Related Articles

Upper airway stimulation for obstructive sleep apnoea in Asians: A Singapore sleep centre experience

Dear Editor, Obstructive sleep apnoea (OSA) is the most prevalent sleep-related breathing disorder, affecting approximately 15% of the global population.1 In Singapore, 30.5% of the population has moderate-to-severe OSA.2 The gold standard treatment, continuous positive airway pressure (CPAP) therapy, often has poor adherence, with only 13.8% of Singaporeans diagnosed with...

Radiologic placement of totally implantable venous access devices: Outcomes and complications from a large oncology cohort

Long-term intermittent venous access has proven to be indispensable for oncology patients who require frequent intravenous (IV) infusions and repeated phlebotomies apart from facing the discomfort of frequent venepuncture.1 Totally implantable venous access devices (TIVADs) or ports are preferred to external catheters, especially in these patients, due to their...

Intrapleural fibrinolytic therapy for pleural infections: Outcomes from a cohort study

Pleural infection, defined as bacterial infection and replication in the pleural space,1 remains a significant cause of mortality.2 Over 80,000 cases of pleural infection are diagnosed each year in the US and the UK.3,4 Data from East Asia suggest that the annual incidence of pleural infections is 8.4 to...

Prevalence and causes of rifampicin-resistance genotypic/phenotypic discrepancy detected on Xpert MTB/RIF in Singapore

Dear Editor, The Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) (Cepheid, Sunnyvale, CA, US) has been pivotal in tuberculosis (TB) diagnostics, enabling the rapid detection of both TB and RIF resistance. Xpert, a nucleic acid amplification test (NAAT), is recommended by both the World Health Organization (WHO)1 and Singapore's clinical management guidelines2 as...

Corticosteroids in critically ill patients with community-acquired pneumonia: A systematic review and Bayesian meta-analysis

Community-acquired pneumonia (CAP) is a common cause of hospital mortality. Each year, in the US alone, more than 1.5 million pneumonia patients are hospitalised, and 1 in 3 of them die within 1 year.1 Mortality is the highest among patients requiring organ support in the intensive care unit (ICU)....

Journey towards a smoke-free nation

“A journey of a thousand miles begins with a single step.” Singapore’s journey towards a smoke-free society started early in the 1970s when legislations were introduced to restrict smoking in certain public spaces and ban tobacco advertising.1 The National Smoking Control Programme was launched in 1986 with important objectives...

Delayed treatment with nirmatrelvir/ritonavir could remain effective in patients with Omicron BA2.2 variant of COVID-19

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 individuals aged ≥80 years who are unvaccinated are particularly at high risk of poor outcomes. COVID-19 vaccines and antiviral therapeutics have protected individuals most at risk...

Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial

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 unsafe recovery include sudden unpredictable emergence or delayed return of airway tone and reflex with risk of airway obstruction.1 Agitation includes straining, sitting up, screaming...

Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae infections among hospitalised children in Singapore

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, including Singapore.1 M. pneumoniae is intrinsically resistant to beta-lactams due to the absence of cell walls. Macrolides, tetracyclines, and fluoroquinolones are used to treat M....

Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations

Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into an ongoing global pandemic.2 In May...

Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series

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 (ACA), IgG anti-β2-glycoprotein I antibodies (aβ2GPI) and IgA aβ2GPI, though not for the lupus anticoagulant (LAC). In a Singapore study comprising 47,527 patients, 19 (0.04%) developed...

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 American Society for Parenteral and Enteral Nutrition (ASPEN) developed a set of nutrition guidelines that addresses issues on nutrition assessment; timing and feeding route; caloric...

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 patients with COVID-19 has been highly challenging. In this issue of the Annals, Lew et al.1 reported the results of a multicentre retrospective observational study...

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 a clinical review followed by a protocol to screen for cardiac, respiratory, haematological, endocrine/renal and neurological complications after recovery from infection. Both the study and screening...

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...

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 with either radical hysterectomy or radical radiotherapy. However a proportion of patients treated with surgery may be classified as having a significant risk of relapse...

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...

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...

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 of full-time intensivists has been associated with improved survival. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 respiratory compliance, bilateral pulmonary infiltrates and reported a survival rate of 42%. This article is available only as a PDF. Please click on “Download PDF” on...

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. The mechanisms responsible for the development of multisystem organ failure in the critically ill patient are unknown. This article is available only as a PDF. Please...

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 subsequent change over time consequent to a therapeutic intervention. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 for percutaneous insertion of central venous lines. In 1973, Shaw invented a technique of cannulating peripheral veins with silastic catheters, as an alternative approach to...

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) use about 15% of the total hospital cost or about 1% of the gross national product. This article is available only as a PDF. Please click...

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 arrived at different paradigms—open versus closed models, specialty-based intensive care units (ICUs) versus general ICUs, internist versus pulmonologist or anaesthetist, and so forth. This article is...

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 to amputation. The extent of injury is proportional to the magnitude of trauma. This article is available only as a PDF. Please click on “Download PDF”...

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

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 by either intrinsic airway disease (bronchitis) or parenchymal destruction (emphysema). COPD is a leading cause of death and a major medical and economic problem. This 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 cost of hospitalisation is enormous and approaches nearly US$4 billion per year. This article is available only as a PDF. Please click on “Download PDF” on...

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 with a number of avoidable factors such as deficiencies in personal and professional management that can potentially be remedied if identified. This article is available only...

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 oxygen desaturation and sleep fragmentation. This condition can lead to the effects of sleep fragmentation such as motor vehicular accidents, accidents in the workplace, social...

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 tuberculosis</i> by culture has been the “gold standard” for the diagnosis of tuberculosis, as it gives a specificity that approaches 100% and permits susceptibility testing...

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

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 most disabling and distressing consequence of COPD for the majority of patients. This article is available only as a PDF. Please click on “Download PDF” on...

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 multiple susceptibility genes and environmental factors. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 increase in new TB patients, is at the epicentre of this pandemic. This article is available only as a PDF. Please click on “Download PDF” on...

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 a PDF. Please click on “Download PDF” on top to view the full article.

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

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. This article is available only as a PDF. Please click on “Download PDF”...

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 obstructive pulmonary disease who are severely hypoxaemic. Short-term supplemental O<sub>2</sub> is required in medical emergencies and various acute disease states such as respiratory failure, circulatory...

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 Goldman et al2 formulated the “cardiac risk index”, implicating previous myocardial infarction (MI), heart failure and unstable angina as major determinants of postoperative cardiac events. This...

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...

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. This article is available only as a...

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

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 asthmatics where the cause could be occupational range from 4% to 9%. This article is available only as a PDF. Please click on “Download PDF” on...

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 patency and reduce the risk of pulmonary atelectasis in mechanically ventilated patients. This article is available only as a PDF. Please click on “Download PDF” on...

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 years ago when Asclepiades of Bithynia described it in the second century BC. This article is available only as a PDF. Please click on “Download PDF”...

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 and autonomy. In recent years, the efficacy and scientific foundation of pulmonary rehabilitation have been firmly established. This article is available only as a PDF. Please...

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). Indeed, in many centres, possible OSAHS is now the most common respiratory referral and OSAHS is the most common outpatient respiratory diagnosis. This article is available...

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 Lille, France. In Singapore, all newborn babies are given the vaccination at birth, and until recently, a second vaccination was given to children at the...

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 6.9 per 100,000 per year for men and 1.7 per 100,000 per year for women in Singapore. This article is available only as a PDF. Please...

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

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. This article is available only as a PDF. Please click on...

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 epidural analgesia; and effective postoperative pain relief is a prerequisite to attain improved postoperative outcome. This article is available only as a PDF. Please click on...

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

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 in many parts of the world, making it a global health concern. In Singapore, asthma is a highly prevalent problem, with an increasing societal and...

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 an indication of clinically severe disease, inadequate preventive treatment and failure of self-medication for acute symptoms. This article is available only as a PDF. Please click...

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 (daily and intermittent) regimen. However, patients with smear-negative PTB who have small lesions in the lung may not require the full duration of chemotherapy. This 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 the likelihood that the patient has active PTB, but also the consequences of a mistaken diagnosis and the adverse effects of TB treatment. Patients with...

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 restricts also the use of patient documents of asthmatics especially in detailed causal analysis, although they could give important information for research and administration. This 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 66 per million for men aged 35 and above. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 still considered the gold standard. With improvements in operative techniques, video endoscopy, anaesthetic care and intraoperative monitoring of fluid and electrolytes, rates of intraoperative and...

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

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 and spatial resolution, as well its high selectivity and ability to show the full extent of vascular disease, presence of contralateral disease, patterns of collateral...

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. This article is available only as a PDF. Please click on “Download...

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

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...

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 contours. Dentofacial deformity has been described as a deformity that affects primarily the jaws and dentition, although the mid and lower faces are also affected. This...

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 usually happens when the prevailing southwest monsoon winds blow the smoke from regional forest fires to Singapore. This article is available only as a PDF. Please...

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 atrophy that may represent sequelae of previous episodes. CSCR can arise secondary to chronic treatment with steroids. This article is available only as a PDF. Please...

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 2002 in Guangdong, southern China. SARS was the first pandemic of the 21st century. This article is available only as a PDF. Please click on “Download...

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...

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 in industrial processes, internal combustion engines, malfunctioning home appliances and as a result of the incomplete combustion of wood and tobacco products This article is available...

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

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 studies have helped identify the risk factors for identifying sleep apnoea, particularly in the Western population. This article is available only as a PDF. Please click...

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 article is available only as a PDF. Please click on “Download PDF” on top to view the full 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, correction of deformity and improved functional outcomes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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 prevalence of childhood OSA diagnosed by varying criteria was 1% to 4%. This article is available only as a PDF. Please click on “Download PDF” on...

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 problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty. This article is available only as...

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 1% to 3% of children. This article is available only as a PDF. Please click on “Download PDF” on top to view the full 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 a bedroom, since the child is often unaware of what happens when he or she is asleep. This article is available only as a PDF. Please...

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 sleep develops and matures, resulting in changing patterns of normal behaviours and of sleep disorders. This article is available only as a PDF. Please click on...

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). Standard PSG scoring rules using the criteria of Rechtschaffen and Kales have recently been revised and updated by the American Academy of Sleep Medicine. This 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 14% to 36% in spite of advancements in anaesthesia, surgical techniques and nursing care.1,2 In addition, epidemiological studies have shown that the incidence of hip...

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 present in adults. This article is available only as a PDF. Please click on “Download PDF” on top to view the full 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 prevalence, which is about 5% of the population. But has one of the highest rates of asthma deaths in the world. This article is available only...

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. This article is available only as a PDF....

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 access surgery. Open appendicectomy (OA) has been accepted as the standard procedure for PA. However, OA has been associated with prolonged hospitalisation and significant complications...

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 unusual presenting complaint and may arise from structural abnormalities persisting from birth such as a patent urachus or secondary to instrumentation. This article is available only...

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 cause long-term deleterious alterations in the immune reactivity. The impact of these influences on the epidemiology and pathogenesis of chronic illness in affected populations is...

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 more deaths than prostate, breast and colon cancers combined. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 its knowledge, detection and treatment. Asthma is very common in Singapore and it consumes a considerable amount of healthcare service resources. This article is available only...

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 more severe infections, a different spectrum of bacteriology and a worse outcome. In our experience, of all patients with upper limb infections, those with end-stage...

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 individual sufferer. It also impacts significantly on healthcare expenditure. For instance, the direct costs of allergic rhinitis in the United States (US) alone were approximately...

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 presents with fever, chronic cough, weight loss and lack of appetite, dypsnoea and night sweats. This article is available only as a PDF. Please click on...

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 even direct puncture of the aorta from a translumbar approach, have been utilised in the past. This article is available only as a PDF. Please click...

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 from complications, which lead to disability, poor quality of life and an enormous health cost. This article is available only as a PDF. Please click on...

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 achieve maximum physical, social, psychological and vocational function within limits imposed by cancer and its therapy through a multi-disciplinary approach. This article is available only as...

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 in Dublin in 1912, the son of a doctor. His earliest recollection was of hearing the bullets hitting the ceiling of his nursery in the...

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 constitutional symptoms. Physical examination revealed stony dullness to percussion over the right lower thorax posteriorly. This article is available only as a PDF. Please click on...

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 appendicectomy (OA) pioneered by McBurney in 1894. In 1981, the laparoscopic technique was introduced by Kurt Semm and since then, laparoscopic appendicectomy (LA) is increasingly...

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 reversible cardiorespiratory failure until organ recovery or organ transplantation. Since the first report of successful ECMO support in an adult was published by Hill in...

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 intensive care. Although the majority have mild infections, up to 20% are estimated to become critically ill from severe disease.1 Age, concurrent comorbidities, more severe...

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 to be associated with reduced cardiac arrest rate and improved mortality,4,5 their optimal composition, activation criteria and how they should be evaluated, remain controversial.6-9 It...

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. She had become increasingly breathless in the last 2 years, with further deterioration from New York Heart Association (NYHA) II to III in the last...

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...

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 than 50 distinct serotypes have been identified since the early 1950s. The wide spectrum of symptoms includes upper respiratory tract illness, pneumonia, conjunctivitis, cystitis and...

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 recurrent inflammation, airway obstruction and mucous plugging. The past 2 decades have seen a significant increase in its prevalence, exceeding the threshold of 5 per...

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 most important factor determining health-related QoL in ILD; contributing factors include reduced exercise capacity, loss of mental well-being and social isolation. This article has been updated...

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 computed tomography (HRCT) features of the lungs during the onset of COVID-19; however, few studies have described the radiological changes and outcome of residual lesions...

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 was reported to the World Health Organization (WHO) on 31 December 2019. An outbreak of unknown aetiology was suspected because many early cases were linked...

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, and the public is increasingly conscious of its burden to society. A population survey conducted in Singapore in 2010 showed that 53 out of 1067...

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 most intubations performed in the operating room (OR). Additionally, difficult airways are more prevalent in emergency department (ED) populations due to acute conditions such as...

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 the clinical features and risk factors for ARDS and critical illness even as the number of COVID-19 cases continues to climb at an alarming rate...

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