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Can a Bayesian approach clarify if corticosteroids are beneficial for severe community-acquired pneumonia?

Despite advances in the antimicrobial treatment of sepsis and organ support in the intensive care unit (ICU), community-acquired pneumonia (CAP) remains a leading cause of mortality and disability-adjusted life years lost globally.1 Severe CAP, where CAP becomes complicated by acute hypoxaemic respiratory failure or shock, is also the most...

Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...

Multisystem inflammatory syndrome in children in Singapore

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

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

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

Neck pain with prevertebral soft tissue thickening

A 37-year-old man presented with a history of sudden-onset neck pain, which was worse on movement and neck extension. He reported no history of trauma or infection. He denied any neurological symptoms. A physical examination showed limited neck motion in all directions due to pain. Blood tests showed total...

Sepsis, cardiovascular events and short-term mortality risk in critically ill patients

Sepsis is defined as “life-threatening organ dysfunction caused by a dysregulated host immune response to infection”.1 It is one of the most common conditions afflicting intensive care unit (ICU) patients, causing a high mortality rate. An estimated 48.9 million incident cases of sepsis and 11 million sepsis-related deaths were...

Sepsis and cardiovascular events: The story so far

Sepsis is a state of life-threatening organ dysfunction that results from a dysregulated host immune response to infection.1 Sepsis is a common condition that leads to admission to the intensive care unit (ICU). Although advances have been made in the management of sepsis, mortality from sepsis remains high.2 Among...

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 imbalanced inflammatory response, immune disorder, neuroendocrine abnormality, coagulopathy, mitochondrial damage and endoplasmic reticulum stress.2 A recent study reported that the age-standardised sepsis incidence rate fell...

Continuous Renal Replacement Therapy: Continuous Blood Purification in the Intensive Care Unit

The last decade has seen a progressive change in the style of management of severe acute renal failure (acute renal failure which requires the use of renal replacement therapy) as well as in the epidemiology of this condition. Severe acute renal failure (SARF) is now most commonly seen in...

Intravital Microscopy for the Study of the Microcirculation in Various Disease States

It is more than 150 years ago when the first detailed description of intravital microscopy was given by Waller, demonstrating in the frog tongue the passage of leukocytes (at that time interpreted as “mucous and pus globules”) through microvessels. Later, the mesentery was acknowledged as the most suitable object...

Retinol Palmitate Counteracts Oxidative Injury During Experimental Septic Shock

Gram-negative bacteria induced septic shock, a condition with high mortality, is frequently seen in critical care medicine. The wall of gram-negative bacteria consists of endotoxin, which is chemically composed of lipopolysaccharide, and is extremely biologically active. This article is available only as a PDF. Please click on “Download PDF” on...

Thyroid Dysfunction in Elderly Patients

Symptoms and signs of thyroid dysfunction in the elderly tend to be atypical and may be mistakenly attributed to the ageing process. Currently, thyroid function tests are performed on patients who manifest signs and symptoms of overt thyroid disease or as part of the investigations for dementia in the...

Routine Microbiological Screening in Septic Patients in a Cardiac Surgical Intensive Care Unit

Compared to in-hospital patients, patients treated in an intensive care unit (ICU) have the highest risk of contracting an infection. The risk correlates well with underlying and accompanying diseases and invasive monitoring. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

In vivo Pro- and Anti-inflammatory Cytokines in Normal and Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by severe joint deformities due to bony erosions and tendon damage. The chronic inflammatory process is mediated through a complex cytokine network. The clinical expressions and outcome of the disease can vary among different ethnic groups, possibly depending upon the...

Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis

Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis is rare. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?

In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence suggests the presence of interactions between the immune system, the central nervous system (CNS) and the endocrine system, where these systems can be influenced by...

Challenges and Pitfalls in the Introduction of Pharmacogenetics for Cancer

Pharmacogenetics, by definition, refers to the study of genetic differences in metabolic pathways which can affect an individual’s responses to drugs in terms of both therapeutic and adverse effects. In recent years, there have been several success stories such as HER2 for trastuzumab in breast cancer and VKORC1/CYP2C9 for...

The Golden Hours in Paediatric Septic Shock—Current Updates and Recommendations

Sepsis in children is a global health issue. The Global Health Observatory estimates that 58% of deaths in children under 5 years old are caused by infectious diseases. Mortality increases as sepsis progresses to septic shock. The implementation of childhood vaccination programmes and the advent of vaccines such as...

Immunomodulator use in paediatric severe sepsis and septic shock

Paediatric sepsis is one of the main causes of childhood mortality.1 Globally, paediatric severe sepsis and septic shock accounts for 6.2% to 23.1% of paediatric intensive care unit (PICU) admissions, and mortality rates can be as high as 21.3% in North America and Europe to 50.0% in Asia.2-4 Of...

Radiological changes on chest CT following COVID-19 infection

COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution computed tomography (HRCT) features of the lungs during the onset of COVID-19; however, few studies have described the radiological changes and outcome of residual lesions...

Controversies in Sepsis Management—What is the Way Forward?

Sepsis is a common and life-threatening medical condition which has high incidence and mortality rates. Health care professionals are increasingly familiar with this syndrome, and the public is increasingly conscious of its burden to society. A population survey conducted in Singapore in 2010 showed that 53 out of 1067...