens that cause a variety of human illnesses. They are non-enveloped, linear double-stranded deoxyribonucleic acid (DNA) viruses. More...
Original Article
Heterogeneity of non-cystic-fibrosis bronchiectasis in multiethnic Singapore: A prospective cohort study at a tertiary pulmonology centre
Bronchiectasis is a chronic lung disease of significant morbidity and mortality. The pathological hallmarks of the disease are abnormal dilatation of airways resulting from...
Letter to the Editor
Impact of pulmonary rehabilitation in patients with interstitial lung disease in Singapore
Interstitial lung diseases (ILD) encompass a heterogeneous group of lung parenchymal disorders. ILD-related symptoms impact significantly on quality of life (QoL). Dyspnoea is the...
Letter to the Editor
Radiological changes on chest CT following COVID-19 infection
COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution...
Editorial
The Novel Coronavirus (SARS-CoV-2) Pandemic
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and...
Original Article
Emergency airway management in a Singapore centre: A registry study
Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to...
Original Article
Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection
In this report, we describe a patient who developed acute respiratory distress syndrome (ARDS) with rapid clinical deterioration. Unfortunately, not much is known about...