Related Articles

HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?

Dear Editor, Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent...

Singapore tuberculosis (TB) clinical management guidelines 2024: A modified Delphi adaptation of international guidelines for drug-susceptible TB infection and pulmonary disease

Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis complex. For decades, it was the leading cause of death worldwide from a...

Hantavirus haemorrhagic fever and renal syndrome, caused by the Hantaan virus in Singapore: A case report

Dear Editor, We outline a case of a 59-year-old Malaysian man of Indian origin with no known past medical history apart from diabetes mellitus and...

The potential of RNA therapeutics in dermatology

Graphic design by Liu Yujia Ribonucleic acid (RNA) therapeutics involving, among others, microRNAs (miRNAs), small interfering RNAs (siRNAs) and/or antisense oligonucleotides (ASOs) hold great potential...

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...

Outcomes of nurse-led cryotherapy treatment for viral warts

Dear Editor,  Cryotherapy is a cost-effective treatment that can be performed by non-dermatologists for viral warts, which are very common.1,2 The National University Hospital, Singapore...

Impact of pre-existing depression on severe COVID-19 outcomes

The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the...

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

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

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...

Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome

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

Clinical outcome of bacterial endogenous endophthalmitis in 15 patients

Dear Editor, Endophthalmitis refers to the inflammation of the ocular cavities and their immediate adjacent structures without extension beyond the sclera, usually secondary to...

Combating a resurgence of poliomyelitis through public health surveillance and vaccination

Singapore was certified poliomyelitis (polio)-free by the World Health Organization (WHO) on 29 October 2000, together with 36 other countries in the Western Pacific...

Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients

The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with...

Early COVID-19 booster is beneficial in cancer patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in...

Vaccination and surveillance: Two basic tools for a final poliomyelitis eradication

Over the past 3 decades, the Global Polio Eradication Initiative (GPEI) has strived to achieve a poliomyelitis (polio)-free world. Wild poliovirus (WPV) types 2...

Lichen planus pemphigoides after pembrolizumab immunotherapy in an older man

An 84-year-old Chinese man with stage IV non-small cell lung cancer was initiated on pembrolizumab, an anti-programmed cell death (PD)-1 monoclonal antibody, 4 times...

Drug interactions between common dermatological medications and the oral anti-COVID-19 agents nirmatrelvir-ritonavir and molnupiravir

In December 2021, an Emergency Use Authorisation was issued by the U.S. Food and Drug Administration (FDA) for the use of the orally active...

Characteristics of anti-transcriptional intermediary factor 1 gamma autoantibody-positive dermatomyositis patients in Singapore

Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of acquired, systemic autoimmune conditions characterised by muscular and extramuscular manifestations. As a subset within the...

Pharmacokinetic and pharmacogenomic considerations in managing use of nirmatrelvir-ritonavir and molnupiravir and dermatological treatments

The COVID-19 pandemic has been unprecedented in its impact on global health, economic, financial, psychosocial and political systems. The World Health Organization estimates approximately...

Idiopathic inflammatory myopathies: Not nearly the end of the road

The clinical spectrum of idiopathic inflammatory myopathies (IIM) has broadened over the past half century from a simple disease characterised primarily by muscle and...

A strategy to make COVID-19 vaccination more accessible to the elderly

Dear Editor, Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the...

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...

A man with bark-like skin

A 65-year-old Chinese man was admitted for evaluation of chronic anaemia. He had a history of hypertension and chronic kidney disease, and his regular...

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

Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus...

TB or not TB? The axillary lump question

An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule...

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

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

Teaching and learning during the COVID-19 pandemic: Perspectives of medical students in Singapore

Dear Editor, The coronavirus disease 2019 (COVID-19) pandemic has resulted in many changes to medical education, including the site and mode of teaching, conducting of...

Global monkeypox outbreak 2022: First case series in Singapore

Monkeypox has been declared a public health emergency of international concern. Up until 2022, most cases of monkeypox have been reported in parts of...

The global emergence of monkeypox

Monkeypox is so named because the poxvirus was first identified in 2 outbreaks among cynomolgus monkeys housed at the Statens Serum Institut, Denmark, in...

Neuralgic amyotrophy in COVID-19 infection and after vaccination

Dear Editor, Various neurological manifestations associated with coronavirus disease 2019 (COVID-19) have been described,1 conditions which left a significant proportion of patients with permanent disability....

Attitude towards screening for congenital cytomegalovirus infection in newborns in Singapore

Dear Editor, Cytomegalovirus (CMV) infection is the most common congenital infection.1 A systematic review that included 77 studies from 36 countries reported that the overall...

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...

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...

Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore

Within 3 weeks of the World Health Organization declaring the COVID-19 pandemic on 11 March 2020, the Society of Critical Care Medicine (SCCM) and...

Challenges and considerations in delivering nutritional therapy in the ICU during COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) has created unprecedented challenges for healthcare workers in Singapore and across the world. Providing clinical nutrition and metabolic care to...

BNT162B2 COVID-19 mRNA vaccination did not promote substantial anti-syncytin-1 antibody production nor mRNA transfer to breast milk in an exploratory pilot study

Dear Editor, Vaccine hesitancy still threatens global efforts to end the COVID-19 pandemic caused by SARS-CoV-2 and its emerging variants. Social media-driven “conspiracy theories”...

COVID-19 vaccination acceptance of healthcare workers in Singapore

The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end...

Prevalence and correlates of psychological distress and coronavirus anxiety among hospital essential services workers in Singapore

The Coronavirus Disease 2019 (COVID-19) has affected almost all geographies in the world since 2020. Many countries have imposed strict isolation measures to contain...

Injection site reactions after COVID-19 mRNA vaccination

Dear Editor, The Pfizer-BioNTech (BNT162b2 mRNA) and Moderna (mRNA-1273) COVID-19 vaccinations were approved for use in Singapore in December 2020 and February 2021, respectively. To...

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

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

Intravascular large B-cell lymphoma associated with sudden stridor arising from thyroid mucormycosis and concomitant bacterial infection

Dear Editor, Mucormycosis is a life-threatening fungal infection that mainly affects immunocompromised patients. It typically has low prevalence, but fatality rate is as high...

Cryptococcal Prostatic Abscess in an Immunocompromised Patient: A Case Report and Review of the Literature

Cryptococcosis is a well-recognised infection in immunocompromised patients, although its prevalence varies with the type of immune defect. We report a patient with myasthenia...

Cutaneous Polyarteritis Nodosa: A Case Report and Literature Review

Cutaneous polyarteritis nodosa (CPN) is an uncommon form of vasculitis of the small-and medium-sized arteries in the reticular dermis and subcutaneous tissue. It remains...

Sezary Syndrome: A Case Report and a Review of the Molecular Pathomechanism and Management

Our patient is a 64-year-old Malay man who first presented in July 1993 with a history of rash starting on the hands 1½ years...

A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia

Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy. This...

Emerging Therapies for Sepsis and Septic Shock

Septic shock remains a major cause of morbidity and mortality among hospitalised patients despite advances in antimicrobial therapy and medical support. This article is available...

Rosai-Dorfman Disease with Primary Cutaneous Manifestations—A Case Report

In 1969, Rosai and Dorfman first described a newly recognised benign systemic histioproliferative disease characterised clinically by bilateral striking cervical lymphadenopathy, fever, leukocytosis, and...

Epidemiological Surveillance of Melioidosis in Singapore

Melioidosis was first described in 1911 among vagrants and morphine addicts brought into the mortuary in Rangoon, Burma. However, the disease received little attention...

The Global Pandemic of Dengue/Dengue Haemorrhagic Fever: Current Status and Prospects for the Future

The world has experienced unprecedented population growth in the past 50 years that continues unabated in the waning years of the 20th century. It...

Bullous Dermatomyositis Associated with Nasopharyngeal Carcinoma —A Case Report

Bullous dermatomyositis is a rare variant of dermatomyositis and has been reported in the literature. It is believed to be strongly associated with the...

Case Reports of Linear IgA Bullous Dermatosis of Childhood

Linear IgA bullous dermatosis of childhood (LADC) is an acquired subepidermal blistering disorder of young children which is characterised by the unique finding of...

Atypical Mycobacterium Infection with Sporotrichoid Spread in a Patient with Human Immunodeficiency Virus

Mycobacteria other than tubercle bacilli (MOTT) were shown to be agents of human disease in the 1950s. They are also known as atypical, environmental...

One-year Review of Pityriasis Rosea at the National Skin Centre, Singapore

Pityriasis rosea is a common, self-limited disorder of unknown but suspected viral aetiology, that develops abruptly with few or no prodromal symptoms. Classically, the...

Repigmentation of Vitiligo with Autologous Blister-induced Epidermal Grafts

Treatment of vitiligo can sometimes be difficult and disappointing. Medical treatment includes topical or systemic steroids and psoralen with ultraviolet A light (PUVA). This article...

Palm Printing on Agar Plates of Hands of Health Care Workers from the Intensive Care Units of the National University Hospital of Singapore

Nosocomial infections are one of the major causes of morbidity and mortality in hospitals resulting in increasing health care costs. The intensive care unit...

Disseminated Penicillium marneffei Infection: A Report of Five Cases in Singapore

Penicillium marneffei is a dimorphic fungus that can cause infection in immunocompromised hosts. Reports on infection with this organism were initially uncommon, but after...

Eccrine Porocarcinoma: A Case Report

Porocarcinoma is a rare malignant tumour, arising from the intra-epidermal ductal portion of the eccrine sweat gland, also known as “acrosyringium”.’ According to the...

A Comparison of Antigen Dipstick Assays with Polymerase Chain Reaction (PCR) Technique and Blood Film Examination in the Rapid Diagnosis of Malaria

According to the 1996 epidemiological studies in Singapore done by the Ministry of the Environment, a total of 364 cases of malaria were reported...

Retrospective Study of Behcet’s Disease seen at the National Skin Centre, Singapore

Behcet’s disease, first described by a Turkish dermatologist, Dr Hulusi Behcet, is a multisystem inflammatory disorder of unknown aetiology. The diagnosis of Behcet’s disease...

Use of Ligase Chain Reaction and Polymerase Chain Reaction on Urine Specimens to Detect Chlamydia trachomatis Infections in a Sexually Transmitted Diseases Clinic in Singapore

Infections caused by Chlamydia trachomatis are amongst the most common bacterial sexually transmitted diseases (STDs) in the world, causing substantial morbidity in young sexually-active...

A Case Report: Persistent Acantholytic Dermatosis in Chronic Renal Failure

A 70-year-old Chinese man with end-stage renal failure (ESRF), who has been on continuous ambulatory peritoneal dialysis for 6 months, was referred by the...

Squamous Cell Carcinoma arising in a Cutaneous Epidermal Cyst—A Case Report

Epidermal cysts are common benign subcutaneous lesions. Malignant transformation in epidermal cysts is a rare but recognised occurrence. This article is available only as a...

Granuloma Annulare: A Review of 41 Cases at the National Skin Centre

Granuloma annulare (GA) is a benign, inflammatory disorder of the skin that has no proven aetiology or widely accepted theory of pathogenesis. There are...

Correlation of Baseline Quantitative Plasma Human Immunodeficiency (HIV) Type 1 RNA Viral Load with Clinical Status and CD4+ T-cell Counts in Treatment-Naïve HIV-Positive Patients in Singapore

Quantitative plasma human immunodeficiency virus type 1 (HIV-1) ribonucleic acid (RNA) viral load is used clinically as a predictor of progression of HIV-1 infection...

A Case Report of Erythema Induratum of Bazin’s Disease

There are many dermatological manifestations of tuberculosis, ranging from distinct entities such as tuberculosis verrucosa cutis, lupus vulgaris, scrofuloderma, to tuberculides. The term tuberculide...

A Case of Mycobacterium scrofulaceum Osteomyelitis of the Right Wrist

Whilst infections caused by Mycobacterium tuberculosis may be a common occurrence in this part of the world, those caused by atypical mycobacteria are rarely...

Case Report of Staphylococcus lugdunensis Native Valve Endocarditis and Review of the Literature

Coagulase-negative staphylococci cause 5% of native valve endocarditis. Of the 30 species identified currently, Staphylococcus epidermidis is a well-recognised cause of native valve endocarditis;...

Re: One-year Review of Pityriasis Rosea at the National Skin Centre, Singapore

I refer to a paper published in the Annals Vol. 28 No. 6 November 1999 titled “One-year review of pityriasis rosea at the National...

Treatment of Chronic Urticaria with Thyroxine in an Euthyroid Patient with Thyroglobulin and Microsomal Antibodies

Chronic urticaria is defined as daily outbreaks of urticaria of at least 6 weeks duration. Despite being a common disorder, the cause of chronic...

An Unusual Case of Cutaneous Vasculitis

A 49-year-old Chinese man presented at the Tan Tock Seng Hospital with painful gangrene of the right second and left third and fourth toes...

Classical and Amyopathic Dermatomyositis seen at the National Skin Centre of Singapore: A 3-year Retrospective Review of their Clinical Characteristics and Association with Malignancy

Polymyositis/dermatomyositis is a connective tissue disorder with inflammatory muscle disease resulting in muscle weakness. When there is only muscle involvement, the term polymyositis is...

Case Reports of Nocardiosis in Patients with Human Immunodeficiency Virus (HIV) Infection

Nocardiosis is an infection caused by a soil-borne aerobic filamentous bacterium in the genus Nocardia and the order Actinomycetales. Within the genus Nocardia, N....

Neonatal Lupus Erythematosus: Our Local Experience

Neonatal lupus erythematosus (NLE) is related to the transplacental passage of anti-Ro antibodies from mother to foetus. The commonest manifestations involve the skin and...

Lichen Amyloidosus: A Bullous Variant

Systemic amyloidosis, first reported in 1886, is characterised by deposits of amyloid in various organs including the skin, which may manifest as skin purpura,...

Pericardial effusion and tamponade in a young woman

A young woman presented to the Singapore General Hospital with a history of cough in the 2 weeks prior. She had no significant past...

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...

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...

Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality worldwide. The development of mRNA vaccines has heralded much hope in...

Human Immunodeficiency Virus Infection Presenting with Chronic Actinic Dermatitis: A Case Report

A 40-year-old Chinese man of skin phototype III (Table I), formerly a welder in a shipyard, presented with pruritic papules on his face, neck...

Histoplasmosis Presenting with Progressively Worsening Backache—A Case Report

A 55-year-old man presented with intermittent low back pain of 2 months’ duration which was progressively worsening, fever, anorexia and a 10-kg weight loss....

In vitro Activity of Moxifloxacin against Local Bacterial Isolates

The introduction of newer generation fluoroquinolones has generated great interest, especially in this era of increasing antimicrobial resistance. Among gram-positive resistant bacteria, the most...

Comparison of Allergic Contact Dermatitis Cases in the Private and Subsidised Clinics in the National Skin Centre, Singapore

Allergic contact dermatitis is a common clinical problem seen in our dermatology outpatient clinics, comprising 0.5% of patients seen in 1999. In addition to...

Malignant Melanoma Seen in a Tertiary Dermatological Centre, Singapore

Unlike in Caucasians, primary malignant melanoma is an uncommon skin malignancy in Singapore. There have been little published data on cutaneous melanoma in Southeast...

A Retrospective Study of Incontinentia Pigmenti Seen at the National Skin Centre, Singapore Over a 10-year period

Incontinentia pigmenti, called Bloch-Sulzberger syndrome, is a rare X-linked dominant disorder involving ectodermal structures. It is a multisystem disorder with cutaneous, ocular, dental, cerebral...

Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci: Emerging Problems and New Prospects for Management

The prevalence of nosocomial infections due to Gram-positive bacteria has increased dramatically over the last two decades. In North America, Gram-positive cocci now are...

Bugs for the Next Century: The Issue of Antibiotic Resistance

Emerging antibiotic resistance is a global problem. Antibiotic resistance results in morbidity and mortality from treatment failures and increased health care costs. This article is...

Melioidosis Splenic Abscess—An Unusual Presentation as Osteomyelitis of Rib

A 74-year-old Chinese gentleman first presented in February 1999 with an abscess over his left lower chest. He was treated for pulmonary tuberculosis in...

A Retrospective Study of Melanocytic Naevi at the National Skin Centre

Melanocytic naevi are benign proliferation of melanocytes of congenital and acquired types which usually appear during adolescence or early adult life. Naevi are of...

Antibiotic Sensitivity of Propionibacterium acnes Isolates from Patients with Acne Vulgaris in a Tertiary Dermatological Referral Centre in Singapore

In Southeast Asia, there have been few studies on the emergence of antibiotic-resistant strains of Propionibacterium acnes on the skin of patients with acne...

Clinical Utility of Polymerase Chain Reaction in the Detection of Mycobacterium tuberculosis in Different Types of Cutaneous Tuberculosis and Tuberculids

Laboratory confirmation of cutaneous tuberculosis has remained difficult using conventional techniques which include the demonstration of acid-fast bacilli (AFB) on histopathologic examination and culture....

A Retrospective Study on the Characteristics of Androgenetic Alopecia among Asian Races in the National Skin Centre, a Tertiary Dermatological Referral Centre in Singapore

Androgenetic alopecia is hair thinning or balding due to the influence of androgens in males and females. Androgenetic alopecia is reported to affect 50%...

A Review of Cutaneous Granulomas and Lupus Vulgaris Following BCG Vaccination in a Skin Hospital in Singapore

BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in...

The Epidemiology and Treatment of Anogenital Warts in Singapore: A Retrospective Evaluation

Anogenital warts are caused by specific subtypes of the human papillomavirus (HPV), of which serotypes HPV 6 and 11 are the most common. There...

Fluconazole Susceptibility of Candida Species in Singapore by Disc Diffusion Test

Candida species is becoming increasingly important as a cause of serious infections particularly in immunocompromised patients. Surveillance in the USA between April 1995 and...

Sexually Transmitted Diseases in the Older Population in Singapore

Sexually transmitted diseases (STDs) in persons older than 50 years are rarely studied because STDs are more common in young people. There is very...

Allopurinol Hypersensitivity Syndrome and Acute Myocardial Infarction—Two Case Reports

Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe multiorgan disease. It usually begins 2 to 6 weeks (up...

Influenza in Singapore: Assessing the Burden of Illness in the Community

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

Bullous Pemphigoid Seen at the National Skin Centre: A 2-year Retrospective Review

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder affecting mainly the elderly. It is characterised by autoantibodies to the basement membrane zone (BMZ),...

Clinical Profile and Treatment Outcome of Livedoid Vasculitis: A Case Series

Livedoid vasculitis is a clinicopathological entity that has variously been referred to as atrophie blanche, livedoid vasculopathy or segmental hyalinising vasculitis. It presents with...

A Case of Penicillamine-induced Dermopathy

D-penicillamine is a copper chelator used primarily in Wilson’s disease and cystinuria. Other long-term indications include rheumatoid arthritis, scleroderma and primary biliary cirrhosis. This article...

The Role of Influenza Vaccine in Healthcare Workers in the Era of Severe Acute Respiratory Syndrome

The new coronavirus responsible for severe acute respiratory syndrome (SARS) found its first victims in healthcare workers with attack rates of more than 50%...

Sweet’s Syndrome Associated with Mycobacterium chelonae and Herpes Simplex Virus Infections: A Case Report

Sweet’s syndrome is an acute febrile neutrophilic dermatosis. An association with malignancy is well recognised. This article is available only as a PDF. Please click...

Severe Acute Respiratory Syndrome (SARS) — 150 Days On

The Severe Acute Respiratory Syndrome (SARS) has been identified as a new clinical entity in the year 2003. It was on 12 March 2003...

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...

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...

An intensely pruritic disseminated skin eruption

A 64-year-old man presented to the dermatology outpatient clinic with a 4-month history of pruritic papules. He had a significant medical history of thyrotoxicosis,...

Pressure injuries related to N95 respirator masks among healthcare workers during the COVID-19 pandemic

Dear Editor, The coronavirus disease 2019 (COVID-19) pandemic outbreak, which started in 2019, has affected millions of patients globally.1 Singapore is not spared, being one...

Novel transdermal device for delivery of triamcinolone for nail psoriasis treatment

Psoriasis is a chronic immune mediated inflammatory skin condition that affects about 2–4% of the Western populations, with rising incidence over the years.1,2 The...

Oral Pemphigus Vulgaris: A Case Report and Literature Update

Autoimmune blistering conditions are an uncommon cause of chronic ulceration of the oral mucosa. Nevertheless, it is important to diagnose these conditions early and...

Melanocytic Lesions of the Face: Diagnostic Pitfalls

Cutaneous melanocytic lesions are amongst the commonest tumours in all races but are more common in Caucasians with fair skin. Although most are benign...

A Case of Recurrent Erythema Multiforme and its Therapeutic Complications

Recurrent erythema multiforme (EM) is a disabling condition with a specific diagnosis and certain diagnostic criteria. Systemic corticosteroid therapy is frequently used to treat...

A Review: The Location, Molecular Characterisation and Multipotency of Hair Follicle Epidermal Stem Cells

There have been significant advances in the understanding of keratinocyte stem cells since the 1970s, when the concept of interfollicular epidermis was initially proposed;...

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...

A Clinical Audit of Presentation and Outcome of Salmonella Septicaemia

Salmonella infection occurs globally and has diverse presentations including enteric fever, gastroenteritis, localised infection, chronic enteric or urinary carrier state and bacteraemias. Enteric fever,...

Serum Interleukin-2, Interleukin-6, Tumour Necrosis Factor-Alpha and Nitric Oxide Levels in Patients With Behçet’s Disease

Behçet’s disease (BD) is characterised by oral aphthous lesions, genital ulcerations and eye inflammation. The disease was first described by Hulusi Behçet in 1937....

Cutaneous Mycobacterium haemophilum Infections in Immunocompromised Patients in a Dermatology Clinic in Singapore

Mycobacterium haemophilum is a nontuberculous mycobacterium (NTM) that is increasingly recognised as a cause of cutaneous, joint, or pulmonary infections in immunocompromised patients and...

A Case of Nephrogenic Fibrosing Dermopathy

Nephrogenic fibrosing dermopathy (NFD) is a recently described and recognised fibrosing disorder occurring in patients with renal disease. The condition resembles scleromyxoedema clinically and...

Dapsone Hypersensitivity Syndrome Masquerading as a Viral Exanthem: Three Cases and a Mini-Review

Dapsone hypersensitivity syndrome (DHS) is a rare condition mostly occurring in leprosy patients on multidrug therapy. Dapsone is also combined with pyrimethamine as maloprim...

Cyclosporin in the Treatment of Severe Atopic Dermatitis: A Retrospective Study

Cyclosporin is a potent immunosuppressant that inhibits cell-mediated immunity, mainly via inhibition of T helper cells. It has been used successfully in the treatment...

Salivary Immunoglobulin A and Lysozyme in Patients with Psoriasis

The pathophysiological mechanisms in psoriasis are still unclear. Many factors, such as infection, trauma and stress, could cause psoriasis. This article is available only as...

Laboratory Safety Aspects of SARS at Biosafety Level 2

In Singapore, the majority of patients suffering from the severe acute respiratory syndrome (SARS) were cared for at Tan Tock Seng Hospital. The dramatic...

Varicella Screening and Vaccination for Healthcare Workers at KK Women’s and Children’s Hospital

Due to the increased morbidity and mortality of varicella zoster (VZ) in adults and increased exposure to chickenpox in hospitals, especially in paediatric hospitals,...

Lymphomatoid Papulosis Associated with Recurrent Cutaneous T-Cell Lymphoma

Lymphomatoid papulosis is a self-healing recurrent popular eruption often exhibiting a chronic course. It is associated with malignant lymphomas in 10% to 20% of...

Extensive Calcinosis Cutis in Relapsed Acute Lymphoblastic Leukaemia

Calcinosis cutis is characterised by the aberrant deposition of calcium salts in the skin. In metastatic calcinosis cutis, calcium salts are precipitated in normal...

Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context

Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44...

Delusional Parasitosis: Case Series of 8 Patients and Review of the Literature

Delusional parasitosis (DP), or delusional infestation, is a condition in which a person has the unshakeable and mistaken belief of being infested with parasites....

Severe Adult Chickenpox Infection Requiring Intensive Care

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

Laser Doppler Perfusion Imaging (LDPI) and Transepidermal Water Loss (TEWL) Values in Psoriatic Lesions Treated with Narrow Band UVB Phototherapy. Dermal Vascularity may be useful Indicator of Psoriatic Activity

Non-invasive techniques have become useful procedures in measuring skin physiology and skin response to treatment. This study attempts to objectively measure physiological changes in...

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...

Comparison of Completely versus Incompletely Excised Cutaneous Squamous Cell Carcinomas

Non-melanoma skin cancer is the most common skin cancer worldwide and its incidence has risen in the last few decades. Approximately 80% of non-melanoma...

Viral Warts in Children Seen at a Tertiary Referral Centre

Viral warts are a common affliction in children. It is caused by the human papilloma virus, of which there are more than 80 serotypes. This...

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...

Presumed Dapsone-induced Drug Hypersensitivity Syndrome Causing Reversible Hypersensitivity Myocarditis and Thyrotoxicosis

A 22-year-old Malay soldier doing his National Service was warded with a 6-day history of an itchy generalised rash associated with fever and lymphadenopathy....

A Study on the Knowledge, Attitudes and Practices of Southeast Asian Dermatologists in the Management of Atopic Dermatitis

Atopic dermatitis (AD) is a chronic and pruritic inflammatory skin disorder that occurs worldwide. Several guidelines on the management of AD have been published...

Early Dengue Infection and Outcome Study (EDEN) – Study Design and Preliminary Findings

Dengue fever/dengue haemorrhagic fever (DF/DHF) is a re-emerging disease that is endemic in the tropical world. It is caused by 4 closely-related dengue viruses...

Seroepidemiology of Pertussis in the Adult Population of Singapore

Pertussis is a highly communicable, vaccine-preventable respiratory disease and is a frequent but often underestimated cause of prolonged cough illness in adults. Whereas in...

Travel Characteristics and Health Practices Among Travellers at the Travellers’ Health and Vaccination Clinic in Singapore

The South-east Asian region has seen recent increases in travel, and pre-travel health advice is important in protecting these travellers from risks. Travellers now...

Understanding the Super-spreading Events of SARS in Singapore

Severe acute respiratory syndrome (SARS) was the first emerging infectious disease of this century with true epidemic potential. Worldwide, the virus caused a total...

SARS Plague: Duty of Care or Medical Heroism?

SARS has been described as a Chinese plague because it emerged from the colourful markets of wild animals and the exotic kitchens of Guangdong,...

SARS: How to Manage Future Outbreaks?

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

SARS Revisited: Managing “Outbreaks” With “Communications”

In the short span of 3 years since SARS first appeared on the Asian landscape, terms like “risk communications” and “outbreak communications” have assumed...

Laboratory Containment of SARS Virus

Severe acute respiratory syndrome (SARS) emerged in November 2002 in Guangdong Province in China and quickly spread to 26 countries/areas with local transmission in...

SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity above National Sovereignty

The majority of the world’s information about infectious disease outbreaks no longer comes from voluntary reporting by countries, the willingness of which is influenced...

SARS in Singapore – Key Lessons from an Epidemic

The 2003 severe acute respiratory syndrome (SARS) outbreak represented the most severe communicable disease challenge to the public health system and the government and...

Clinical and Laboratory Findings of SARS in Singapore

An outbreak of atypical pneumonia was recognised in Singapore soon after the release of a global alert by the World Health Organization (WHO) on...

SARS in Singapore – Predictors of Disease Severity

Severe acute respiratory syndrome (SARS) is a recently defined illness caused by a novel coronavirus. The outbreak in Singapore originated from Hong Kong via...

The Outbreak of SARS at Tan Tock Seng Hospital – Relating Epidemiology to Control

Severe acute respiratory syndrome (SARS) is an emerging infectious disease caused by a novel coronavirus. Worldwide, the virus caused a total of 8098 reported...

Epidemiology and Control of SARS in Singapore

Since the 1990s, a number of infectious diseases have emerged in Singapore, despite its high standard of environmental hygiene, comprehensive childhood immunisation programme and...

Lessons From the SARS Crisis – More Relevant Than Ever

This issue of the Annals contains articles on the severe acute respiratory syndrome (SARS). One might wonder what else there is to write about...

Delayed Hypersensitivity Reaction After Intravenous Glucagon Administered for a Barium Enema: A Case Report

A 74-year-old Chinese woman presented with a 1-week history of an itchy rash on the trunk and legs. A barium enema was performed a...

Modelling the Utility of Body Temperature Readings From Primary Care Consults for SARS Surveillance in an Army Medical Centre

There has been increasing interest in building surveillance systems capable of detecting outbreaks of infectious diseases, at the stage where clinical presentation would still...

Anaerobic Culture of Diabetic Foot Infections: Organisms and Antimicrobial Susceptibilities

Singapore has a relatively high prevalence of diabetes mellitus, with a recent survey showing an age-standardised prevalence of 7.8% in 2004. Diabetic soft-tissue infections...

Electrocardiographic Changes in Patients with Cutaneous Leishmaniasis Treated with Systemic Glucantime

Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). The efficacy of sodium stibogluconate (pentostam) and the other compound of...

Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis

Coronary artery disease (CAD), also called coronary heart disease, is the leading cause of death for both men and women. CAD is usually caused...

The Evolution of Teaching and Learning Medical Microbiology and Infectious Diseases at NUS

The Straits and Federated Malay States Government Medical School was founded in 1905. Dr Chen Su Lan, 1 of the 7 graduates in the...

Infection Control Practices at the Singapore General Hospital: From a Swedish Point of View

Methicillin-resistant Staphylococcus aureus (MRSA) is the most common antibiotic resistant pathogen in many parts of the world, and is associated with significant in hospital...

Methicillin-resistant Staphylococcus aureus Control in Singapore – Moving Forward

The significance of methicillin-resistant Staphylococcus aureus (MRSA) is indisputable. Its successful establishment and maintenance as the most important endemic healthcare associated infection (HCAI) results...

“Future” Threat of Gram-negative Resistance in Singapore

Gram-negative bacteria are important causes of urinary tract infections, bloodstream infections, healthcare-associated pneumonia, and intra-abdominal infections. The increasing resistance of Enterobacteriaceae is a significant...

Polymyxins: A Review of the Current Status Including Recent Developments

Polymyxins are polypeptide antibiotic that becomes available for clinical use in the 1960s, but was replaced in the 1970s by antibiotics considered less toxic....

Vancomycin-resistant Enterococcus – A Review From a Singapore Perspective

The first isolates of high-level vancomycin-resistant enterococci (VRE) were reported from the United Kingdom in the late 1980s. Since then rates of VRE infection...

Methicillin-resistant Staphylococcus aureus Control at the National University Hospital, Singapore: A Historical Perspective

The National University Hospital (NUH) was established in 1985 as the first restructured hospital and medical centre in Singapore. At its official opening in...

Gram-negative Resistance in Singapore: A Historical Perspective

Standardised antimicrobial susceptibility testing was first introduced to Singapore in the mid-1970s. The earliest Singapore antibiogram the author is aware of was published in...

In vitro Activities of Antifungal Drugs Against Yeasts Isolated from Blood Cultures and Moulds Isolated from Various Clinically Significant Sites in Singapore

Fungaemia carries with it high mortality rates and appropriate as well as timely antifungal therapy has been shown to be life saving. Amphotericin B...

A Retrospective Analysis of Antifungal Susceptibilities of Candida Bloodstream Isolates From Singapore Hospitals

Nosocomial infection with Candida species is increasing in significance worldwide. A recent review of positive blood cultures noted the relative increase in importance of...

Ertapenem for Treatment of Extended-spectrum Beta-lactamase-producing and Multidrug-resistant Gram-negative Bacteraemia

Extended-spectrum beta-lacatamase (ESBL)-producing gram-negative bacteraemia is optimally treated with carbapenem. In our institution, Escherichia coli and Klebsiella pneumoniae are the most common and third...

Independent Predictors for Mortality in Patients with Positive Stenotrophomonas maltophilia Cultures

Stenotrophomonas (formally Pseudomonas or Xanthomonas) maltophilia is a gram-negative bacillus emerging as an opportunistic, nosocomial pathogen associated with a high mortality rate. Although it...

Antibiotic Resistance in Gram-negative Bacilli: A Singapore Perspective

In contrast to recent media reviews on gram-positive pathogens such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and Clostridium difficile, the increasing complexity and multiplicity...

Antimicrobial Resistance: A New Beginning and the Need for Action

In this issue, the articles (historical, original and review papers) highlight the extent and problem of antimicrobial resistance in Singapore. The authors should be...

Healthcare Workers and HIV Health Issues

This paper aims to present a comprehensive review of issues related to HIV testing in healthcare workers (HCWs) and proposes appropriate measures in response...

The 2005 Dengue Epidemic in Singapore: Epidemiology, Prevention and Control

Dengue is the most important human viral disease transmitted by arthropod vectors. Some 2500 million people – two-fifths of the world’s population – are...

Antiviral Drugs for the Control of Pandemic Influenza Virus

Over the past 100 years there have been 3 major influenza virus pandemics, which have among them claimed millions of lives. In 1918 the...

Vaccines for Pandemic Influenza. The History of our Current Vaccines, their Limitations and the Requirements to Deal with a Pandemic Threat

The ongoing epizootic of avian influenza due to A (H5N1) viruses, the growing count of associated human fatalities, and the fear that this may...

Prevention and Control of Avian Influenza in Singapore

Avian influenza (AI) or “bird flu” is a highly infectious disease of birds. AI viruses are negative single-stranded enveloped RNA viruses that belong to...

Preparing for an Influenza Pandemic in Singapore

The last influenza pandemics occurred in 1957 and 1968. Few remember the pandemic in 1968 in Singapore as it was relatively mild. This article is...

Avian Influenza and Pandemic Influenza Preparedness in Hong Kong

In 1997, Hong Kong became reputed by identifying the first instance of human infection with avian influenza H5N1. A total of 18 cases occurred...

Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia

Since July 2005 to December 2007, Indonesia has reported the highest number of influenza A (H5N1) human cases in the world, i.e., 116 cases...

A Global Perspective on Avian Influenza

The world is confronted by many important public health challenges, some of which constitute potentially devastating global threats. Prime among these is the threat...

Twentieth Century Influenza Pandemics in Singapore

Tropical countries such as Singapore, although without well-defined influenza seasons, are also affected by influenza epidemics and pandemics. Twenty per cent of Singapore’s population...

The Efficacy of Influenza Vaccination in Healthcare Workers in a Tropical Setting: A Prospective Investigator Blinded Observational Study

Influenza causes significant morbidity, mortality and economic impact in Singapore. According to a recent report, there are about 4.2 million cases of influenza-like illness...

A Cross-sectional Study of Primary-care Physicians in Singapore on Their Concerns and Preparedness for an Avian Influenza Outbreak

Outbreaks of avian influenza (AI) caused by the H5N1 subtype in several Asian countries have raised concern all over the world. AI is endemic...

Clinical and Epidemiological Features of Patients With Confirmed Avian Influenza Presenting to Sulianti Saroso Infectious Diseases Hospital, Indonesia, 2005-2007

The first human cases of H5N1 avian influenza (AI) virus infection were reported in Indonesia in July 2005. On 19 September 2005, the Ministry...

To Kill a Mocking Bird Flu?

Why devote an entire issue of the Annals to pandemic influenza when there are so many other pressing health needs around us? With a...

Cutaneous Leishmaniasis Mimicking Squamous Cell Carcinoma

Leishmaniasis is a parasitic infection caused by different species of the obligate intracellular protozoa Leishmania. This disease is transmitted through the bite of an...

Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care

The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the...

Laboratory-acquired Brucellosis

Brucellosis is a serious disease seen worldwide and has been historically known as undulant fever, Bang’s disease, Gibraltar fever, Mediterranean fever, and Malta fever....

The Utility of Liver Function Tests in Dengue

Dengue infection is endemic in many countries along the tropical and subtropical belt, with more than 100 million cases and 24,000 deaths annually worldwide....

A Comparative Study of Polymerase Chain Reaction Detection of Clonal T-cell Receptor Gamma Chain Gene Rearrangements Using Polyacrylamide Gel Electrophoresis versus Fluorescence Capillary Electrophoresis

Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of malignancies of skin-homing T-cells, of which mycosis fungoides (MF) is the most common form. CTCL...

Treatment Gets Better, but Leprosy Remains a Global Problem

Rising standards of living and the provision of effective medical treatment have resulted in good control of leprosy in many parts of the world,...

Mohs micrographic surgery in Singapore: A long-term follow-up review

Dear Editor, Mohs micrographic surgery (MMS) has become the treatment of choice for high-risk non-melanoma skin cancers (NMSC) worldwide.1 Unlike wide local excision, MMS...

Lamotrigine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Singapore: A case series

Dear Editor, With the advancements in pharmacogenetics, potential genetic associations with severe cutaneous adverse drug reactions (SCAR)—which include Stevens- Johnson syndrome (SJS) and toxic...

Development of Ceftazidime Resistance in Burkhoderia pseudomallei in a Patient Experiencing Melioidosis with Mediastinal Lymphadenitis

Melioidosis caused by Burkholderia pseudomallei is endemic to Southeast Asia and Northern Australia. Melioidosis was nicknamed the “greater mimicker” because of its diverse clinical...

Cutaneous Angiosarcoma Associated with the Kasabach–Merritt Syndrome

Angiosarcoma is a rare tumour commonly affecting elderly men, usually occurring on the head and neck region. The tumour usually presents as ecchymosis-like plaques,...

Human Rights as a Cornerstone of AIDS Prevention, Treatment and Public Health Measures

The International AIDS Conference (IAC) and the Singapore AIDS Conference (SAC) are biannual meetings held on even years. Both these meetings are occasions for...

Epidemiology of Skin Diseases in Renal Transplant Recipients in a Tertiary Hospital

Various types of skin lesions are more common in renal transplant recipients compared to the general population, mainly attributable to post-transplant immunosuppression. The well-documented...

Changing Epidemiology of Enteric Fevers in Singapore

Typhoid and paratyphoid fever – collectively referred to as enteric fevers - are serious systemic infections caused by Salmonella enterica serovar Typhi (S. Typhi)...

Expanding the Scope of Antiretroviral Therapy for HIV Infection

The 2010 Global Report on AIDS contains some welcome news: the number of annual AIDS-related deaths has continued to decrease from a peak of...

Bosentan – A Previously Unrecognised Cause of Facial Telangiectasia

Bosentan is an endothelin-1 (ET-1) receptor antagonist approved for the treatment of pulmonary artery hypertension (PAH). Although flushing is a documented side effect of...

Blistering Eruption Following a Rubefacient Rub for Shoulder Discomfort

A 96-year-old woman was referred as an emergency with a suspected allergic reaction to Deep Heat® rub (Mentholatum Company Ltd, East Kilbride, Scotland). Five...

An 11-year Review of Dermatomyositis in Asian Patients

Dermatomyositis (DM) is an acquired multisystem inflammatory disease with prominent, characteristic cutaneous manifestations and proximal muscle myopathy. A clinically distinct amyopathic variant with typical...

A Cross-Sectional Study on Reference Ranges of Normal Oral Temperatures Among Students in Singapore

Severe acute respiratory syndrome (SARS), an infection caused by the SARS Coronavirus (SARS-CoV), was imported into Singapore in late February 2003 by a local...

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...

Levofloxacin-induced Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin

Toxic Epidermal Necrolysis (TEN) is a rare, fulminating rash with a mortality rate of 35%.1 It is predominantly medication-induced; allopurinol, ampicillins, anticonvulsants and non-steroidal...

Changing Seroprevalence of Hepatitis B Virus Markers of Adults in Singapore

In Singapore, epidemiological surveillance and research on hepatitis B virus (HBV) infection were initiated when acute viral hepatitis was made a notifiable disease under...

Personalised Medicine for Psoriasis: A Real Possibility Ahead

In the last decade, our understanding of psoriasis has increased by leaps and bounds, resulting in many new targeted therapies being introduced for those...

Evaluation on the Effectiveness of the National Childhood Immunisation Programme in Singapore, 1982-2007

Singapore has a comprehensive National Childhood Immunisation Programme (NCIP) which first covered smallpox (1862), followed by diphtheria (1938), tuberculosis (TB) (1957), poliomyelitis (1958), pertussis...

Epidemiological Characteristics of Cholera in Singapore, 1992-2007

Cholera is an acute diarrhoeal disease that usually presents as abrupt massive watery diarrhoea and vomiting. The causative organism is Vibrio cholerae which is...

Erythematous Plaques in a Filipino Man

Three years after emigrating from Philippines to Singapore, a 34-year-old, otherwise healthy man presented with a progressive erythematous eruption on his lower limbs. Six...

Influenza B Outbreak among Influenza-vaccinated Welfare Home Residents in Singapore

Influenza has a major impact on the health of residents of long-term residential care facilities (LTCF). Residents of LTCFs are especially vulnerable to influenza...

Beyond Blood Safety

World Blood Donor Day takes place on 14 June each year. Established in 2005 by the World Health Assembly, it aims to raise global...

Inflammatory Tinea Capitis: Non-healing Plaque on the Occiput of a 4-year-old Child

Tinea capitis is a fungal infection of the hairs of the scalp. Although commonly described in children, it is uncommonly seen in Singapore. This article...

Afterword

My first involvement with pandemic influenza preparedness planning began in January 2004, when I attended an urgent meeting organised by the Ministry of Public...

Use of Healthcare Worker Sickness Absenteeism Surveillance as a Potential Early Warning System for Influenza Epidemics in Acute Care Hospitals

The global spread of emerging infectious diseases can strain resources and result in healthcare staff absenteeism, as was the case during the severe acute...

Streptococcus pneumoniae Bacteraemia in a Young Man with Pandemic Influenza A (H1N1) 2009

The contributory role of bacterial infection to severe influenza illness during a pandemic is not entirely clear. The post-mortem samples of those who died...

Surveys of Knowledge, Attitudes and Practices on the Influenza A (H1N1) Pandemic

Statistical surveys are in general an efficient and flexible means of collecting a wide range of information from large numbers of respondents. These are...

2009 Pandemic Influenza H1N1: Paediatric Perspectives

The pandemic H1N1 influenza virus, containing genes from avian, human and swine influenza viruses, emerged in North America, and caused illness in more than...

Severe Infection with H1N1 Requiring Intensive Care – Lessons for Preparedness Programmes

Severe cases of influenza have traditionally generated much interest. The pandemic of 1957 provided instructive materials on the subject, with publications on the pulmonary...

International Health Regulations: Lessons From the Influenza Pandemic in Singapore

By virtue of the International Health Regulations (IHR) which came into force on 15 June 2007, countries are required to report specific infectious diseases...

Influenza A (H1N1-2009) Pandemic in Singapore – Public Health Control Measures Implemented and Lessons Learnt

The novel influenza A(H1N1) outbreak was officially declared a pandemic by the World Health Organization (WHO) on 11 June 2009. We describe the public...

Attitudes of Patients, Visitors and Healthcare Workers at a Tertiary Hospital Towards Influenza A (H1N1) Response Measures

Following the announcement by the World Health Organization (WHO) that outbreaks of a novel influenza virus had occurred in Mexico and several parts of...

Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club

Influenza A (H1N1-2009) is a novel strain of influenza virus. The infection is thought to have first occurred in Mexico in March 2009, and...

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...

Tracking the Emergence of Pandemic Influenza A/H1N1/2009 and its Interaction with Seasonal Influenza Viruses in Singapore

The global preparedness that followed the severe acute respiratory syndrome (SARS) outbreaks of 2003 and the re-emergence of a potentially pandemic avian influenza A/...

An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza Admitted to Singapore Hospitals from July to September 2009

On 17 April 2009, the US Centers for Disease Control (CDC) determined that febrile respiratory illness occurring in 2 children residing in adjacent counties...

Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009

The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas...

Pandemic (H1N1) 2009: Clinical and Laboratory Findings of the First Fifty Cases in Singapore

Just over a year ago, the swine-origin influenza A (H1N1) virus emerged in Veracruz, Mexico, and rapidly alarmed public health and influenza experts by...

The Influenza A (H1N1) 2009 Pandemic in Singapore

Just over a year ago, the swine-origin influenza A (H1N1) virus emerged in Veracruz, Mexico, and rapidly alarmed public health and influenza experts by...

Tuberculosis – An Under-appreciated Disease

Tuberculosis (TB, as usually abbreviated) is a major cause of morbidity and mortality in many countries, and a significant public health problem worldwide. The...

Subungual Nodule of the Right Fourth Finger

A 14-year-old, otherwise healthy boy presented with a skin nodule for the past 3 years which slowly lifted up the right fourth fingernail. The...

Knowledge and Practice of Household Mosquito Breeding Control Measures between a Dengue Hotspot and Non-Hotspot in Singapore

Dengue is the most common mosquito-borne viral disease in the world and its severity is reflected by a 30-fold increase over the last 50...

Chronic Truncal Plaques and Palmoplantar Keratotic Lesions in an Elderly Man

A 70-year-old gentleman with a significant past history of using traditional medication presented to our clinic with multiple dysplastic lesions of varying severity on...

Evaluation of the Dried Blood Spot (DBS) Collection Method as a Tool for Detection of HIV Ag/Ab, HBsAg, anti-HBs and anti-HCV in a Malaysian Tertiary Referral Hospital

Dried blood spot (DBS) or dried plasma spot (DPS) collection offers to be a promising alternative to whole blood or plasma sampling, as it...

Challenges Facing the Control of Leprosy in the Indian Context

Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects the skin, peripheral nerves, the eyes and the mucosa of the...

Lower limb nodules

A 45-year-old Chinese woman with no medical history or regular medications presented with painful nodules on her left shin that progressed to involve her...

Plasma IP-10 could identify early lung disease in severe COVID-19 patients

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

Dermatological Disorders at the Emergency Department of a Tertiary Hospital in Singapore

Skin disorders pose a frequent diagnostic challenge for emergency physicians due to their broad spectrum and varied clinical manifestations. The diagnosis of acute dermatologic...

An Interesting Finding in a Patient with Chronic Diarrhoea

A 25-year-old man presented with intermittent selflimiting episodes of diarrhoea for 5 months. At times, he opened his bowel 8 times a day with...

Adverse reactions and safety profile of the mRNA COVID-19 vaccines among Asian military personnel

The COVID-19 pandemic has led to significant changes in the way of life for many around the world.1,2 After more than a year, many...

Re: An Alternative Diagnosis: Bartonella Neuroretinitis

I would like to thank the authors for the reply to our case report. The differential diagnosis of Bartonella neuroretinitis in this patient was...

An Alternative Diagnosis: Bartonella Neuroretinitis

We refer to the letter ‘Lyme Neuroretinitis in Singapore: A Diagnostic Dilemma’ published in the April 2012 Vol. 41 No. 4 issue of the...

MERS-CoV: Where Are We Now?

Prior to 2002, coronaviruses were known mainly for causing mild human upper respiratory tract infections (URTIs) and enteric and respiratory infections in many animals....

Diagnosing Bacteraemia Early in Older Adults

Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop...

Pyoderma Gangrenosum Mimicking Early Acute Infection Following Total Knee Arthroplasty

Pyoderma gangrenosum (PG) is an ulcerative neutrophilic dermatosis of uncertain aetiology. Known associations include inflammatory bowel disease, myeloproliferative disease and various arthritides. There have...

Anti-BP180 NC16A IgG Titres as an Indicator of Disease Activity and Outcome in Asian Patients with Bullous Pemphigoid

Bullous pemphigoid (BP) is a subepidermal blistering dermatosis characterised by circulating autoantibodies targeting BP180 and BP230 hemidesmosomal proteins. Anti-BP180 NC16A IgG antibodies have been...

Localised Dermatitic Nodules but No Itch

In 1909, Hyde first described nodular prurigo as pruritic nodules on the extensor surfaces of the lower extremities in middle-aged women. Thus, nodular prurigo...

Anaerobic Bacteraemia Revisited: Species and Susceptibilities

Over the last 2 decades, the importance of anaerobic bacteraemia has undergone various shifts in opinion. Early studies in the 1970s reported that anaerobes...

Chorea precipitated by phototherapy as initial presentation of systemic lupus erythematosus

Dear Editor, Chorea is a well-recognised albeit rare neuropsychiatric manifestation of systemic lupus erythematosus (SLE). We describe here a case of a 67-year-old woman presenting...

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...

The Greying Pandemic: Implications of Ageing Human Immunodeficiency Virus-Positive Population in Singapore

Human immunodeficiency virus (HIV) remains a global public health issue. It is estimated that there are 37.9 million people living with HIV (PLHIV) today....

The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown

Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties...

ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series

Coronavirus disease 2019 (COVID-19) has been associated with thromboembolic phenomenon in the early phase of disease. Growing evidence suggests a hypercoagulable state as well...

Pelvic mass mimicking advanced tubo-ovarian malignancy with hepatic metastasis

A 49-year-old woman presented with mild pain in her lower abdomen and changes in bowel habits for 2 months. She also experienced 20kg of...

Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 Panel for early diagnosis of COVID-19

An effective response to the SARS-CoV-2 that has caused the coronavirus disease 2019 (COVID-19) pandemic1 requires rapid and accurate diagnostic testing. We evaluate the...

Antibiotic stewardship algorithm to rationalise antibiotic use among hospitalised COVID-19 patients

As presentation of COVID-19 may mimic that of bacterial pneumonia, antibiotics are often prescribed. Concerns regarding overuse of antibiotics are now being raised particularly...

Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore

The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during...

Radiological changes on chest CT following COVID-19 infection

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

Severe COVID-19 and coagulopathy: A systematic review and meta-analysis

Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications....

Estimating the impact of COVID-19-induced coagulopathy

The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is...

Impact of COVID-19 on mental health and occupational burnout in a surgical unit in Singapore

In this study, we assessed the impact of COVID-19 on the psychological well-being and burnout among staff who manage critically ill general surgery and...

Optimum early orthopaedic surgery in COVID-19 patients

Multiple guidelines have been established regarding the management of COVID-19 patients. However, there remains a paucity regarding specific guidelines on the optimal timing for...

Vulnerability to rumours during the COVID-19 pandemic in Singapore

The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found...

Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore

In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community...

The impact of COVID-19 pandemic on global mental health: From the general public to healthcare workers

The COVID-19 pandemic began in late 2019 and was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. To decrease...

The Novel Coronavirus (SARS-CoV-2) Pandemic

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

Precautions When Providing Dental Care During Coronavirus Disease 2019 (COVID-19) Pandemic

Coronavirus disease 2019 (COVID-19) is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported to the World Health Organization...

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...

Cross-reaction of Sera from COVID-19 Patients with SARS-CoV Assays

SARS-CoV-2 is a new zoonotic coronavirus (CoV) that emerged in Wuhan, China, which was first reported to the World Health Organization (WHO) on 31...

COVID-19 and Singapore: From Early Response to Circuit Breaker

The COVID-19 pandemic first broke out in Wuhan, China, in December 2019, where a cluster of pneumonia cases was reported and the novel coronavirus...

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...

Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months

Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared...

Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore

Since the first cases of coronavirus disease 2019 (COVID-19) in pregnancy were described, significant concerns have been raised about the potentially increased susceptibility of...

Obesity in COVID-19: A Systematic Review and Meta-analysis

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

Acquired hypohidrosis following a drug reaction

A 44-year-old Chinese man presented with a 3-week history of heat intolerance and a reduced ability to sweat even upon strenuous physical exertion. His...

Resuming otolaryngology services following a COVID-19 lockdown in Singapore

When the COVID-19 outbreak first occurred, we tweaked our department workflows to cope with the various demands of our practice and the pandemic. When...

COVID-19: Lessons from Thailand

The COVID-19 pandemic has massively disrupted the social and economy of many countries. Thailand has been successful in controlling the spread of the disease...

Hypervirulent Klebsiella pneumoniae carriage in polyclinic attendees and national servicemen presenting with diarrhoea

Klebsiella pneumoniae liver abscess is an invasive syndrome that mainly affects people living in East Asia. It especially affects adults with diabetes and is...

Videoconsultation to overcome barriers during COVID-19

Since February 2020, Government Restructured Hospitals in Singapore began deferring non-urgent outpatient appointments. This aimed to facilitate physical distancing and reallocate healthcare resources to...

Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review

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

Positive RT-PCR detected in patients recovered from COVID-19

Positive real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acid following 2 consecutive negative RT-PCR tests have been reported in China and Korea....

Cerebral venous thrombosis in a patient with mild COVID-19 infection

Emerging reports suggest venous and arterial thromboembolic diseases can complicate recovery from COVID-19. Postulated mechanisms include hypercoagulability, hypoxia, immobilisation, excessive inflammation and diffuse intravascular...

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...

Primary cutaneous umbilical melanoma

A 59-year-old woman with a pre-existing asymptomatic pigmented nevus on the umbilicus for the past 20 years was seen in the outpatient dermatology clinic...

A clinico-pathological approach to management of atopic dermatitis

Recent research in atopic dermatitis (AD) has identified it to be a heterogeneous inflammatory skin disorder of different endotypes (immune polarisation of T-cell subsets...

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...

Mental Health Strategies to Combat the Psychological Impact of Coronavirus Disease 2019 (COVID-19) Beyond Paranoia and Panic

On 30 January 2020, the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) an international public health emergency after the...

Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection

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

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...