Related Articles

Striving for our most vulnerable children: Buffering against the impact of child maltreatment

One of the fundamental pillars of our society is the presence of strong and stable families. In 2024, the inaugural edition of the Domestic Violence Trends Report1 by the Ministry of Social and Family Development, which provides an overview of key domestic violence trends in Singapore, was published. From...

The impact of Anchor, a home visitation programme for maltreated children, on child developmental and behavioural outcomes

Adverse childhood experiences (ACEs) can occur in the form of abuse (physical, emotional, sexual), neglect (physical, emotional) and household dysfunction. The first ACEs study published in 1998 demonstrated the association between ACEs and multiple risk factors of mortality in adulthood.1 The greater the number of ACEs exposure, the higher...

Adolescent self-harm and suicide attempts: An analysis of emergency department presentations in Singapore

Within 3 years from 2019 to 2021, adolescent suicide rates in Singapore almost doubled from 5.35 to 9.14 per 100,000 population.1,2 This is against a backdrop of a silently brewing adolescent behavioural and mental health crisis locally and globally, which started before the COVID-19 pandemic but has since been...

Adolescent self-harm and suicide attempts in the emergency department in Singapore

The youth mental health crisis has taken centre stage globally in recent years with increased reporting of young persons suffering from mental health problems and mental illnesses. Singapore is not spared. The COVID-19 pandemic has been largely blamed for the onset of the mental health crisis due to its...

Navigating health challenges: Singapore’s National University Health System’s approach to child and family well-being

Dear Editor, Singapore’s progressive commitment to addressing child and family well-being is anchored in its forward-thinking public health agenda. Recognising that long-term population health outcomes are shaped by early-life interventions, Singapore has directed increasing attention towards addressing complex health challenges that emerge during childhood and across the family unit. These...

Organ donation in the paediatric intensive care unit: Time for change?

Organ transplantation remains the definitive treatment option for improving the lives of patients with end-stage organ failure. To our knowledge, the first solid organ transplantation performed in Singapore in July 1970 involved a kidney from a deceased donor.1 Since then, rapid advancements in both transplant surgery and immunosuppressive medical...

Exploring the perspectives of child health strategy stakeholders on resilience and well-being in children and youths in Singapore: A qualitative study

Dear Editor, Resilience has been defined as the capacity of a dynamic system to adapt well to potential threats,1 while mitigating the negative impact of behavioural and physiological changes due to chronic stress,2 and the resumption of positive functioning thereafter.3 Resilience enables one to adapt positively to adversities in life...

Improving school teachers’ self-efficacy and knowledge on food allergy and management of anaphylaxis using a virtual multidisciplinary workshop

Dear Editor, Children with food allergies are at risk of inadvertent allergic reactions that range from mild to potentially life-threatening anaphylaxis, even with appropriate dietary avoidance.1 This risk is often increased in community settings such as schools via accidental exposure to allergens during learning activities or meal times. A quarter...

Epidemiology of paediatric intensive care unit admissions, deaths and organ donation candidacy: A single-centre audit

With advancements in medical care, mortality rates in critically ill patients have decreased substantially.1,2 Contemporary studies from developed countries report paediatric intensive care mortality rates of 2–3%3,4 in 2014 to 2019, whereas mortality in developing countries can be as high as 50%5 as of 2024, indicating large disparities in...

Optimising paediatric urinary tract infection diagnosis

Urinary tract infection (UTI) is the most common cause of serious bacterial illness among children and infants.1 Up to 2% of boys and 8% of girls will develop at least 1 episode of UTI by the age of 7 years.1,2 Of these, it is estimated that 12% to 30%...

Beyond survival: Addressing gaps in psychosocial support for survivors of childhood cancer

I read with great interest the study conducted by Fong et al. published in this issue of Annals, which evaluated psychological symptoms and health-related quality of life (HRQOL) among a cohort of 143 young adult survivors of childhood cancer in Singapore.1 Almost 1 in 4 survivors demonstrated significant psychological...

Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study

Urinary tract infection (UTI) is a common diagnosis in the paediatric emergency department (ED). It accounts for an estimated 5–14% of paediatric ED visits yearly in the US.1-3 It is a common cause of serious bacterial infections in children, and the most common microorganism is Escherichia coli (65–75%), followed...

Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore

Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...

Quality of life of family caregivers of children and young adults with Down syndrome: A systematic review and meta-analysis

The family caregiver is “any relative, partner, friend or neighbor who has a significant personal relationship with, and provides a broad range of assistance for a person with a chronic or disabling condition.”1 Family caregivers for children with chronic illnesses are commonly parents, who fulfil their children’s physical and...

Living longer and stronger: Are children and young adults with Down syndrome experiencing healthier and better lives?

Down syndrome (DS) is the most common genetic cause of intellectual disability and is associated with multiple medical conditions affecting various organ systems, impacting the individual’s health, development and function.1 In Singapore, the life-birth prevalence of DS was 0.89 per 1000 births in the 1990s, a figure expected to...

Quality of life of children and young adults with Down syndrome from caregivers’ perspective: A systematic review and meta-analysis

Down syndrome (DS), with an incidence of about 1/1000 to 1/1100 live births1 is the most common autosomal trisomy and genetic cause of intellectual disability. Individuals with DS may have multiple comorbidities including congenital cardiac and gastrointestinal anomalies, obesity, sleep disorders, and visual and hearing impairments.2,3 Despite the comorbidities,...

Delayed presentation is associated with serious bacterial infections among febrile infants: A prospective cohort study

Young infants ≤90 days old are at risk of serious bacterial infections (SBIs) due to their immature immune systems and may develop severe complications resulting in neurocognitive deficits, hearing loss and even mortality.1,2 The diagnosis of SBIs remains challenging as fever may be the only symptom of SBIs in...

Diagnostic performance of classification criteria for systemic lupus erythematosus: A validation study from Singapore

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a broad spectrum of clinical presentation.1 Clinical diagnosis by rheumatologists remains the gold standard, but the diagnosis is often challenging due to variability in disease expression mimicking other conditions. As such, classification criteria have been developed to establish homogeneous groups...

Promoting evidence-based care for children and adolescents on the autism spectrum

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has been increasing in worldwide prevalence,1 including Singapore. In this latest issue of the Annals, we share the latest Singapore Clinical Practice Guidelines (CPG) for Autism in Children and Adolescents, discussed by Wong et al.2 This is the culmination of...

Caregiver reported long-term outcomes in children with major trauma and traumatic brain injuries: A single-centre retrospective study

Traumatic injuries in children are a significant cause of mortality and morbidity worldwide.1 Children with major trauma are at risk of poor outcomes.2-4 These include disabilities that require assistance with activities of daily living, intellectual disability and behavioural problems.5 In the US, it is estimated that more than 50...

An augmented reality mobile application for weight estimation in paediatric patients: A prospective single-blinded cross-sectional study

Drug and defibrillation energy doses for children rely on accurate weight measurement, making it essential during emergencies.1,2 However, quickly weighing children in distress is often a challenging task.3,4 Conventionally, age-dependent formulas and length-based tapes like the Broselow tape (BT) and Paediatric Advanced Weight Prediction in the Emergency Room extra-long...

How do current paediatrics residency selection criteria correlate with residency performance?

Dear Editor, The selection process for potential residents needs to be reviewed regularly and assessed if effective in selecting the best-fit residents who can achieve academic and professional excellence. Objective measures must take precedence over subjective criteria to reduce selection bias while ensuring transparency and accountability. However, the predictors of...

Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground

In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....

Long COVID prevalence, risk factors and impact of vaccination in the paediatric population: A survey study in Singapore

On 5 May 2023, more than 3 years since the start of the COVID-19 pandemic, the World Health Organization (WHO) declared that COVID-19 no longer constituted a public health emergency. Despite high numbers of children and younger persons (CYPs) having acute COVID-19,1 information on the quality of health and...

Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests

Congenital heart diseases (CHDs) are the most common major congenital anomaly at up to 28%1 and are responsible for 5.7% of all infant mortality.2 While earlier studies in developed countries reported an overall CHD birth prevalence of 3.7–5.54 per 1000 live births,3,4 more recent studies report a global and...

Improving neonatal counselling service for premature births

Dear Editor,  Despite the substantial advancement of neonatal care leading to increased survival of infants of periviable gestation, as young as 22 weeks,1 the anticipated birth of an extremely low gestational age infant remains challenging for both the parents and physician, with regard to decision-making in initiating resuscitation post-delivery. Ideally,...

Consensus statement on Singapore integrated 24-hour activity guide for early childhood

Early childhood is a critical period for growth and development, setting the foundation for future and lifelong well-being.1 Adopting healthy lifestyle behaviours in early childhood can potentially influence and shape behaviours later in life.2 Frameworks have been developed, such as from the Center on the Developing Child at Harvard...

Proactive steps to population health: Starting early, starting right

The global burden of non-communicable diseases is rising, with continued projected increases in the prevalence of metabolic syndrome (MetS) in the future. This epidemic, albeit of a metabolic nature, poses broad socioeconomic and healthcare burdens worldwide. Population health improvement and optimisation of healthcare are important to addressing these burdens....

Sublingual ondansetron for treatment of acute gastroenteritis in children in the children’s emergency

Dear Editor, Acute gastroenteritis (GE) is a leading cause of death globally in children aged below 5 years and the third most common indication for hospital admission in some countries.1,2 Currently, norovirus is the most common cause of GE in children in developed countries.3 Rehydration, either orally or intravenously, is...

Rash characteristics of paediatric patients with COVID-19 in Singapore

Dear Editor, Children with COVID-19 infection can present with a variable spectrum of clinical manifestations, and sometimes mucocutaneous manifestations can be the only manifestation of COVID-19 infection in children.1,2,3 We report 4 cases of paediatric patients who had COVID-19 with mucocutaneous involvement, admitted to a tertiary children’s hospital in Singapore....

Rapid exome sequencing to aid diagnostics in genetic disorders: Implementation and challenges in the Singapore context

Dear Editor, There is a high burden of genetic disorders in patients admitted to the intensive care unit (ICU), ranging from 45–56%,1,2 and delayed definitive diagnoses with a long diagnostic odyssey often contribute to increased healthcare costs.3 The application of clinical exome sequencing in ICU has been gaining traction, where...

Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders

Dear Editor, Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based patient-centric care.1 We have developed and implemented a deep-learning model using bidirectional long short-term memory (Bi-LSTM) neural network to enable automated triage of unstructured free-text...

Early rehabilitation to improve functional outcomes in childhood cancer in Singapore

Dear Editor, We conducted a prospective, single-centre cohort study to review the impact of a multidisciplinary rehabilitation programme in children with cancer in Singapore. The Template for Intervention Description and Replication (TIDieR) checklist was used to allow sufficient details for replication of the study (see Appendix in online Supplementary...

Multisystem inflammatory syndrome in children in Singapore

While children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulting in coronavirus disease 2019 (COVID-19) have milder manifestations compared to adults,1,2 a rare multisystem inflammatory syndrome leading to multiorgan failure and shock (multisystem inflammatory syndrome in children ) has been recognised to affect children with exposure to...

Multisystem inflammatory syndrome in children: A unique manifestation of COVID-19

During the coronavirus disease 2019 (COVID-19) pandemic, children have been relatively spared from the severe symptomatic infection affecting adults, particularly the elderly and those with comorbidities. One of the most challenging aspects of paediatric SARS-CoV-2 infection has been the discovery of a unique late manifestation of infection characterised by...

Child passenger safety training for healthcare professionals in Singapore

Dear Editor, Road traffic injuries are a preventable cause of childhood morbidity and mortality.1,2 Use of age-appropriate child car seats (CCS) lowers the risk of injury and death by about 82% and 28%, respectively.3-5 In Singapore, although the Road Traffic Act states that CCS use is mandatory,6 many children...

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....

Childhood interstitial lung disease: The end of a diagnostic odyssey

Dear Editor, Childhood interstitial lung disease is a heterogeneous group of rare disorders featuring pulmonary interstitial remodelling and diffuse parenchymal infiltrates on imaging.1 Incidence is estimated at 0.13–16.2 cases/100,000 children per year.1 ABCA3 (ATP-Binding Cassette, Subfamily A, Member 3) (OMIM #601615) is expressed in alveolar type II cells involved...

Validation and comparison of the PECARN rule, Step-by-Step approach and Lab-score for predicting serious and invasive bacterial infections in young febrile infants

The diagnostic approach and management of febrile infants <90 days of age remain a challenge, given that the majority of these infants have no localising signs and symptoms, and may appear clinically well at presentation.1 In addition, the majority of these infants have benign viral illnesses, for which hospitalisation...

High burden of respiratory viral infection-associated mortality among critically ill children

Dear Editor, Acute lower respiratory infections (ALRIs) are a leading cause of under-5 mortality globally—two-thirds could be attributable to respiratory viral infections (RVIs).1,2 The burden of paediatric RVIs in settings of tropical climate with year-long virus circulation is relatively underreported.3,4 Previous studies in these areas have estimated that around 8–11%...

Non-motorised active mobility device use by children in Singapore: Injury patterns and risk factors for severe injury

The Active Mobility Act was introduced in Singapore in 2017 to promote the safe use of personal mobility devices. Non-motorised active mobility devices (AMDs) are popular among children and include tricycles, bicycles, scooters, inline skates, skateboards, longboards and waveboards. While the use of AMDs contributes towards an active lifestyle...

Screening for somatisation in an Asian children’s hospital emergency setting

Dear Editor, In recent years, self-harm is the leading cause of morbidity and mortality among adolescents in Singapore.1,2 This is just the tip of the iceberg as youths with undiagnosed mental health disorders often present to the healthcare system with non-psychiatric symptoms.3 These psychosomatic symptoms do not have an organic...

Cause of vaginal spotting in an older woman

A 77-year-old Chinese woman with a past medical history of Sjogren’s syndrome, nodular goitre and right-sided neck lymphadenopathy, presented to the gynaecological service for per-vaginal spotting. On clinical examination, she was noted to have a cervical polyp. A polypectomy was performed and the specimen was sent for histological examination. The...

Congenital cytomegalovirus infection: Advocating for screening and education

Cytomegalovirus (CMV) infection is the leading non-genetic cause of congenital neurosensory hearing loss in children, accounting for 21% of cases of hearing loss at birth and 25% of deafness at age 4 years.1 It can also give rise to other serious sequelae such as cerebral palsy, cognitive impairment, seizures...

Epidemiological trends and outcomes of children with aural foreign bodies in Singapore

Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to their inquisitive minds and experimental nature.1 Aetiologies for aural FBs include accidental or intentional insertion of FBs into body orifices, ear irritation caused by rhinitis...

Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents

The World Health Organization’s Global action plan for the prevention and control of noncommunicable diseases 2013–2020 provided guiding principles for national efforts in controlling and reducing non-communicable diseases (NCDs).1 The major NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes—they form a major public health challenge, and are...

Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore

Functional gastrointestinal (GI) disorders, such as colic, gastroesophageal reflux (GER) and constipation, are common in infants under 1 year. They are a frequent cause of concern for parents and result in a significant healthcare burden1,2 due to their negative impact on feeding behaviours, caregivers’ mental wellbeing and quality of...

Gastroesophageal reflux disease in Asian infants: Similar condition, different perceptions

Gastroesophageal reflux disease (GERD), a common problem in infancy, may lead to troublesome symptoms or complications such as oesophagitis or oesophageal stricturing in a small minority of infants.1 In the majority of cases, however, frequent regurgitations, the commonest symptoms of GERD, resolves with age spontaneously without any medical intervention.2,3...

Risk Factors for Predicting Mortality in a Paediatric Intensive Care Unit

Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care, outcome analysis including mortality risk prediction has become a challenge for the modern day intensivists. During the early 90s, the focus has shifted from the...

Experience with a Nine-step Policy Dealing with Requests for Medically Inappropriate Interventions for Cancer

Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is available. Physicians then face the difficult task of informing patients that, although palliation is always possible, cure is not. This article is available only as a...

Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia

The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix. The impact of the programme depends both on the detection of women with cervical intraepithelial neoplasia (CIN) and upon their being treated effectively. This article is...

The Polarprobe—Emerging Technology for Cervical Cancer Screening

Cervical cancer is a preventable disease that affects nearly half a million women worldwide. The Papanicolaou smear has been used for screening for over fifty years and the test has the advantage of fast and relatively easy sample collection. This article is available only as a PDF. Please click on...

Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Pelvic Spleen Masquerading as an Ovarian Neoplasm

A 53-year-old Caucasian woman, a receptionist in a general practice, was referred to the gynaecology outpatient clinic with an 18-month history of heavy, irregular menses and a pelvic mass on an abdominal ultrasound arranged by her General Practitioner (GP). She was otherwise asymptomatic. This article is available only as a...

Repair of Complex Ureterovaginal and Vesicovaginal Fistulas with Ileal Cystoplasty and Ureteric Reimplantation into an Antireflux Ileal Nipple Valve—A Case Report

Urogenital fistulas are a known but uncommon complication of gynaecological surgery, especially those involving a malignant process. Its incidence does not exceed 2%. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Case Report—Delayed Vesicocutaneous Fistula After Radiation Therapy for Advanced Vulvar Cancer

To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Optimal Treatment in Gestational Trophoblastic Disease

Gestational trophoblastic diseases (GTD) encompass a spectrum of interrelated conditions: Hydatidiform mole (HM) Invasive mole (IM) Choriocarcinoma (CC) Placental site trophoblastic tumour (PSTT) This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Fallopian Tube Carcinoma—A Review

Fallopian tube cancer is the least common of gynaecological malignancies. It was first described by Renaud in 1847. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Current Management of Early Vulvar Cancer

Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although patient and physician delay remains common, an increasing number of patients are being diagnosed with early stage disease. This article is available only as a PDF....

Topoisomerase-I Inhibitors in Gynaecologic Tumours

Topoisomerases are essential nuclear enzymes with a multiplicity of cellular functions involving DNA replication, RNA transcription, mitosis, and chromosome condensation. Two classes have been identified: the class I topoisomerases, named “I” because they induce single-strand breaks and reunions of the DNA double helix, and the class II topoisomerases, named...

Screening for Ovarian Cancer

Ovarian cancer is the most common gynaecological malignancy with over 5000 new cases diagnosed every year in the UK and 22 000 in the United States. Four thousand women die each year of ovarian cancer in England and Wales, and 13 000 die in the USA. This article is available...

Biomarkers in Carcinoma of the Cervix: Emphasis on Tissue-related Factors and Their Potential Prognostic Factors

Accurate staging is of utmost importance in determining the prognosis of carcinoma of the cervix. Demographic features such as race and socio-economic status have been demonstrated as not having significant influence. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

The Management Dilemma of the Mildly Abnormal Smear: Fact or Fiction?

Carcinoma of the cervix is still a relatively common gynaecological malignancy. However, despite being potentially preventable it still claims the lives of many women even in those countries where organised screening programmes exist. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Adenocarcinoma of the Cervix

It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the incidence of squamous carcinoma of the cervix but indeed in the last 10 to 15 years has halved the mortality rate from this disease. In...

Malignant Ovarian Germ Cell Tumours: Experience in the National University Hospital of Singapore

One of the most remarkable advances in the management of gynaecological cancers is in malignant ovarian germ cell tumours. Before the early 70s, some of the malignant ovarian germ cell tumours had a notoriously bad reputation in terms of aggressiveness and poor prognosis. This article is available only as a...

A Phase II Study of Combined CPT-11 and Mitomycin-C in Platinum Refractory Clear Cell and Mucinous Ovarian Carcinoma

Platinum resistance, either de novo or acquired, is a major obstacle in the treatment of advanced ovarian cancer. Platinum-resistance has been classified into the following three categories; (1) primarily (intrinsically) platinum-resistant disease: tumours showing no change (NC) or progressive disease (PD) while on initial platinum-based chemotherapy; (2) secondarily platinum-resistant...

Single Agent Paclitaxel in Resistant and Relapsed Epithelial Ovarian Cancer After First-line Platinum-based Chemotherapy—Experience in an Asian Population

Ovarian carcinoma ranks fourth among causes of death in women and is the leading cause of death from gynaecological malignancies in Western countries. In Singapore, the incidence of this cancer has been rising for the last 25 years. This article is available only as a PDF. Please click on “Download...

Uterine Papillary Serous Carcinoma—The KK Hospital Experience

Endometrial carcinoma comprises a morphologically heterogeneous group of tumours. Several authors during the 1960s and 1970s described an unusual variant of endometrial cancer containing psammoma bodies. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Radiotherapy as Local Adjuvant Treatment for Endometrial Carcinoma—A Review of 45 Patients

Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control as well as to achieve excellent survival rates. Over the years, however, the specific role and relative benefit of postoperative radiotherapy for this particular cancer...

Outcome of Obstructive Uropathy After Pelvic Irradiation in Patients with Carcinoma of the Uterine Cervix

Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at high risk for local recurrence after radical hysterectomy. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The Surgical Management of Colorectal Complications from Irradiation for Carcinoma of the Cervix

Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma of the cervix, because radiotherapy is the principle mode of treatment for this fourth most common malignancy in women in Singapore (after carcinoma of the...

Adjuvant Chemotherapy in “High Risk” Patients after Wertheim Hysterectomy—10-year Survivals

Wertheim radical hysterectomy has today become an accepted method of management of stage IB and early stage IIA cervical carcinoma, particularly in young patients in whom preservation of ovarian and coital function cannot be achieved if they were subjected to radiotherapy instead. However, a group of patients undergoing radical...

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...

Outcome of Early Cervical Carcinoma Treated by Wertheim Hysterectomy with Selective Postoperative Radiotherapy

Cancer of the cervix is the fourth most common cancer in females in Singapore after breast, colorectal and lung cancers. It forms 7.8% of all cancers in females for the period 1988 to 1992. This article is available only as a PDF. Please click on “Download PDF” on top to...

Gynaecologic Oncology—The Next Lap

Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all age groups: rhabdomyosarcoma in young girls, germ cell tumours in teenage girls and young women, cervical cancer in the middle age women, and epithelial ovarian...

Urinary Deoxypyridinoline is a Useful Biochemical Bone Marker for the Management of Postmenopausal Osteoporosis

Postmenopausal osteoporosis is the most common cause of osteoporosis. It is heralded by the cessation of oestrogen production by the ovaries resulting in at least 10% to 15% bone loss over the next 10 to 15 years from menopause. This article is available only as a PDF. Please click on...

Infections in Acute Lymphoblastic Leukaemia

Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy. Empiric antimicrobial chemotherapy is the mainstay of therapy for febrile neutropenic episodes pending the culture results. This article is available only as a PDF. Please click...

Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore

In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has focused especially on cancer and the possible link between immunology and psychological factors. This article is available only as a PDF. Please click on “Download PDF”...

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 reviewed its use for inguinal and genital surgery in children. This article is available only as a PDF. Please click on “Download PDF” on top to...

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 of these infants would meet the criteria for the use of extracorporeal membrane oxygenation (ECMO). This article is available only as a PDF. Please click on...

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 studied in Singapore children; hence we report our experience with the use of adenosine for the treatment and diagnosis of supraventricular tachycardia in children over...

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...

A Case of Accelerated Development of Proliferative Diabetic Retinopathy in a Woman with Type 2 Diabetes Mellitus after Pregnancy

Diabetic retinopathy is the leading cause of blindness in persons between the age of 24 and 64 years both in the US and the UK. Peak fertility and childbearing years correspond to the first half of this period. This article is available only as a PDF. Please click on “Download...

Survey of Aerobic Bacterial Infections in Paediatric Surgical Intensive Care Unit Patients

Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric medical patients, paediatric surgical patients are a special group in their spectrum of diseases and treatment requirements. This article is available only as a PDF. Please...

Rapid One-day Fluorescence In Situ Hybridisation in Prenatal Diagnosis Using Uncultured Amniocytes and Chorionic Villi

The most common chromosomal abnormalities in newborns are trisomy 21, trisomy 18, trisomy 13, and monosomy X, with incidences of 1/800, 1/8,000, 1/20,000, and 1/10,000, respectively. Conventional cytogenetic approaches traditionally employ foetal cells from amniotic fluid (AF) or chorionic villus (CV) grown in vitro and metaphase banding for chromosome...

Parainfluenza Type 3 Viral Outbreak in a Neonatal Nursery

Parainfluenza viruses are relatively large RNA paramyxoviruses. Four serologic types cause disease in humans. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report

T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T wave during sinus rhythm without any changes in the QRS complex, is an uncommonly recorded rhythm. We report here an unusual case of T wave...

A Preliminary Study of the Immunohistochemical Detection of a Novel Tumour Marker, 22-1-1 Antigen, in Gynaecological Cancer Specimens

Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been useful in diagnosis and treatment of certain cancers (as tumour markers) and many such antibodies have now been described. This article is available only as a...

The Future of Medicine from the Standpoint of the Practising Paediatrician

From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had practised the art and science, on the basis of curing the patient when he has an illness. The doctor is sought out when the patient...

Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children

Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease. This article is available only as...

Prognostic Factors in Endometrial Carcinoma

In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of 72 per 100,000 women. In Singapore it is the third most common female genital tract cancer after cancer of the cervix and ovary. This article is...

Factors Affecting Success in an Embryo Cryopreservation Programme

The first pregnancy resulting from the thaw and transfer of cryopreserved pre-embryos was reported in 1983 by Trounson and his team, in Melbourne, Australia. This technological breakthrough in infertility treatment has been successfully repeated since then and cryopreservation of excess embryos now forms an integral part of any assisted...

Bidirectional Cavopulmonary Anastomosis

Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to Fontan’s operation has been undertaken in an effort to reduce the volume load of a single ventricle as early as possible and to minimise the...

Hyperlipidaemia during Normal Pregnancy, Parturition and Lactation

Increase in the plasma lipid fractions in normal pregnancy have been described but irregularity of sampling, difference in materials studied (whole blood, serum, and plasma) and the variations in the method of reporting precluded any comparison of results. In Western populations normal pregnancy leads to an increase in cholesterol...

Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship between the risk of this disease with birth weight and gestational age had been well-documented, in particular, in infants with birth weight ≤1500 g (very...

Echocardiographic Features and Management of Neonatal Ductal Aneurysm

Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few years. It has been noted as an incidental finding in autopsy, echocardiography and angiography, but can present with symptoms of cough, dyspnoea, hoarseness of voice...

An Unusual Tumour Metastasis to the Cervix

A 55-year-old Chinese lady had a left mastectomy in April 1995 for an invasive lobular carcinoma of the breast. Axillary lymph node metastases were present. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Transaminitis in Duchenne’s Muscular Dystrophy

Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine and aspartate transaminase (AST) levels have been found in patients with muscle diseases such as Duchenne’s and Becker’s muscular dystrophy, myotonic dystrophy and the inflammatory...

Twenty-four hour, Non-invasive, Neonatal Chromosome Analysis—Application in a Case of Mixed Gonadal Dysgenesis

Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but longer if the initial 48-h culturing period proves unsuccessful. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies

Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of G<sub>M2</sub> gangliosides, particularly in the neuronal cells. The infantile form, similar to Tay Sach’s disease, may present in the first year of life with an...

A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block

The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is the commonest of these disorders, and a leading cause of heart block in newborns. This article is available only as a PDF. Please click on “Download...

Genetics of Male Infertility: Role of Androgen Receptor Mutations and Y-Microdeletions

Three to four per cent of men have severe defects in sperm production that result in infertility. Most of these men are healthy and the causes of depressed spermatogenesis are rarely identified with certainty. This article is available only as a PDF. Please click on “Download PDF” on top to...

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

Association or Agreement

Association and agreement between two factors are very different concepts, although the methods used to describe them appear similar. For example, the association between levels of aflatoxin serum albumin adducts and dietary aflatoxin intake can be demonstrated in a bivariate scattergram; the agreement between two methods of measuring aflatoxin...

Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months

Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay, India. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

DNA Testing for Fragile X Syndrome in 255 Males from Special Schools in Singapore

Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It is associated with a cytogenetically visible fragile site in Xq27.3, termed FRAXA, which results from the unstable expansion of a trinucleotide (CGG)n repeat sequence in...

Microdochectomy for Single-duct Nipple Discharge

Nipple discharge is a common disturbing symptom for many women and often leads to a surgical referral. It accounts for 3% to 5% of all breast symptoms. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients

Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations, or some other less specific complaints such as nausea, pallor and sweatiness. This article is available only as a PDF. Please click on “Download PDF” on...

Paediatric living-donor liver and kidney transplantation during COVID-19

Dear Editor, The coronavirus disease 2019 (COVID-19) pandemic has impacted global healthcare including paediatric solid organ transplantation (SOT). We report our experience of resuming paediatric living-donor SOT during COVID-19, which took into account safety considerations for living donors, paediatric recipients and the transplant healthcare team. The US Centers for Disease...

The evolution of severity of paediatric COVID-19 in Singapore: Vertical transmission and multisystem inflammatory syndrome in children

Dear Editor, Coronavirus disease 2019 (COVID-19) arrived in Singapore in January 2020 as imported cases, followed by local transmission predominantly involving dormitories, with later spread within the wider community. Children still represent the minority of cases in Singapore, with around 8,000 paediatric cases as of 6 November 2021 out of...

Systemic antibiotic prophylaxis for recurrent infective flares in children and adolescents with atopic dermatitis

Dear Editor, Atopic dermatitis (AD) is a chronic inflammatory skin disease, affecting approximately 20% of children in Singapore.1 It is associated with skin barrier defects2 and increased skin colonisation with Staphylococcus aureus, which can trigger infective flares, especially in more severe disease. Strategies to reduce S. aureus colonisation and infection...

Diagnosing and Prognosticating Acute Meningitis in Young Infants within 24 Hours of Admission

Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which present with a short history of symptoms and are caused by either bacteria (acute bacterial meningitis, ABM) or viruses (acute aseptic meningitis, AAM). This article is...

Prevention of Human Immunodeficiency Virus (HIV) Transmission from Mother to Child—A Cohort Study in Singapore

Since the onset of the acquired immunodeficiency syndrome (AIDS) epidemic in the mid-1980s, the number of HIV-infected cases has risen sharply throughout the world. Globally, 5.8 million new HIV infections have been diagnosed in 1998 with 1.2 million being diagnosed in Southeast Asia. This article is available only as a...

Book Review

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it as there are so few books of medicine written and published in Singapore. This article is available only as a PDF. Please click on “Download PDF”...

Obstetric Admissions to the Intensive Therapy Unit of a Tertiary Care Institution

Pregnancy is associated with physiological changes in various organ systems and complications arising from the interaction between these changes and disease processes may be severe enough to require admission to the intensive therapy unit (ITU) for management. The purpose of this study was to review all obstetric patients admitted...

Enteral Nutrition of the Very Low Birth Weight (VLBW) Infant

Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely delivered. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Case Series of Six Children with Primary Pulmonary Hypertension

Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of the pressure in the pulmonary artery to above a mean of 25 mmHg at rest, or 30 mmHg during exercise. This article is available only as...

2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore

When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think of quite a few other paediatricians more qualified and appropriate as speakers and hoped that my emphatic no would work. This article is available only as...

Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome

Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the short arm of chromosome 20. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Use of Vigabatrin in Infantile Spasms in Asian Children

Infantile spasms are a form of age-dependent myoclonic epilepsy that is difficult to control. Agents such as adrenocorticotrophic hormone (ACTH) and prednisolone have been used as first-line therapy, but are associated with major side effects. This article is available only as a PDF. Please click on “Download PDF” on top...

Management of Premalignant Lesions of the Cervix

Cervical cancer is one of the most common female cancers worldwide. It is ranked second only to breast cancer and in many underdeveloped countries, it is the most common female cancer. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Four Pregnancies in Two Patients with Essential Thrombocythaemia—A Case Report

Essential thrombocythaemia (ET) is a rare myeloproliferative disease which manifests with an elevated platelet count. It presents predominantly in the middle-aged population, occurring slightly more frequently in women than men. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Course of Pregnancy in a Patient with Nail-Patella Syndrome

The nail-patella syndrome (NPS) is a rare autosomal dominant disorder defined by the association of nail dysplasia, bone abnormalities and, frequently, renal disease. We report the course of pregnancy in a patient with such a condition. This article is available only as a PDF. Please click on “Download PDF” on...

Rheumatic Heart Diseases in Pregnancy

Rheumatic heart disease comprises acute rheumatic fever following group A beta-haemolytic streptococcal infection of the tonsillopharynx, and its long-term sequelae of heart valve fibrosis causing chronic valvular lesions. Severe myocardial and pericardial involvements are much less common. This article is available only as a PDF. Please click on “Download PDF”...

Idiopathic Thrombocytopenia in Pregnancy

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which platelets are sensitised with an antiplatelet autoantibody and then destroyed by the reticuloendothelial system.1 Hence, it is also known as primary autoimmune thrombocytopenic purpura. There are two forms of ITP—acute and chronic. This article is available only as a PDF....

Thrombophilia in Pregnancy

A clear understanding of thrombophilia is becoming increasingly important in the practice of high-risk obstetrics. In addition to their role in thromboembolic disease, there is increasing evidence linking thrombophilia and adverse pregnancy outcomes such as pre-eclampsia, intrauterine growth restriction, placental abruption and recurrent pregnancy loss. This article is available only...

Current Understanding of Pre-eclampsia

Pre-eclampsia is a major cause of adverse obstetric outcome. It remains one of the leading causes of maternal mortality1 and continues to contribute significantly to perinatal morbidity and mortality. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Management of Thromboembolic Disease in Pregnancy

Venous thromboembolism (VTE) refers specifically to 2 related entities: deep vein thrombosis (DVT) and pulmonary embolism. The management of arterial thrombo-embolism, in particular that of women with artificial heart valves, is beyond the scope of this paper. This article is available only as a PDF. Please click on “Download PDF”...

Management of Haematologic Malignancies in Pregnancy

Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The most commonly diagnosed malignancies during pregnancy are breast cancer, cervical carcinoma, Hodgkin’s lymphoma and melanoma. This article is available only as a PDF. Please click on...

Thyroid Diseases in Pregnancy

Abnormalities of thyroid function associated with pregnancy encompass both hyperthyroidism and hypothyroidism. These may have been present before the onset of pregnancy, or occurred only during or after pregnancy. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Outcome of Pregnancy in Asian Women with Systemic Lupus Erythematosus: Experience of a Single Perinatal Centre in Singapore

Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more commonly than men (ratio 9:1), particularly those in the child-bearing age (15:1). This article is available only as a PDF. Please click on “Download PDF” on...

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 wish to have children. Conception rate has been reported to improve dramatically from 1 in 200 dialysis patients to 1 in 50 women with a...

Gestational Diabetes Mellitus: A Call for Systematic Tracing

The prevalence of diabetes is increasing worldwide. In Singapore, the prevalence of diabetes has increased dramatically from 4.7% in 1984 to 8.6% in 1998. Diabetic complications lead to a significant number of patients with blindness, amputations and end-stage renal failure annually. This article is available only as a PDF. Please...

Pregnancy in Women with Idiopathic Thrombocytopaenic Purpura

Idiopathic thrombocytopaenic purpura (ITP) is the most common autoimmune haematological disorder in pregnancy. The pathophysiology of the disease is peripheral destruction of platelets mediated by antiplatelet antibodies. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Are Maternal Deaths on the Ascent in Singapore? A Review of Maternal Mortality as Reflected by Coronial Casework from 1990 to 1999

It is said that, worldwide, over half a million maternal deaths occur annually. This might well be a conservative estimate, given the difficulties inherent in collecting the relevant data, compounded by the under-reporting and misclassification of such deaths. This article is available only as a PDF. Please click on “Download...

Medical Disorders in Pregnancy—The Challenges Ahead

Nowhere is the fate of two individuals more closely intertwined than that of the mother and her fetus. Pregnancy is a unique state where the physiology of the mother is greatly altered to accommodate the newly developing “organ”—the fetus. This article is available only as a PDF. Please click on...

Paediatric Extracranial Germ Cell Tumours: A Retrospective Review

Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Two-year Outcome of Normal-birth-weight Infants Admitted to a Singapore Neonatal Intensive Care Unit

With the rapid advances in the field of neonatal intensive care, the focus of interest has been on the very-low-birthweight (VLBW) infant in recent years. The outcome of these infants has been extensively studied and widely reported. On the other hand, data on the incidence, risk prediction and outcome...

Bronchopulmonary Dysplasia and Chronic Lung Disease of Infancy: Strategies for Prevention and Management

Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal repair of lung injury in the neonatal period. Although BPD and CLD are closely related, they have differing diagnostic criteria and the spectrum of severity...

Intussusception: A Three-Year Review

Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into another. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Osteoporosis in Relation to Menopause

Singapore has a rapidly ageing population. In 1990, only 6% of the population was above the age of 65 years but this percentage of elderly citizens will rise rapidly to 17% by the year 2030. As Singaporean women achieve longer life expectancy and live a greater portion of their...

Burch Colposuspension: Review of Perioperative Complications at a Women’s and Children’s Hospital in Singapore

Genuine stress incontinence (GSI) is the most common cause of female urinary incontinence. When conservative treatment fails, surgery is indicated. Open Burch colposuspension is an established surgical procedure1 and remains the gold standard upon which the efficacy of newer surgical options is evaluated. This article is available only as a...

Endometrioid Adenocarcinoma of the Uterus: Surgico-Pathological Correlations and Role of Pelvic Lymphadenectomy

Endometrial cancer is the most common female genital malignancy in industralised countries today. Despite the overall favourable prognosis in this neoplasia, survival is associated with several prognostic factors. In endometrial cancer, one of the most potent prognostic factors is nodal metastasis. This article is available only as a PDF. Please...

FIGO Stage 1B2 Cervical Carcinoma – The KK Women’s and Children’s Hospital Experience

Important prognostic factors in stage 1B cervical carcinoma include primary tumour diameter, nodal metastases, depth of stromal invasion, lymph-vascular invasion, microscopic parametrial extension and status of surgical margins.1 In 1994 FIGO addressed the significance of tumour diameter by designating stage 1B into 1B1 (clinical lesions no greater than 4.0...

Bowel Surgery for Epithelial Ovarian Cancer – An Early Case Series

Epithelial ovarian cancer is the leading cause of death in patients with gynaecological malignancies in Singapore and developed countries, the main reason being the advanced stages of the disease (stage III or IV) at diagnosis. This is largely due to the lack of an effective screening tool to detect...

Pregnancy Following Embolisation of Uterine Arteriovenous Malformation – A Case Report

Arteriovenous malformations (AVMs) of the uterus are rare but potentially life-threatening lesions. The common presentation is vaginal bleeding and, if not diagnosed correctly, can result in torrential bleeding, especially following dilatation and curettage. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Severe Newborn Encephalopathy Unrelated to Intrapartum Hypoxic Events: 3 Case Reports

Since Little’s article of 1862, it was popularly believed that brain damage in the majority of cases of cerebral palsy occurs during labour and delivery. However, the growing evidence in literature has refuted this belief. This article is available only as a PDF. Please click on “Download PDF” on top...

A Case Series of Gastrointestinal Abnormalities in Fetuses with Echogenic Bowel Detected During the Antenatal Period

Although the presence of fetal echogenic bowel (EB) has been largely regarded as benign, it has been viewed as a soft marker for various congenital anomalies. To date, no studies have been conclusive and the importance of antenatal EB amongst the low-risk population has remained confusing. This article is available...

A Case Series of Pre-Viable Severe Twin-Twin Transfusion Syndrome

Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Idiopathic Chronic Fetomaternal Haemorrhage Resulting in Hydrops – A Case Report

Small amounts (<0.1 mL) of fetal blood are commonly found in maternal circulation. Massive fetomaternal haemorrhage (FMH) involves fetal blood loss into the maternal circulation of greater than 150 mL or more than half the fetal blood volume. This article is available only as a PDF. Please click on “Download...

Audit of ‘Crash’ Emergency Caesarean Sections Due to Cord Prolapse in Terms of Response Time and Perinatal Outcome

Umbilical cord prolapse is an uncommon intrapartum event with a reported incidence of 1 in 160 to 714 deliveries. Predisposing factors include fetal malpresentation, prematurity, small fetal size, multiple gestation, polyhydramnios and membranes rupture prior to head engagement. This article is available only as a PDF. Please click on “Download...

Quality Control Assurance in National Screening Programmes for Cervical Cancer

The National Health Service (NHS) was established in the United Kingdom (UK) in 1948, against a post-war background of poverty and ill health. The aim was to provide healthcare based on need to all citizens of the UK, free at the point of delivery. This article is available only as...

The Combined Oral Contraceptive Pill in Women Over Age Forty

In the 1970s, several studies appeared to suggest that users of oral contraceptives (OCs) were at increased risk of cardiovascular events. More recently following newer studies on lower dose OCs and re-analysis of the old studies, it was concluded that the risk of cardiovascular accidents was attributable primarily to...

Contemporary Management of Fibroids

Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in most women. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Investigating the Infertile Couple

Infertility is defined as the inability to conceive after 1 to 2 years of unprotected intercourse. In general, an estimated 84% of all women would conceive after a year of intercourse. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Use of Hormone Replacement Therapy in the Asymptomatic Postmenopausal Woman: What is the Current Evidence?

The understanding of hormone replacement therapy (HRT) for postmenopausal women has undergone dramatic change since the publication of the results of the Women’s Health Initiative (WHI) study in July 2002. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Fetal Cells in Maternal Blood: State of the Art for Non-Invasive Prenatal Diagnosis

Without prenatal diagnosis, 1 in 50 babies are born with serious physical or mental handicap, and as many as 1 in 30 with some form of congenital malformation. These may be due to structural or chromosomal abnormalities, or single gene disorders. This article is available only as a PDF. Please...

Human Papillomavirus Triage of Patients with Atypical Squamous Cells of Undetermined Significance on Cervical Papanicolaou Smear

Cervical cancer affects >400,000 women a year worldwide, and represents a significant health issue for women. In the United States (US) however, screening programmes have reduced the incidence to 8.3 cases per 100,000 women with only 14,000 cases and 5000 deaths annually. This article is available only as a PDF....

Screening for Chromosomal Anomalies: First or Second Trimester, Biochemical or Ultrasound?

A chromosome abnormality contributes significantly to fetal loss during pregnancy, and perinatal morbidity and mortality. The contribution of chromosomal abnormalities to fetal loss decreases as pregnancy progresses; an estimated 50% of first-trimester spontaneous abortions are due to chromosomal abnormalities. This article is available only as a PDF. Please click on...

Should Doctors Perform an Elective Caesarean Section on Request?

Caesarean sections performed without medical indication, better known as maternal request caesarean sections, have generated intense debate in recent times. While uncommon in the past, a recent national audit in the United Kingdom (UK)1 revealed that 7% of all elective caesarean sections were performed for precisely this reason. This article...

Recent Advances in Obstetrics and Gynaecology

The science and art of providing quality health care to women has made tremendous strides in recent years. In the subspecialties of Obstetrics and Gynaecology, recent advances in laboratory techniques and in clinical diagnostic, surgical and laparoscopic skills have improved the prevention and early detection of disease. This article is...

Imaging of Paediatric Mediastinal Masses

A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for thoracic masses in children. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

MR Imaging of the Fetal Brain and Spine: A Maturing Technology

The introduction of a new diagnostic test into a clinical arena goes through a number of stages. The first stage is technical development. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Relationship Between Scoring Systems and Cytokine Levels in Neonatal Sepsis

In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm infants are usually nonspecific. Many clinical and haematological scoring systems have been developed in the early diagnosis of neonatal sepsis. This article is available only as...

Clinical Characteristics of an Outbreak of Hand, Foot and Mouth Disease in Singapore

The enterovirus family causes a wide array of illnesses, some easily recognised clinically and others diagnosed as non-specific viral illnesses. This large family of viruses, composed of more than 70 serotypes, accounts for at least 10 to 15 millions of asymptomatic infection per year in the United States. This article...

Perinatal Care at the Threshold of Viability—From Principles to Practice

One of the major challenges in neonatal-perinatal medicine in the new century is the optimal management of the mother and infant when delivery is imminent or at the threshold of viability. Considerable debate has arisen regarding the appropriate approach and strongly polarised viewpoints are held with and without supporting...

Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital

The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and medical personnel. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Long-term Follow-up and Outcome of Extremely-low-birth-weight (ELBW) Infants

With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great degree of interest focused on the functioning of these high-risk survivors and their outcome into childhood and recently up to adolescence and early adulthood. Prospective...

Exogenous Surfactant Therapy in Newborn Infants

Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of other neonatal respiratory disorders as well. Numerous randomised controlled trials have been conducted in neonatology to study different aspects of surfactant therapy. This article is available...

The Use and Abuse of Steroids in Perinatal Medicine

Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality. Despite advances in medical technology, the prevalence of preterm birth in Singapore has increased, secondary to an increase in multiple gestations and obstetric interventions. This article...

Mass Newborn Screening in Singapore—Position and Projections

Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome with early intervention. The development in 1960 by the late Dr Robert Guthrie of a simple test, the GuthrieTest, that enabled the detection of phenylketonuria...

Neonatology In Singapore: The Way We Were, The Way Forward

Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore. As I look at the present-day status of neonatology, it gives me a sense of achievement and accomplishment. This article is available only as a PDF....

Chorioamnionitis and Outcome in Extremely Preterm Infants

Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is a major predisposing factor for preterm delivery. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Changing Trends in Indications for Caesarean Sections in a Tertiary Hospital

Increasing rates of caesarean deliveries have received widespread attention in recent years and has increased widespread discussion in the public domain. The ideal caesarean section rate has never been defined and national rates of caesarean delivery vary from country to country. This article is available only as a PDF. Please...

Obstetric Cholestasis: Current Opinions and Management

Obstetric cholestasis (OC) is a pregnancy-specific liver disorder. It is also known by other names, such as pruritus gravidarum, recurrent intrahepatic cholestasis of pregnancy and obstetric hepatosis. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Advances in Imaging in Prenatal Diagnosis and Fetal Therapy

Technology in sonography has advanced tremendously in recent years, contributing to improvements in clinical applications for prenatal diagnosis and fetal therapy. These include transvaginal scanning, harmonic imaging, Doppler imaging, 3-dimensional (3D) ultrasonography and magnetic resonance imaging (MRI) ultrafast sequences. This article is available only as a PDF. Please click on...

Factors Influencing Fetal Growth

Birth weight remains one of the most important measures we have of the health status of a population, being a strong predictor of both mortality and morbidity, and reflecting nutritional status and growth rates. Yet, the estimation of the normal growth potential — and hence the definition of growth...

Challenges in Perinatal Medicine

One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This signaled the beginning of increased collaboration between the obstetricians and neonatologists in the management of high-risk pregnancies through multidisciplinary birth defect clinics and high-risk perinatal...

Predicting Significant Hyperbilirubinaemia and Early Discharge for Glucose-6-Phosphate Dehydrogenase Deficient Newborns

Glucose-6-phosphate dehydrogenase (G6PD) deficiency occurs in 2.5% of Singapore’s population, and affected newborns are at risk for severe neonatal hyperbilirubinaemia and kernicterus. In the past four decades, neonatology units in local restructured hospitals have hospitalised all affected newborns for at least 14 days after birth because of this risk. This...

Autoimmune Liver Disease in Children

Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1) and serologically by the presence of non-organ and liver-specific autoantibodies and increased levels of immunoglobulin G (IgG), in the absence of a known aetiology. They...

HIV/AIDS in Children

The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major public health threat with wide-ranging medical, social and economic consequences. First gaining foothold among intravenous drug users and commercial sex workers, HIV quickly spreads to...

Nipah Encephalitis Outbreak in Malaysia

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started in Ulu Piah, Tambun and Ampang near Ipoh in the state of Perak, later involved Sikamat, Sungai Nipah, Kampong Sawah and Bukit Pelanduk areas in...

Improving the Uptake of Human Immunodeficiency Virus (HIV) Antenatal Screening in a Primary Healthcare Setting

Since the acquired immunodeficiency syndrome (AIDS) was first diagnosed in Singapore in 1985, its incidence rose from 15 cases in 1988 to 226 in 2000. There has also been a change in the profile of AIDS patients over this period. This article is available only as a PDF. Please click...

Adolescent Health Education Programmes: Theoretical Principles in Design and Delivery

Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually transmitted infections and unplanned pregnancy, accidental and intentional injury, including suicide, affect youth disproportionately and appear to be increasing. This article is available only as a...

Art and “the Language of Well-Being” in Adolescent Health Care

Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration. Creative activity parallels important strategies for mental and spiritual health—people who participate in well-designed creative processes report that it is powerfully restorative. This article is available...

From Recreation to Creative Expression: The Essential Features of an Adolescent Inpatient Psychosocial Support Programme

In 1984, the Royal Children’s Hospital (RCH) in Melbourne, Australia opened a new ward specifically for adolescent inpatients. This initiative was the result of many years of observation, patient survey, discussion and debate about the possibility of allowing teenagers to stay in a children’s hospital. This article is available only...

Adolescent Admissions to a Tertiary Paediatric Hospital: A Dynamic Pattern

The nature of paediatric practice is changing worldwide. In developing countries, infant mortality from infectious diseases continues to fall with improved immunisation, medical care and pharmaceutical advances. This has resulted in a corresponding rise in the number of adolescents, who now constitute 30% of the world’s population. This article is...

Clinical Assessment, Management and Outcomes of a Group of Adolescents Presenting with Complex Medico-psychosocial Conditions

Increased sensitivity to biological change can make adolescents particularly vulnerable to non-organic symptomatic disorders. A variety of pains, headaches, dizziness and fatigue may remain unexplained after medical assessment. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Adolescent Chronic Illness: A Qualitative Study of Psychosocial Adjustment

Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many challenges including dealing with the symptoms of illness, side effects of medications, altered body image, unpredictable disease progression, depression and anxiety. This article is available only...

Strategies to Promote Better Outcomes in Young People with Chronic Illnesses

The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to public health measures, such as sanitation and immunisation, better housing and sweeping improvements in health care. This article is available only as a PDF. Please click...

Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent and future adult health and well being. Adolescent substance use and abuse is an example of this. This article is available only as a PDF. Please...

Sexually Transmitted Infections in Singapore Teenagers

Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and changes. The transition from childhood to adulthood includes the formation of successful intimate relationships and avoidance of the pitfalls of sexually transmitted infections (STI), including...

Eating Disorders in Singapore: A Review

Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms of shape/weight dissatisfaction and eating abnormalities. Anorexia nervosa is characterised by significant self-induced weight loss secondary to fear of fatness, amenorrhoea (cessation of menstruation for...

Youth Suicide and Parasuicide in Singapore

The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or herself in the knowledge, or expectation, of its fatal outcome. Parasuicide or attempted suicide is distinguished from suicide by the non-fatal outcome. This article is available...

Five-Year Review of Adolescent Mental Health Usage in Singapore

The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in almost every area, including epidemiology, classification and treatment. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The Perils of Puberty

Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such as cytochrome P450 systems, accretion of peak bone mass, and the development of sexually dimorphic adult patterns in blood lipids, blood pressure, haemoglobin and red...

Adolescent Health—A New Perspective in Singapore

In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field of Adolescent Health has only recently been recognised to be an important specialty which has not received due emphasis in the medical curriculum for undergraduates,...

Labour epidural practice in a tertiary training centre

Dear Editor, Labour analgesia provided through the central neuraxial approach is offered for parturients who are in their active stage of labour, usually after 2–4cm of cervical dilatation. Lumbar epidural, the gold standard for labour analgesia, is recently recommended over other alternative methods of analgesia such as pressurised gaseous nitrous...

MELAS: A Case Report

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to multiple dental caries, phenytoin-induced gingival hyperplasia and severely worn-down and eroded dentition. He is under regular follow-up by the Paediatrics Department of the National University...

Evaluation of a Bedside Test for Phosphorylated Insulin-like Growth Factor Binding Protein-1 in Preterm Labour

The diagnosis of preterm labour poses a problem. Preterm labour accounts for about 50% of preterm births; however, most data reveal that only about 20% of women presenting with suspected preterm labour actually deliver preterm. This article is available only as a PDF. Please click on “Download PDF” on top...

Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey

Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an area of considerable interest, and many unanswered questions surround this organism and the types of diseases it causes. This article is available only as a PDF....

Inaugural College of Obstetricians & Gynaecologists Lecture: Recent Developments in Obstetric Care and Maternal Fetal Medicine in Singapore

Has it done any good to pregnancy outcome as promised? This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Importance of High Resolution Chromosome Analysis in the Diagnosis of Birth Defects: Case Reports of Holoproscencephaly and Cystic Hygroma

Optimal chromosome preparation is a function of many factors. These include cell density culture initiation, optimal time for harvest, concentration and exposure duration to a mitotic arrestant, appropriate hypotonic treatment and adequate fixation with modified Carnoy’s fixative. This article is available only as a PDF. Please click on “Download PDF”...

Tailoring the Field and Indication of Adjuvant Pelvic Radiation for Patients with FIGO Stage Ib Lymph Nodes-Negative Cervical Carcinoma Following Radical Surgery Based on the GOG Score – A Pilot Study

Although no significant survival difference exists between primary surgery and radiotherapy (RT) for the treatment of FIGO stage Ib cervical cancer, radical surgery is the preferred modality of treatment as conservation of the ovarian and vaginal function is of prime importance. It also allows the study of prognostic histopathological...

A Case of Cystic Leiomyoma Mimicking an Ovarian Malignancy

Uterine leiomyomas are the most common gynaecological tumour. Typical appearances of leiomyomas are easily recognised on imaging. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Marijuana in Pregnancy

Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include a unique blend of effects of alcohol, opioids, tranquilisers and hallucinogens, the clinical picture could be very unpredictable and the diagnosis is often difficult. This article...

Abnormal Liver Function Tests in the Symptomatic Pregnant Patient: The Local Experience in Singapore

The diagnostic work-up of abnormal liver function tests (LFT) in pregnancy is challenging, as the conditions peculiar to pregnancy have to be considered in addition to the causes affecting the non-pregnant population. The spectrum of disease is varied and the abnormal LFT can be mild with no long-term consequence,...

Twin Births in Singapore: A Population-Based Study Using the National Birth Registry

Twin studies are regarded as one of the better ways to study the effects and significance of gene, environment and interactions of both. The study of monozygotic (MZ) and dizygotic (DZ) twins allows for an estimation of the relative importance of genes and environment. This article is available only as...

A Fatal Turkish Case of Campomelic Dysplasia

Paediatric Medicine (CD) is a rare form of congenital short-limbed dwarfism, classically characterised by campomelia (bowing of the long bones of the lower extremities) in association with a posterior cleft palate, flattened facies and hypoplastic scapulae. It was first fully and originally described by Spranger et al and Maroteaux...

Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore

Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase in prevalence has also been attributed to the changes in lifestyle and urbanisation in developed countries. This article is available only as a PDF. Please click...

Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome

Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first described in 1961 and the phenotype was subsequently expanded in 1972. This article is available only as a PDF. Please click on “Download PDF” on top...

Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article

Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital setting, such as nebulisers, water baths, dialysis machines and intravenous fluids. This article is available only as a PDF. Please click on “Download PDF” on top...

Gender Disparity in Paediatric Hospital Admissions

Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories appears not to attract much attention or research interest. Gissler and colleagues, in a longitudinal follow-up of all children born in Finland in 1987, reported...

The Effectiveness of Transvaginal Anterior Colporrhaphy Reinforced with Polypropylene Mesh in the Treatment of Severe Cystoceles

Using the Baden-Walker halfway system, Grade 4 cystoceles are defined as extrusions of the bladder base beyond the vaginal introitus with patient straining maximally and represent the extremes of anterior vaginal wall prolapse (Table 1). They result from increased laxity and weakness of the urethrovesical supporting system comprising the...

Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience

Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an enzyme deficiency which led directly to the disruption of cellular metabolism. However 40 years later, it was discovered that many inherited diseases were not due...

Does Visual Turbidity Correlate With Serum Triglyceride Levels in Babies on Total Parenteral Nutrition?

Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles endogenously produced chylomicrons. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Corticosteroids are not Present in a Traditional Chinese Medicine Formulation for Atopic Dermatitis in Children

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have a history of AD. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore

Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the general public, with many of them utilising it for a whole spectrum of ailments. This article is available only as a PDF. Please click on “Download...

Book Review

This handbook is written by 3 obstetricians and gynaecologists based at the KK Women’s & Children’s Hospital, Singapore. It is an excellent book that answers the everyday questions that general practitioner (GP) will ask in their clinical practice. This article is available only as a PDF. Please click on “Download...

Recurrent Non-immune Fetal Hydrops: A Case Report

The incidence of non-immune hydrops (NIH) has been reported to be 1/10001 and is associated with high perinatal morbidity and mortality at all gestational ages with an overall perinatal mortality rate (PNMR) of 86.6%. If the diagnosis is made before 24 weeks’ gestation, the PNMR is 95%, with 30%...

The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004

Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8 months. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia

Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an estimated incidence of 1 in 350,000 in a newborn screening programme. This article is available only as a PDF. Please click on “Download PDF” on top...

Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis

Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this entity became more frequent after the introduction of vasoactive drugs for intracavernosal injections. This article is available only as a PDF. Please click on “Download PDF”...

Paediatrics to Geriatrics: The Continuum

In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it was no different up to the mid 1980s. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore

Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection from close contact. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Rotavirus Vaccine for Infants: The Asian Experience

Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20% of all diarrhoea-related deaths and global mortality among children less than 5 years of age is estimated at nearly half a million. This article is available...

Therapeutic Hypothermia for Neonatal Hypoxic-Ischaemic Encephalopathy

Hypoxic-ischaemic encephalopathy (HIE) is an important cause of death and later neurological disability in full-term neonates worldwide. Perinatal asphyxia causes about 19% of the over 5 million neonatal deaths worldwide annually. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Outcome of Organic Acidurias in China

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Organising Services for IMD in Thailand: Twenty Years Experience

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Newborn Screening in Pakistan – Lessons from a Hospital-based Congenital Hypothyroidism Screening Programme

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Newborn Screening in Bangladesh

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Newborn Screening in China: Phenylketonuria, Congenital Hypothyroidism and Expanded Screening

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Minimising Harm from Newborn Screening Programmes

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Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?

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Financing Newborn Screening Systems: US Experience

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Inborn Errors of Metabolism Presenting as Neonatal Encephalopathy: Practical Tips for Clinicians

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Legal Issues in Neonatal Screening

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Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening

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External Quality Assurance Programme for Newborn Screening of Glucose-6-Phosphate Dehydrogenase Deficiency

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Glucose-6-Phosphate Dehydrogenase Deficiency: Correlation between the Genotype, Biochemistry and Phenotype

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Disorders of Vitamin B12 Metabolism Presenting Through Newborn Screening

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Diagnosis of Tetrahydrobiopterin (BH4) Responsive Mild Phenylketonuria in Japan over the Past 10 Years

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Fatty Acid Oxidation Defects

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Disorders of the Carnitine Cycle and Detection by Newborn Screening

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Spectrum of Inherited Metabolic Disorders in Malaysia

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Establishing a Universal Newborn Hearing Screening Programme

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Current Understanding of Auditory Neuropathy

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A Multidisciplinary Approach to Paediatric Hearing Loss: Programme at the Centre for Hearing Intervention and Language Development, National University Hospital, Singapore

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Early Intervention For Hearing Impairment: Appropriate, Accessible and Affordable

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Impact of the National Hearing Screening Programme in China

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Outcome of Early Cochlear Implantation

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Eliminating Iodine Deficiency: Obstacles and Their Removal

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Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism

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Issues on Universal Screening for Galactosemia

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Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case

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Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: Supporting Arguments

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My Early Experiences in Establishing Neonatal Screening and the Reason for Regional Meetings of the International Society for Neonatal Screening

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Diagnosis and Management Support for an Expanded Newborn Screening Programme

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Considerations in Choosing Screening Conditions: One (US) Approach

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Clinical Applications of Molecular Genetics: The Model of Congenital Adrenal Hyperplasia

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Newborn Screening in Japan: Restructuring for the New Era

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Improved Health and Development of Children who are Deaf and Hard of Hearing Following Early Intervention

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Towards Universal Newborn Screening in Developing Countries: Obstacles and the Way Forward

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Improving Child Health – Newborn Screening for All?

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Neonatal Screening – A Global Perspective

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Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia

Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected vision equal to or worse than 20/40, and it varies from as low as 2.72% in South Africa to as high as 15.8% in Chile. This...

Right Atrial Isomerism – Preponderance in Asian Fetuses. Using the Stomach-distance ratio as a Possible Diagnostic Tool for Prediction of Right Atrial Isomerism

Atrial isomerism is a disorder of lateralisation characterised by symmetric development of normally asymmetric cardiac atria and organ systems. The synonyms for these defects include heterotaxy syndrome, polysplenic/ asplenic syndrome, right/left isomerism, isomerism of the atrial appendages and situs ambiguous. This article is available only as a PDF. Please click...

Assessment of Medical Graduates Competencies

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...

When Words Really Matter

I think a lot these days about doctors giving advice. Nobody taught me, back in medical school, how to give advice. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Behavioural Sleep Disorders in Children and Adolescents

Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are often overlooked by healthcare practitioners. This article is available only as a PDF. Please click on “Download PDF” on top to view the full 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 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...

Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most current version of the Diagnostic and Statistical Manual of Diseases (DSM), fourth edition, has 2 lists of behavioural symptoms grouped under “inattentive” and “hyperactive-impulsive” symptoms,...

Inflammatory Cytokines and Childhood Obstructive Sleep Apnoea

Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway occlusion during sleep that are associated with daytime behavioural changes and abnormalities in cardiovascular function. In adults, it has been shown that OSA is an independent risk factor for cardiovascular diseases. This article is available only as a...

Nasal Obstruction in Children with Sleep-disordered Breathing

Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in the newborn nursery. Later, during development in the first years of life, abnormal nasal breathing has important consequences for facial growth. This article is available only...

The Singapore Years and Subsequently

As a small-town upcountry Malay boy, Singapore was to me a great big city when I first arrived in 1947 to join the King Edward VII Medical College. The tallest building was the Cathay Building, a full 13-storey high. It housed the Cathay Cinema and belonged to the enormously...

Chylous Ascites in Recurrent Gynaecological Malignancies

Chylous ascites is an unusual phenomenon where there is accumulation of chyle in the peritoneal cavity. It is especially rare following treatment of gynaecological cancers. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Placental Calcification in Pseudoxanthoma Elasticum

Pseudoxanthoma elasticum (PXE) is an inherited multisystem disorder of the elastic tissue leading to skin disease as well as ocular and cardiovascular complications. Although earlier literature on pregnancy in PXE contained reports of severe complications, most patients show no serious complications during pregnancy. This article is available only as a...

Holoprosencephaly: An Antenally-diagnosed Case Series and Subject Review

Holoproscencephaly (HPE) is an uncommon congenital developmental defect of the forebrain structures to divide into separate hemispheres and ventricles during embryogenesis. The prevalence rate of HPE is estimated to be between 1 in 11,000 to 1 in 20,000 live births, and 1 in 250 during early embryogenesis. This article is...

Immunogenicity, Reactogenicity and Safety of a Diphtheria-Tetanus-Acellular Pertussis-Inactivated Polio and Haemophilus Influenzae Type b Combination Vaccine in a Placebo-controlled Rotavirus Vaccine Study

Singapore’s national immunisation programme for the 6 traditional Expanded Programme on Immunisation (EPI) vaccines (i.e. BCG, diphtheria, tetanus, pertussis, polio and measles) and hepatitis B has been in place for many years and its success has been dramatic. Despite being previously endemic to Singapore in the 1950s, diphtheria has...

Transfusion-dependent Microcytic Anaemia in a 10-year-old Girl

A 10-year-girl from Bangladesh presented with a moderately severe anaemia (lowest recorded haemoglobin level of 5.6 g/dL) and a mild jaundice (latest serum bilirubin, 31 μmol/L) 3 years ago (Figs. 1 and 2). Test for haemoglobin electrophoresis on agarose gel did not reveal any abnormal bands. This article is available...

Caudal Regression Syndrome

A white female with an uncomplicated history of birth delivery and a familial history of diabetes mellitus presented to the orthopaedic clinic at the age of 16 months old with bowel dysfunction, inability to walk, one kidney, and a gibbus noted at T12. A “frog-like” appearance was noted of...

Laparoscopic Heller’s Cardiomyotomy for Achalasia of the Cardia in a Pregnant Patient

Laparoscopy was first used for the evaluation of acute abdominal pain in pregnancy by gynaecologists in 1980. The most commonly reported laparoscopic procedure during pregnancy is laparoscopic cholecystectomy. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Spontaneous Vaginal Expulsion of a Filshie Clip

Laparoscopic sterilisation is a common method of permanent contraception. The Filshie clip system is a safe and effective method of female sterilisation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

3rd College of Paediatrics and Child Health Lecture – The Past, the Present and the Shape of Things to Come…

In the post-war days of the 1950s, Singapore children were faced with problems of malnutrition and infectious diseases. There was poverty, overcrowded housing and lack of hygiene, and the social conditions were apparently appalling. This article is available only as a PDF. Please click on “Download PDF” on top to...

Auricular Anthropometry of Newborns at the Singapore General Hospital

Abnormalities of the external ear are described in many syndromes and genetic conditions. Melnick et al reported an incidence of 1 in 90 births for external ear malformations and branchial sinuses and tags, with about 1 in 670 births having malformations of the pinna. This article is available only as...

Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation

Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations, especially among children. The severity of the envenomation is related to haemodynamic and cardiorespiratory alterations, with cardiac failure and cardiogenic pulmonary oedema being the major...

Care of Women in Menopause: Sexual Function, Dysfunction and Therapeutic Modalities

Menopause is a life change described by biological alterations occurring in the context of important social changes. There is an increasing appreciation for the role of sexual function in menopause and its importance for a woman’s health and well-being. This article is available only as a PDF. Please click on...

Screening Tools for Bacteraemia in a Selected Population of Febrile Children

Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from bacteraemia and sepsis, which is accompanied by findings of serious systemic illness. This article is available only as a PDF. Please click on “Download PDF” on...

Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined

Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications of osteonecrosis and chondrolysis, preventing further slips, and promoting physeal closure. This article is available only as a PDF. Please click on “Download PDF” on top...

An Unexpected Presentation of Endometriosis – A “Parasitic” Cyst of the Bowel in a Menopausal Woman on Hormone Therapy

Endometriosis commonly affects women during their reproductive years and may involve any organ. Although rare, endometriosis has been reported in postmenopausal women and is often associated with hormone replacement or tamoxifen. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Menopause, Hormone Therapy and Cardiovascular and Cerebrovascular Disease

Cardiovascular disease is a major cause of morbidity among postmenopausal women. Up to the age of 50 years, the prevalence of coronary artery disease (CAD) among women is lower than among men, but the incidence rises significantly after the menopause. This article is available only as a PDF. Please click...

Adverse Hospital Outcomes Associated With the Choice of Empiric Antibiotics in Klebsiella pneumoniae Pneumonia: A Retrospective Observational Study

Klebsiella pneumoniae ranks high as a cause of community-acquired pneumonia (CAP) in hospitalised patients in Malaysia.1-3 This appears unique, as most reports from other countries including Thailand4 do not always share this finding. Studies from Singapore have shown that K. pneumoniae is important in severe CAP requiring hospitalisation,5 not...

Impact of Various Continuing Medical Education Activities on Clinical Practice – A Survey of Malaysian Doctors on its Perceived Importance

Continuing medical education (CME) plays an indispensable role in the clinical practice of any doctor. The practice of evidence-based medicine today,1 or any meaningful learning per se, requires at least appropriate access to relevant updated medical information. However, the acquisition of such relevant medical knowledge can prove difficult and...

Paediatric perineal skin pit: More than skin deep?

A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth, his parents were informed that he had a “bilobed scrotum and a deep perineal skin pit” that may pose hygiene and cosmetic issues. They had...

Violence-Related Behaviours among Malaysian Adolescents: A Cross Sectional Survey among Secondary School Students in Negeri Sembilan

Adolescent violence is a serious social issue globally. Adolescent violence is also making its presence felt in Malaysia, as evidenced by newspaper reports. Violence can be defined in many ways and is a subset of aggressive behaviour. Some have suggested that aggression in childhood leads to violence in adolescent...

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

Morbidity of Parainfluenza 3 Outbreak in Preterm Infants in a Neonatal Unit

Parainfluenza type 3 virus (PIV-3) is an important nosocomial pathogen. It closely mimics respiratory syncytial virus (RSV) in its clinical presentations, and in infants. It is the second commonest cause of pneumonia and bronchiolitis after RSV. This article is available only as a PDF. Please click on “Download PDF” on...

An Unexpected Outcome following Radial Head Excision for Jeffrey Type II Fracture-Dislocation of the Proximal Radius in a Child

We present a case of a 10-year-old child who sustained a traumatic fracture-dislocation of his proximal radius and subsequently underwent surgical removal of the radial head. At 3 years of follow-up, he had regained full painless flexion and extension with loss of pronosupination. This article is available only as a...

Temporary Tattoo Associated Type IV Delayed Hypersensitivity Dermatitis in a Child – A Case Report and Call for Parental Caution in Singapore

A 5-year-old, previously healthy French Caucasian boy was seen at a Paediatric Emergency Department for a skin rash over his left forearm. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Influence of Maternal Ethnic Group and Diet on Breast Milk Fatty Acid Composition

Human milk is the ideal food which provides the complete nutritional requirements for infants during the first 6 months of life. The lipids accumulated in an infant represent the majority of all energy retained in the growing tissues during this crucial period of rapid growth and development. This article is...

A Case of Congenital Haemolytic Anaemia and Thrombocytopenia

A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to thrive since birth. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

An Exanthem with An Annular Pattern in a 2-year-old Girl

A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the trunk and hands. The parent’s concern was the rash’s duration and association with 2 episodes of fever. This article is available only as a PDF. Please...

Clinical Features Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis

Causes of neonatal cholestasis (NC) are long and diverse but the responses of newborn liver, either physiological or anatomical, are limited. This is because the ability of a developing liver of responding in the face of a variety of insults are limited. This article is available only as a PDF....

Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children

Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can cause significant morbidity and mortality in children as well as adults. This article is available only as a PDF. Please click on “Download PDF” on top...

A Clinicopathologic Study of Uterine Smooth Muscle Tumours of Uncertain Malignant Potential (STUMP)

Smooth Muscle Tumours of Undetermined Malignant Potential or STUMPs are interesting tumours from both the standpoint of histological diagnosis and classification as well as clinical management mainly because, as a group, its natural history is poorly understood. Prognostic criteria of how STUMP tumours will behave have been studied and...

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...

Bannayan Riley Ruvalcaba Syndrome

Bannayan-Riley-Ruvalcaba syndrome (BRRS) classically presents with macrocephaly, subcutaneous and visceral lipomata, haemangiomata, hamartomatous intestinal polyps and pigmented macules involving the genitalia. This autosomal dominant disorder is linked to germline mutations of the phosphatase and tensine homologue gene (PTEN), a tumour suppressor gene which has a significant role in the...

Dyke-Davidoff-Masson Syndrome

An 8-year-old boy presented with uncontrolled seizures. He was born as the second child to non-consanguineous parents. He had significant perinatal asphyxia in the newborn period. He had developmental delay since infancy and was noticed to have right-sided tonic clonic seizures since the age of 3 years, which was...

Childhood Food Allergy: A Singaporean Perspective

Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the term IgE-mediated food allergy is appropriate. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?

Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of devices has been developed for use over the years, with significant advances achieved in terms of profile and safety. This article is available only as a...

Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns

Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise in numbers of infected cases despite initial containment followed by mitigation efforts. Local incidence for acute upper respiratory infections (which was a reasonable surrogate for...

Obstetric Outcomes of Influenza A H1N1 (2009) Infection in Pregnancy – Experience of a Singapore Tertiary Hospital

Influenza A H1N1 (2009) is a new viral strain containing gene segments from human, swine and avian lineages. Soon after reports of human cases of the infection in April 2009, the World Health Organization declared the situation a public health emergency of international concern. This article is available only as...

Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?

We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the light of some of the points raised such as frequent comorbidities that occur with ADHD as is the case of Autistic disorder and other conditions...

Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?

I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than curing for attention deficit hyperactivity disorder (ADHD) is taking place. There are some evidence-based points that should be noted. This article is available only as a...

Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report

The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to the development of several intravitreal anti-angiogenic therapeutics. Ranibizumab (Lucentis, Genentech, San Francisco, USA) and pegaptanib (Macugen, OSI/Eyetech Pharmaceuticals, New York, USA) have been FDA-approved for...

Dedicated Cytogenetics Factor is Critical for Improving Karyotyping Results for Childhood Leukaemias – Experience in the National University Hospital, Singapore 1989-2006

Acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) make up the bulk of childhood leukaemia cases. With risk stratified therapy being one of the cornerstones of the treatment of childhood leukaemia, it is important to determine the prognostic factors on which risk stratified therapy depends. This article is available...

Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007

Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is of public health importance because of the teratogenic effects of the virus on the developing fetus. This article is available only as a PDF. Please click...

Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study

The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months and partial breastfeeding thereafter for at least 12 or 24 months....

A Missed Bilateral Choanal Atresia

What do you see in the image? a) Deviated posterior nasal septum b) Nasopharyngeal tumour c) Rhinolith with mucous plug d) Bilateral choanal atresia e) Nasal pyriform aperture stenosis This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Dilemmas in Management of Brain Tumours in Pregnancy

Brain tumours in pregnancy are rare with an incidence of 15 per 100,000 and previous reports have shown variable outcomes. We present a case of glioblastoma multiforme (GBM) in pregnancy in which the patient underwent emergency craniotomy and adjuvant radiotherapy before delivering a healthy baby with good outcome. This article...

A Unique Pair of Monozygotic Twins with Concordant Clear Cell Renal Cell Carcinoma: A Case Report

Studies of monozygotic and dizygotic twins represent an important approach in estimating the relative contributions of genes and environment to the development of various cancers and disease in general. However, remarkably and almost curiously, there has been no monozygotic twin-pair concordant for clear cell renal cell carcinoma (ccRCC) reported...

Health-related Quality of Life in Children with Cancer Undergoing Treatment: A First Look at the Singapore Experience

Health-related quality of life (HRQOL) has been progressively acknowledged as an essential health outcome measure in clinical trials and health services research and evaluation. HRQOL, compared to QOL, is a more defined conceptual term which encompasses only health-related aspects of life directly amenable to healthcare services and medical products. This...

Clinical Outcomes of High-risk Labours Monitored Using Fetal Electrocardiography

Intermittent auscultation (IA), cardiotocography (CTG), amniotic fluid colour and fetal scalp capillary blood gas analysis are currently accepted standards for intrapartum fetal monitoring. According to the results of recent randomised clinical trials, intrapartum CTG monitoring is a very sensitive method; however, its very low specificity seems to be strongly...

Microsurgical Reversal of Sterilisation – Is This Still Clinically Relevant Today?

Different contraceptive options are available today; however, tubal sterilisation is still one of the most prevailing contraceptive alternatives. Locally, many prefer mechanically occluding the tubes with Filshie clips. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

TT Genotype of the Methylenetetrahydrofolate Reductase C677T Polymorphism is an Important Determinant for Homocysteine Levels in Multi-Ethnic Malaysian Ischaemic Stroke Patients

Stroke is the major cause of adult disability in developing countries. Traditional risk factors contribute up to 69% of the total risk of ischaemic stroke. There is a substantial body of knowledge to suggest that there are novel risk factors which may confer additional risks. Hyperhomocysteinaemia (hyperHcy) has been...

Normative Data for Quantitative Calcaneal Ultrasound in Asian Children

Dual energy X-ray absorptiometry (DEXA) is currently the gold standard for the assessment of bone mineral density (BMD). It is the commonest tool used to predict fracture risk in patients at risk of osteoporosis. The limitation of DEXA is that it only measures bone density in two dimensions, and...

Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore

The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist into adulthood and increases the risk of cardiovascular metabolic diseases, giving rise to an increased healthcare burden. In Singapore, the prevalence of obesity for adults...

Short- and Long-Term Outcomes at 2, 5 and 8 Years Old for Neonates at Borderline Viability—An 11-Year Experience

Singapore was listed consistently among the top 3 countries in the world with the lowest infant mortality rate. In particular, Asia had seen its infant mortality rate improve dramatically with time. Advances in perinatal care had however, failed to improve the survival of extremely low birth weight infants of...

Neonatal Outcome of the Late Preterm Infant (34 to 36 Weeks): The Singapore Story

Neonatologists were caught looking the other way in the early part of the millennium. While they were keenly following the progress of extreme preterms and their travails, preterms born at the other end of the spectrum were being quietly ignored as “well babies”. In July 2005, the National Institute...

Severe Vitamin B12 Deficiency in a 7-Month-Old Boy

Infantile vitamin B12 deficiency often affects children born to mothers whose nutritional intake is inadequate. We describe a 7-month-old boy with a 2-month history of recurrent vomiting, neurodevelopmental regression, failure to thrive (FTT) and macrocytic anaemia, who was diagnosed to have vitamin B12 deficiency. This article is available only as...

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...

Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?

The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The Fetal Medicine Foundation, London, has refined and populated this screening test that uses a combination of maternal age, nuchal translucency (NT) thickness and biochemical markers,...

Prenatal Diagnosis of Chromosomal Abnormalities—Shifting Paradigm

It is very likely that in 10 years time, invasive prenatal diagnostic tests like amniocentesis and chorionic villus sampling (CVS) will join the club of forgotten obstetric procedures like vaginal breech delivery and rotational forceps delivery. In 1968, Henry Nadler1 and his team were the first to report prenatal...

Treatment of Ewing sarcoma in children: Results from a single centre

Dear Editor, Ewing sarcoma is a malignant mesenchymal tumour that presents as a bone or soft-tissue sarcoma. Translocations involving the EWS gene on chromosome 22q12 are unique molecular signatures.1,2 Compared with the West where the annual incidence is 1–3 per million, incidence has been reported to be lower among Asians1...

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 paediatric intensive care unit (PICU) admissions, and mortality rates can be as high as 21.3% in North America and Europe to 50.0% in Asia.2-4 Of...

A rare case of thigh asymmetry in an infant

A 6-month-old baby boy presented with asymmetry of thighs since birth. On clinical examination, anteromedial aspect of the left thigh was bulky with pale yellow discolouration of the skin and no tenderness. The child was referred for high-resolution ultrasonography. On ultrasonography, there was evidence of a well-defined isoechoic soft...

Impact of true fetal mosaicism on prenatal screening and diagnosis

Over the past decade, the non-invasive prenatal test (NIPT) has increasingly been used as a method for prenatal screening for trisomy 21 (T21) and other aneuploidies, complementing the traditional approach of first trimester screening (FTS). FTS comprises ultrasound of the nuchal thickness and blood test to measure the levels...

A review of child sexual abuse cases presenting to a paediatric emergency department

Child sexual abuse (CSA) is a global public health issue with adverse short- and long-term repercussions. Formal definitions of CSA and the age for defining children differ around the world. In Singapore, CSA refers to any act where a child or young person below 16 years old is used...

Prevalence of thyroid malignancy and hormonal dysfunction following radiation exposure in childhood

The incidence of thyroid cancer has been steadily increasing worldwide. Childhood radiation exposure is a known risk factor for thyroid malignancy. However, data on the incidence of thyroid cancer in this high-risk cohort in Singapore are limited. Thus, we assessed data from patients treated in our institution with a...

Maternal obesity and risk of adverse obstetric outcomes in Malaysia

Obesity during pregnancy is associated with increased risk of adverse health outcomes such as gestational diabetes mellitus (GDM), hypertension and preeclampsia. Unlike the well-known association between maternal hyperglycaemia and pregnancy outcomes, the effect of obesity in pregnancy has drawn some controversial conclusions.1Data are even scarcer in Southeast Asia countries....

Autism Spectrum Disorder and COVID-19: Helping Caregivers Navigate the Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has disrupted societies globally. As of 11 May 2020, 53 children have been infected with COVID-19 in Singapore (Ministry of Health, Singapore, unpublished data). Children generally have mild disease, although there is emerging literature on paediatric multisystem inflammatory syndrome temporally associated with COVID-19....

Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children

Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...

Importance of antenatal blood group typing and antibody screening in non-ABO/Rh haemolytic disease of the newborn

Haemolytic disease of the fetus and newborn (HDFN) is a severe, potentially fatal alloimmune condition where maternal antibodies are produced, transported across the placenta and react against fetal red blood cell (RBC) antigens, resulting in varying degrees of haemolytic anaemia. Although ABO and Rhesus D (RhD) incompatibility is responsible...

Uterine rupture in Singapore: Trends and lessons learnt

Uterine rupture is arguably one of the most dreaded acute obstetric complications in obstetrics. Synonymous with significant maternal and perinatal morbidity and mortality risks, uterine rupture is usually encountered in the context of vaginal births after previous caesarean section (VBAC). This article is available only as a PDF. Please click...

Decrease in emergency department attendances during COVID-19 especially in school-going children

Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with minor ailments, but these observations have yet to be evaluated in Singapore. We investigated ED attendances during the coronavirus disease 2019 (COVID-19) pandemic in Singapore. This...

Alternating hemiplegia of childhood presenting as recurrent apnoea in a term newborn infant

Recurrent apnoea in a term infant is usually pathologic, warranting a thorough aetiologic evaluation. An accurate diagnosis is essential in guiding subsequent management and understanding long-term prognosis. This article is available only as a PDF. Please click on "Download PDF" to view the full article.

Paediatric emergency department attendances during COVID-19 and SARS in Singapore

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...

Epidemiology and risk stratification of minor head injuries in school-going children

Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports and road traffic injuries are common causes in school-going children. Majority of paediatric head injury cases are mild traumatic brain injuries, defined as a Glasgow...

The Singapore Cerebral Palsy Registry: An important new resource for cerebral palsy research

Cerebral palsy (CP) is a common, lifelong disorder of movement and posture resulting from an insult or maldevelopment of the developing brain. The movement disorders of CP are often accompanied by other associated sensory and cognitive impairments. For the majority of children (about 95% in high income countries), the...

Cervical screening in foreign domestic workers in Singapore

Cervical cancer is the most common gynaecological cancer in many countries in Southeast Asia, with a cumulative age-standardised incidence rate (ASRI) of 17.2 per 100,000 and a corresponding mortality rate (ASMR) of 10 per 100,000. In Singapore, cervical cancer is the 10th most common cancer in women with an...

Causes, functional outcomes and healthcare utilisation of people with cerebral palsy in Singapore

Cerebral palsy (CP) describes a group of permanent, but often changing, disorders that affect movement and posture, causing activity limitation, attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The birth prevalence of CP is estimated to be 1.4–2.2 per 1,000 in high-income countries. It...

Risk factors and outcomes of uterine rupture in Singapore: Emerging trends

Uterine rupture is a catastrophic life-threatening complication of pregnancy with associated high maternal and neonatal morbidity and mortality. The incidence of uterine rupture varies with geographical location and obstetric practice. With the changes in obstetric practice over the years, caesarean section rates have increased in our population with undesirable...

Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury

The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range from USD5.9 billion–76.5 billion. Studies performed in the adult population reported that the direct cost of acute rehabilitation had been relatively similar over a 10-year...

Epidemiology and Control of Hand, Foot and Mouth Disease in Singapore, 2001-2007

Hand, foot and mouth disease (HFMD) is a common childhood viral infection, which is typically mild and self-limiting. It is characterised by a brief prodromal fever, followed by pharyngitis, mouth ulcers and rash on the hands and feet. The disease is caused by numerous members of the Enterovirus genus...

Perinatal Drug Abuse in KK Women’s and Children’s Hospital

In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance abuse in a pregnant population to be approximately 11% (range 0.4% to 27%) in a survey of 35 perinatal centres in the United States. This article...

A Pilot Study of the Efficacy and Tolerability of Intralesional Recombinant Human Beta-Interferons in Cervical Intraepithelial Neoplasia

Cervical intraepithelial neoplasia (CIN) is a neoplastic disorder in which infection with sub-types of the human papillomavirus appears to play an important aetiological ro1e. The interferons are a family of proteins which possess anti-viral action, inhibit cell proliferation and modulate the natural immune response2 and which therefore may be...