Commentary
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...
Letter to the Editor
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...
Editorial
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...
Letter to the Editor
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...
Letter to the Editor
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...
Original Article
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...
Letter to the Editor
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...
Review Article
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...
Original Article
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...
Editorial
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...
Editorial
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...
Images in Medicine
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...
Review Article
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...
Original Article
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...
Editorial
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...
Editorial
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...
Letter to the Editor
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...
Editorial
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...
Images in Medicine
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...
Review Article
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...
Images in Medicine
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...
Letter to the Editor
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...
Letter to the Editor
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...
Original Article
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...
Editorial
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...
Letter to the Editor
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....
Letter to the Editor
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...
Commentary
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...
Original Article
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...
Original Article
Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore
Within 3 weeks of the World Health Organization declaring the COVID-19 pandemic on 11 March 2020, the Society of Critical Care Medicine (SCCM) and...
Editorial
Challenges and considerations in delivering nutritional therapy in the ICU during COVID-19 pandemic
Coronavirus disease 2019 (COVID-19) has created unprecedented challenges for healthcare workers in Singapore and across the world. Providing clinical nutrition and metabolic care to...
Letter to the Editor
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”...
Commentary
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...
Original Article
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...
Letter to the Editor
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...
Review Article
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...
Letter to the Editor
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...
Others
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...
Others
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...
Others
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...
Others
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...
Others
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...
Others
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...
Original Article
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...
Review Article
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...
Others
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...
Others
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...
Others
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...
Original Article
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...
Original Article
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...
Letter to the Editor
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...
Others
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...
Others
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...
Original Article
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...
Others
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...
Original Article
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...
Others
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...
Others
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...
Original Article
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...
Original Article
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...
Others
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...
Others
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...
Others
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;...
Letter to the Editor
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...
Others
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...
Others
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...
Original Article
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...
Others
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....
Others
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...
Others
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,...
Images in Medicine
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...
Letter to the Editor
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...
Letter to the Editor
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...
Original Article
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...
Others
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...
Others
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....
Original Article
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...
Others
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...
Original Article
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...
Original Article
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...
Review Article
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...
Commentary
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...
Others
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...
Original Article
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...
Original Article
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...
Original Article
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....
Original Article
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%...
Others
A Review of Cutaneous Granulomas and Lupus Vulgaris Following BCG Vaccination in a Skin Hospital in Singapore
BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in...
Original Article
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...
Original Article
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...
Original Article
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...
Others
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...
Original Article
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...
Original Article
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),...
Others
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...
Others
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...
Editorial
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%...
Others
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...
Editorial
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...
Others
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...
Review Article
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...
Images in Medicine
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,...
Letter to the Editor
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...
Original Article
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...
Others
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...
Review Article
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...
Others
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...
Review Article
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;...
Original Article
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...
Original Article
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,...
Original Article
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....
Others
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...
Others
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...
Others
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...
Original Article
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...
Original Article
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...
Review Article
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...
Original Article
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,...
Others
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...
Others
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...
Others
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...
Others
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....
Others
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Others
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...
Others
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....
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Commentary
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,...
Commentary
SARS: How to Manage Future Outbreaks?
Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV), which crossed from wild animals at live markets to man in mid-November...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Editorial
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...
Others
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Others
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...
Others
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...
Others
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...
Commentary
“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...
Review Article
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....
Review Article
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...
Review Article
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...
Review Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Editorial
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...
Review Article
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...
Original Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Editorial
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...
Letter to the Editor
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...
Original Article
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...
Letter to the Editor
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....
Letter to the Editor
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....
Original Article
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...
Editorial
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,...
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
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,...
Commentary
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...
Original Article
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...
Original Article
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)...
Editorial
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...
Letter to the Editor
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...
Letter to the Editor
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...
Original Article
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...
Original Article
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...
Images in Medicine
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...
Letter to the Editor
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...
Original Article
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...
Editorial
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...
Original Article
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...
Original Article
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...
Images in Medicine
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...
Original Article
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...
Editorial
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...
Others
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...
Letter to the Editor
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...
Letter to the Editor
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...
Commentary
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...
Commentary
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...
Others
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...
Others
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...
Review Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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/...
Original Article
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...
Original Article
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...
Original Article
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...
Editorial
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...
Commentary
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...
Images in Medicine
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...
Others
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...
Images in Medicine
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...
Original Article
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...
Editorial
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...
Images in Medicine
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...
Letter to the Editor
Plasma IP-10 could identify early lung disease in severe COVID-19 patients
Dear Editor,
The global pandemic of SARS-Coronavirus-2 (SARS-CoV-2) infection has imposed tremendous strain on healthcare resources worldwide, as a significant proportion of patients require...
Letter to the Editor
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...
Images in Medicine
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...
Original Article
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...
Letter to the Editor
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...
Letter to the Editor
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...
Editorial
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....
Letter to the Editor
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...
Letter to the Editor
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...
Original Article
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...
Letter to the Editor
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...
Original Article
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...
Letter to the Editor
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...
Original Article
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...
Editorial
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....
Letter to the Editor
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...
Commentary
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...
Images in Medicine
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...
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
Radiological changes on chest CT following COVID-19 infection
COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution...
Review Article
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....
Editorial
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...
Letter to the Editor
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...
Commentary
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...
Original Article
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...
Original Article
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...
Editorial
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...
Editorial
The Novel Coronavirus (SARS-CoV-2) Pandemic
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and...
Review Article
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...
Commentary
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...
Letter to the Editor
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...
Review Article
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...
Original Article
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...
Review Article
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...
Original Article
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...
Review Article
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...
Images in Medicine
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...
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
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...
Commentary
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...
Review Article
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...
Letter to the Editor
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....
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
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...
Commentary
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...
Original 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...
Commentary
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...
Original Article
Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection
In this report, we describe a patient who developed acute respiratory distress syndrome (ARDS) with rapid clinical deterioration. Unfortunately, not much is known about...
Original Article
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...