Original Article
Adolescent self-harm and suicide attempts: An analysis of emergency department presentations in Singapore
Within 3 years from 2019 to 2021, adolescent suicide rates in Singapore almost doubled from 5.35 to 9.14 per 100,000 population.1,2 This is against a backdrop of a silently brewing adolescent behavioural and mental health crisis locally and globally, which started before the COVID-19 pandemic but has since been...
Editorial
Adolescent self-harm and suicide attempts in the emergency department in Singapore
The youth mental health crisis has taken centre stage globally in recent years with increased reporting of young persons suffering from mental health problems and mental illnesses. Singapore is not spared. The COVID-19 pandemic has been largely blamed for the onset of the mental health crisis due to its...
Letter to the Editor
Navigating health challenges: Singapore’s National University Health System’s approach to child and family well-being
Dear Editor,
Singapore’s progressive commitment to addressing child and family well-being is anchored in its forward-thinking public health agenda. Recognising that long-term population health outcomes are shaped by early-life interventions, Singapore has directed increasing attention towards addressing complex health challenges that emerge during childhood and across the family unit. These...
Editorial
Organ donation in the paediatric intensive care unit: Time for change?
Organ transplantation remains the definitive treatment option for improving the lives of patients with end-stage organ failure. To our knowledge, the first solid organ transplantation performed in Singapore in July 1970 involved a kidney from a deceased donor.1 Since then, rapid advancements in both transplant surgery and immunosuppressive medical...
Letter to the Editor
Exploring the perspectives of child health strategy stakeholders on resilience and well-being in children and youths in Singapore: A qualitative study
Dear Editor,
Resilience has been defined as the capacity of a dynamic system to adapt well to potential threats,1 while mitigating the negative impact of behavioural and physiological changes due to chronic stress,2 and the resumption of positive functioning thereafter.3 Resilience enables one to adapt positively to adversities in life...
Letter to the Editor
Improving school teachers’ self-efficacy and knowledge on food allergy and management of anaphylaxis using a virtual multidisciplinary workshop
Dear Editor,
Children with food allergies are at risk of inadvertent allergic reactions that range from mild to potentially life-threatening anaphylaxis, even with appropriate dietary avoidance.1 This risk is often increased in community settings such as schools via accidental exposure to allergens during learning activities or meal times. A quarter...
Original Article
Epidemiology of paediatric intensive care unit admissions, deaths and organ donation candidacy: A single-centre audit
With advancements in medical care, mortality rates in critically ill patients have decreased substantially.1,2 Contemporary studies from developed countries report paediatric intensive care mortality rates of 2–3%3,4 in 2014 to 2019, whereas mortality in developing countries can be as high as 50%5 as of 2024, indicating large disparities in...
Editorial
Optimising paediatric urinary tract infection diagnosis
Urinary tract infection (UTI) is the most common cause of serious bacterial illness among children and infants.1 Up to 2% of boys and 8% of girls will develop at least 1 episode of UTI by the age of 7 years.1,2 Of these, it is estimated that 12% to 30%...
Editorial
Beyond survival: Addressing gaps in psychosocial support for survivors of childhood cancer
I read with great interest the study conducted by Fong et al. published in this issue of Annals, which evaluated psychological symptoms and health-related quality of life (HRQOL) among a cohort of 143 young adult survivors of childhood cancer in Singapore.1 Almost 1 in 4 survivors demonstrated significant psychological...
Original Article
Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study
Urinary tract infection (UTI) is a common diagnosis in the paediatric emergency department (ED). It accounts for an estimated 5–14% of paediatric ED visits yearly in the US.1-3 It is a common cause of serious bacterial infections in children, and the most common microorganism is Escherichia coli (65–75%), followed...
Original Article
Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore
Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...
Letter to the Editor
“Leveraging ChatGPT to aid patient education on coronary angiogram”: Correspondence
Dear Editor,
“Leveraging ChatGPT to aid patient education on coronary angiogram”1 is an interesting article. The study assessed ChatGPT’s ability to conversely provide information regarding the coronary angiography process, pointing out its advantages and disadvantages. Although ChatGPT provided information in an exhaustive and methodical manner, it also had flaws, including...
Review Article
Quality of life of family caregivers of children and young adults with Down syndrome: A systematic review and meta-analysis
The family caregiver is “any relative, partner, friend or neighbor who has a significant personal relationship with, and provides a broad range of assistance for a person with a chronic or disabling condition.”1 Family caregivers for children with chronic illnesses are commonly parents, who fulfil their children’s physical and...
Editorial
Living longer and stronger: Are children and young adults with Down syndrome experiencing healthier and better lives?
Down syndrome (DS) is the most common genetic cause of intellectual disability and is associated with multiple medical conditions affecting various organ systems, impacting the individual’s health, development and function.1 In Singapore, the life-birth prevalence of DS was 0.89 per 1000 births in the 1990s, a figure expected to...
Review Article
Quality of life of children and young adults with Down syndrome from caregivers’ perspective: A systematic review and meta-analysis
Down syndrome (DS), with an incidence of about 1/1000 to 1/1100 live births1 is the most common autosomal trisomy and genetic cause of intellectual disability. Individuals with DS may have multiple comorbidities including congenital cardiac and gastrointestinal anomalies, obesity, sleep disorders, and visual and hearing impairments.2,3 Despite the comorbidities,...
Original Article
Trends in fluid overload-related hospitalisations among patients with diabetes mellitus: The impact of chronic kidney disease
Diabetes mellitus (DM) is a major global health problem, contributing to significant clinical disease burden, healthcare expenditure and societal costs.1 In Singapore, DM accounts for 2.9% of disability-adjusted life years and 4.3% of years lived with disability.2,3 By 2030, it is projected to cost approximately USD 1.89 billion in...
Original Article
Delayed presentation is associated with serious bacterial infections among febrile infants: A prospective cohort study
Young infants ≤90 days old are at risk of serious bacterial infections (SBIs) due to their immature immune systems and may develop severe complications resulting in neurocognitive deficits, hearing loss and even mortality.1,2 The diagnosis of SBIs remains challenging as fever may be the only symptom of SBIs in...
Original Article
Diagnostic performance of classification criteria for systemic lupus erythematosus: A validation study from Singapore
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a broad spectrum of clinical presentation.1 Clinical diagnosis by rheumatologists remains the gold standard, but the diagnosis is often challenging due to variability in disease expression mimicking other conditions.
As such, classification criteria have been developed to establish homogeneous groups...
Editorial
Promoting evidence-based care for children and adolescents on the autism spectrum
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has been increasing in worldwide prevalence,1 including Singapore. In this latest issue of the Annals, we share the latest Singapore Clinical Practice Guidelines (CPG) for Autism in Children and Adolescents, discussed by Wong et al.2 This is the culmination of...
Original Article
Caregiver reported long-term outcomes in children with major trauma and traumatic brain injuries: A single-centre retrospective study
Traumatic injuries in children are a significant cause of mortality and morbidity worldwide.1 Children with major trauma are at risk of poor outcomes.2-4 These include disabilities that require assistance with activities of daily living, intellectual disability and behavioural problems.5 In the US, it is estimated that more than 50...
Letter to the Editor
Knowledge, attitudes and practices of doctors on constipation management in Singapore
Dear Editor,
Constipation is a common gastrointestinal disorder, affecting about 15% of the global population and severely impacting patients’ quality of life.1 The global constipation treatment market is estimated to worth USD22.93 billion in 2025. Patients with functional constipation had the highest treatment dissatisfaction at 63.4%. Poor satisfaction was reported...
Original Article
An augmented reality mobile application for weight estimation in paediatric patients: A prospective single-blinded cross-sectional study
Drug and defibrillation energy doses for children rely on accurate weight measurement, making it essential during emergencies.1,2 However, quickly weighing children in distress is often a challenging task.3,4 Conventionally, age-dependent formulas and length-based tapes like the Broselow tape (BT) and Paediatric Advanced Weight Prediction in the Emergency Room extra-long...
Letter to the Editor
How do current paediatrics residency selection criteria correlate with residency performance?
Dear Editor,
The selection process for potential residents needs to be reviewed regularly and assessed if effective in selecting the best-fit residents who can achieve academic and professional excellence. Objective measures must take precedence over subjective criteria to reduce selection bias while ensuring transparency and accountability. However, the predictors of...
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 isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....
Original Article
Long COVID prevalence, risk factors and impact of vaccination in the paediatric population: A survey study in Singapore
On 5 May 2023, more than 3 years since the start of the COVID-19 pandemic, the World Health Organization (WHO) declared that COVID-19 no longer constituted a public health emergency. Despite high numbers of children and younger persons (CYPs) having acute COVID-19,1 information on the quality of health and...
Original Article
Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests
Congenital heart diseases (CHDs) are the most common major congenital anomaly at up to 28%1 and are responsible for 5.7% of all infant mortality.2 While earlier studies in developed countries reported an overall CHD birth prevalence of 3.7–5.54 per 1000 live births,3,4 more recent studies report a global and...
Letter to the Editor
Improving neonatal counselling service for premature births
Dear Editor,
Despite the substantial advancement of neonatal care leading to increased survival of infants of periviable gestation, as young as 22 weeks,1 the anticipated birth of an extremely low gestational age infant remains challenging for both the parents and physician, with regard to decision-making in initiating resuscitation post-delivery. Ideally,...
Review Article
Consensus statement on Singapore integrated 24-hour activity guide for early childhood
Early childhood is a critical period for growth and development, setting the foundation for future and lifelong well-being.1 Adopting healthy lifestyle behaviours in early childhood can potentially influence and shape behaviours later in life.2 Frameworks have been developed, such as from the Center on the Developing Child at Harvard...
Editorial
Proactive steps to population health: Starting early, starting right
The global burden of non-communicable diseases is rising, with continued projected increases in the prevalence of metabolic syndrome (MetS) in the future. This epidemic, albeit of a metabolic nature, poses broad socioeconomic and healthcare burdens worldwide. Population health improvement and optimisation of healthcare are important to addressing these burdens....
Original Article
Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore
The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe symptoms of COVID-19, losing loved ones to the disease, financial insecurity, and social isolation. Furthermore, children and youths experienced disruption to their usual routine such...
Letter to the Editor
Sublingual ondansetron for treatment of acute gastroenteritis in children in the children’s emergency
Dear Editor,
Acute gastroenteritis (GE) is a leading cause of death globally in children aged below 5 years and the third most common indication for hospital admission in some countries.1,2 Currently, norovirus is the most common cause of GE in children in developed countries.3 Rehydration, either orally or intravenously, is...
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 COVID-19 infection in children.1,2,3 We report 4 cases of paediatric patients who had COVID-19 with mucocutaneous involvement, admitted to a tertiary children’s hospital in Singapore....
Letter to the Editor
The role of PIVKA-II in hepatocellular carcinoma surveillance in an Asian population
Dear Editor,
Alpha-fetoprotein (AFP) is the most established biomarker for surveillance of hepatocellular carcinoma (HCC) in at-risk individuals. However, its sensitivity and specificity are not very satisfactory.1 Protein induced by vitamin K absence or antagonist-II (PIVKA-II) is a newer biomarker for HCC but without a widely established cut-off.2,3 Recent...
Review Article
Through the eyes into the brain, using artificial intelligence
Neurological dysfunction is a leading cause of disability, affecting more than 276 million people worldwide.1 Over the last decades, the prevalence of neurological dysfunction has increased, particularly in the ageing population which is commonly affected by dementia, stroke and brain tumours.1,2 The increasing number of patients suffering from neurological...
Letter to the Editor
Rapid exome sequencing to aid diagnostics in genetic disorders: Implementation and challenges in the Singapore context
Dear Editor,
There is a high burden of genetic disorders in patients admitted to the intensive care unit (ICU), ranging from 45–56%,1,2 and delayed definitive diagnoses with a long diagnostic odyssey often contribute to increased healthcare costs.3 The application of clinical exome sequencing in ICU has been gaining traction, where...
Letter to the Editor
Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders
Dear Editor,
Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based patient-centric care.1
We have developed and implemented a deep-learning model using bidirectional long short-term memory (Bi-LSTM) neural network to enable automated triage of unstructured free-text...
Letter to the Editor
Early rehabilitation to improve functional outcomes in childhood cancer in Singapore
Dear Editor,
We conducted a prospective, single-centre cohort study to review the impact of a multidisciplinary rehabilitation programme in children with cancer in Singapore. The Template for Intervention Description and Replication (TIDieR) checklist was used to allow sufficient details for replication of the study (see Appendix in online Supplementary...
Review Article
The Omicron-transformer: Rise of the subvariants in the age of vaccines
The emergence and evolution of SARS-CoV-2 have been publicly tracked in unprecedented detail through a combination of intensive genomic sequencing and open-access sharing of data.1 This surveillance information describes how waves of COVID-19 infections have been driven by the emergence of new variants of concern (VOCs) and their subvariants....
Review Article
National surgical antibiotic prophylaxis guideline in Singapore
Surgical antibiotic prophylaxis (SAP) refers to the administration of antibiotics prior to clean and clean-contaminated surgeries to prevent postoperative surgical site infections (SSIs). An optimal SAP should be highly effective in preventing SSI. An ideal prophylactic antibiotic regimen is: (1) effective against pathogens—generally skin flora—most likely to contaminate the...
Original Article
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...
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 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...
Letter to the Editor
Child passenger safety training for healthcare professionals in Singapore
Dear Editor,
Road traffic injuries are a preventable cause of childhood morbidity and mortality.1,2 Use of age-appropriate child car seats (CCS) lowers the risk of injury and death by about 82% and 28%, respectively.3-5 In Singapore, although the Road Traffic Act states that CCS use is mandatory,6 many children...
Letter to the Editor
Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae infections among hospitalised children in Singapore
Dear Editor,
Mycoplasma pneumoniae has become the leading cause of paediatric community-acquired pneumonia in countries where pneumococcal vaccination is included in the national immunisation programme, including Singapore.1 M. pneumoniae is intrinsically resistant to beta-lactams due to the absence of cell walls. Macrolides, tetracyclines, and fluoroquinolones are used to treat M....
Letter to the Editor
Childhood interstitial lung disease: The end of a diagnostic odyssey
Dear Editor,
Childhood interstitial lung disease is a heterogeneous group of rare disorders featuring pulmonary interstitial remodelling and diffuse parenchymal infiltrates on imaging.1 Incidence is estimated at 0.13–16.2 cases/100,000 children per year.1 ABCA3 (ATP-Binding Cassette, Subfamily A, Member 3) (OMIM #601615) is expressed in alveolar type II cells involved...
Review Article
Exploring loss and grief during the COVID-19 pandemic: A scoping review of qualitative studies
As of mid October 2022, the World Health Organization recorded that more than 620 million people worldwide have been infected by SARS-CoV-2, the virus causing COVID-19, while over 6.5 million have succumbed to the disease. Many have lost family members and friends as well as jobs and familiar lifestyles,...
Original Article
Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation
The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and major adverse cardiac events (MACE) seen in this group of patients even after surgical aortic valve replacement (SAVR).1,2
In recent times, the role of transcatheter aortic...
Original Article
Validation and comparison of the PECARN rule, Step-by-Step approach and Lab-score for predicting serious and invasive bacterial infections in young febrile infants
The diagnostic approach and management of febrile infants <90 days of age remain a challenge, given that the majority of these infants have no localising signs and symptoms, and may appear clinically well at presentation.1 In addition, the majority of these infants have benign viral illnesses, for which hospitalisation...
Letter to the Editor
High burden of respiratory viral infection-associated mortality among critically ill children
Dear Editor,
Acute lower respiratory infections (ALRIs) are a leading cause of under-5 mortality globally—two-thirds could be attributable to respiratory viral infections (RVIs).1,2 The burden of paediatric RVIs in settings of tropical climate with year-long virus circulation is relatively underreported.3,4 Previous studies in these areas have estimated that around 8–11%...
Review Article
Periodontal disease and systemic health: An update for medical practitioners
Care for the oral cavity lies in the intersection of dentistry and medicine. As the oral cavity serves as an entry to the gastrointestinal tract and the point where the digestion process begins, it is often recognised as an important gateway to dietary and nutritional health. Oral health, however,...
Original Article
Non-motorised active mobility device use by children in Singapore: Injury patterns and risk factors for severe injury
The Active Mobility Act was introduced in Singapore in 2017 to promote the safe use of personal mobility devices. Non-motorised active mobility devices (AMDs) are popular among children and include tricycles, bicycles, scooters, inline skates, skateboards, longboards and waveboards. While the use of AMDs contributes towards an active lifestyle...
Editorial
Different strokes for different folks
Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey’s observation of fibrillating auricles in open chest animal models in 1628. Willem Einthoven first documented ECG tracing of AF in 1906. Fast forward several hundred years since its first observation, AF remains a mystery from its pathogenesis and...
Letter to the Editor
Screening for somatisation in an Asian children’s hospital emergency setting
Dear Editor,
In recent years, self-harm is the leading cause of morbidity and mortality among adolescents in Singapore.1,2 This is just the tip of the iceberg as youths with undiagnosed mental health disorders often present to the healthcare system with non-psychiatric symptoms.3 These psychosomatic symptoms do not have an organic...
Review Article
Barriers to breast cancer screening in Singapore: A literature review
Breast cancer is a major public health concern and a leading cause of cancer death among women worldwide, including Singapore.1 According to the 2018 Singapore Cancer Registry report, breast cancer has been consistently ranked as a leading cancer (29.3% of all cancers in Singapore) among women in Singapore for...
Original Article
Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction
Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to 8.5% in 2014.1 DM has been shown to be a common comorbidity in heart failure (HF) patients ranging from 4.3–28%2 and when present, portends a...
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 Africa. On 7 May 2022, a returning traveller from Nigeria to the UK was confirmed to have contracted monkeypox. By the end of May 2022,...
Letter to the Editor
Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
Dear Editor,
The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an accompanying editorial were published in the January 2022 issue of the Annals.1,2 An evidence-based approach was used with reference made to relevant published literature. The...
Letter to the Editor
Sedation in gastrointestinal endoscopy in Singapore
Dear Editor,
I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during endoscopy in the hospital setting”2 in your journal in January 2022.
The American Society of Gastrointestinal Endoscopy (ASGE) and the European...
Letter to the Editor
Non-anaesthesiologists administering propofol in the Singapore context
Dear Editor,
Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid onset of action and fast post-procedural recovery.1 Nonetheless, propofol depresses cardiorespiratory function and could result in life-threatening adverse effects.
A workgroup, mainly consisting of gastroenterologists and...
Letter to the Editor
Sedation by non-anaesthesiologists in gastrointestinal endoscopy
Dear Editor,
We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. We are especially intrigued by Statement 6, stating that propofol sedation for endoscopy can be safely and effectively administered by trained...
Original Article
Treating acutely ill patients at home: Data from Singapore
Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations age, and hospitals are expensive to build and run.1 There is increasing recognition of the risk of hospitalisation from potent nosocomial infections2,3 (exacerbated by the...
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 birth and 25% of deafness at age 4 years.1 It can also give rise to other serious sequelae such as cerebral palsy, cognitive impairment, seizures...
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 their inquisitive minds and experimental nature.1 Aetiologies for aural FBs include accidental or intentional insertion of FBs into body orifices, ear irritation caused by rhinitis...
Review Article
Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents
The World Health Organization’s Global action plan for the prevention and control of noncommunicable diseases 2013–2020 provided guiding principles for national efforts in controlling and reducing non-communicable diseases (NCDs).1 The major NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes—they form a major public health challenge, and are...
Editorial
Gastroesophageal reflux disease in Asian infants: Similar condition, different perceptions
Gastroesophageal reflux disease (GERD), a common problem in infancy, may lead to troublesome symptoms or complications such as oesophagitis or oesophageal stricturing in a small minority of infants.1 In the majority of cases, however, frequent regurgitations, the commonest symptoms of GERD, resolves with age spontaneously without any medical intervention.2,3...
Original Article
Comparison of planned-start, early-start and deferred-start strategies for peritoneal dialysis initiation in end-stage kidney disease
Peritoneal dialysis (PD) is a well-established long-term dialysis modality for patients with end-stage kidney disease (ESKD).1 It is recommended that a PD catheter should be placed at least 2 weeks prior to the anticipated need of long-term PD treatment for a planned-start PD.2 Despite wide-spread promotion of planned-start dialysis for...
Review Article
Use of Atypical Neuroleptics in a State Mental Institute
Schizophrenia is the most severe of all mental disorders and affects about 1% of the population. The main disturbances of schizophrenia comprise positive symptoms, negative symptoms and disorganisation.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Are Antacids Necessary as Routine Prescriptives with Non-steroidal Anti-inflammatory Drugs?
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic or anti-inflammatory properties in musculoskeletal pain. However, they are not without adverse effects, such as abdominal pain, diarrhoea, nausea and fluid retention, which are reported to occur in 30% of people taking NSAIDs.
This article is available only as a...
Others
9th Seah Cheng Siang Memorial Lecture: Gastric Cancer—Where are we now?
The last two decades have witnessed dramatic changes in the understanding of gastric cancer: a rapid decline in global incidence, its association with Helicobacter pylori gastritis, and the new information regarding its molecular biology. Nevertheless, gastric cancer remains the second commonest cancer in the world in terms of morbidity...
Review Article
Diagnosing and Managing Faecal Incontinence
Faecal incontinence is the inability to control the passage of gas, liquid or solid through the anus. Its severity varies from infrequent passage of gas to persistent lack of control of solid stools.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Original Article
Magnetic Resonance Cholangiopancreatography: Value of Using the Half-Fourier Acquisition Single-Shot Turbo Spin-Echo (HASTE) Sequence
Direct cholangiopancreatography has long been considered the standard of reference for assessment of the biliary tree and is generally safe, reliable and widely available. However, these methods are operator dependant and have the potential for morbidity in some patients (3% to 5%) with complications such as acute cholangitis, pancreatitis,...
Original Article
Bidirectional Cavopulmonary Anastomosis
Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to Fontan’s operation has been undertaken in an effort to reduce the volume load of a single ventricle as early as possible and to minimise the...
Original Article
Standard Oesophageal Manometry in Healthy Adults in Singapore
Although standard oesophageal manometry has been widely used in the West for many years, normal manometric values that have been well described for healthy volunteers in the West may not be applicable to this part of the world. Such normal values vary between investigators, even within the same study...
Review Article
Gut Barrier Dysfunction in Experimental Acute Pancreatitis
Bacterial infections are devastating and potentially lethal complications of acute pancreatitis, responsible for up to 80% of deaths in the condition. Pathogenetic studies of acute pancreatitis imply that the disease is initially a non-bacterial insult and that secondary sepsis frequently occurs during the progression of pancreatitis, concomitant with the...
Review Article
Experimental Models of Pancreatitis
From a historical perspective, the first experimental pancreatitis was induced by Claude Bernard in 1856 by the injection of bile and olive oil into the canine pancreatic duct, thus producing an acute necrotising pancreatitis. Since that time, acute experimental pancreatitis has attracted thousands of researchers, who employ animal models...
Review Article
Experimental Models of Hepatic Fibrosis in the Rat
Hepatic fibrosis and cirrhosis of the liver are complex diseases which, in man, may be caused by such varied factors as alcohol, hepatitis, schistosomiasis, biliary atresia, malnutrition and exposure to carcinogens and hepatotoxins. Although hepatic fibrosis is characterised by the massive deposition of extracellular matrix components in the liver...
Review Article
Development of the Human Intrahepatic Biliary System
The development of the human biliary system has been studied extensively. This knowledge is essential to the understanding of the pathogenesis of a spectrum of diseases termed “ductal plate malformation” (DPM).
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Original Article
Experimental Study of Hypovolaemic Shock-Induced Gastric Mucosal Lesions in the Rat
Hypoxic tissue injury is not only caused by lack of oxygen as was previously believed. Now it is clear that tissue injury associated with hypoxia occurs to a large extent in the post-hypoxic reoxygenation period.
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Original Article
The Role of Mast Cell Degranulation in Ischaemia-reperfusion-induced Mucosal Injury in the Small Intestine
Although a number of data support the notion that mast cell (MC) degranulation Is an important component of the tissue response elicited by ischaemia-reperfusion, the role of the gastrointestinal MC system in the pathophysiology of postischaemic mucosal barrier lesions is still poorly understood. The mucosal MCs (MMCs) of the...
Original Article
Direct Mucosal Targeting of Colonic Receptors by Prokinetic Drugs in an Experimental Model
The direct intraluminal (IL) administration of drugs into the intestine may have an important regional action and therefore clinical implications in the effective management of functional bowel disorders. We have previously published findings in the anaesthetised in vivo pig, that cisapride and mebeverine when infused IL into the sigmoid...
Original Article
Antineutrophil Cytoplasmic Antibodies (ANCAs) in Patients with Inflammatory Bowel Disease Show No Correlation with Proteinase 3, Lactoferrin, Myeloperoxidase, Elastase, Cathepsin G and Lysozyme: A Singapore Study
The diagnostic tests currently employed to diagnose inflammatory bowel disease (IBD) and to differentiate between Crohn’s disease (CD) and ulcerative colitis (UC) are both expensive and invasive. Serological markers that are easily applied which can distinguish between CD and UC with comparable sensitivity and specificity are lacking.
This article is...
Others
Pseudomembranous Colitis in a Patient Treated with Paclitaxel for Carcinoma of the Breast: A Case Report
Paclitaxel was discovered in 1963 as a crude extract from the bark of the pacific yew Taxus brevifolia. Since its development, a range of anticancer activity has been demonstrated.
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Others
Early Hepatocellular Carcinoma Presenting with Biliary Ductal Invasion—A Case Report
Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000 in females.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Survival of Colorectal Cancer Patients in Singapore by Anatomic Subsite: A Population-based Study
Colorectal cancer incidence rates rank second in most developed countries and have been rising rapidly in urban societies of East Asia. Despite much effort to detect early-stage disease and to explore more effective treatment methods, the overall 5-year survival rate has remained around 40% based on the reports from...
Letter to the Editor
Paediatric living-donor liver and kidney transplantation during COVID-19
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has impacted global healthcare including paediatric solid organ transplantation (SOT). We report our experience of resuming paediatric living-donor SOT during COVID-19, which took into account safety considerations for living donors, paediatric recipients and the transplant healthcare team. The US Centers for Disease...
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 within the wider community. Children still represent the minority of cases in Singapore, with around 8,000 paediatric cases as of 6 November 2021 out of...
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 and increased skin colonisation with Staphylococcus aureus, which can trigger infective flares, especially in more severe disease. Strategies to reduce S. aureus colonisation and infection...
Review Article
The efficacy and safety of high-intensity focused ultrasound in the treatment of benign thyroid nodules: A systematic review and meta-analysis from 1990 to 2021
Thyroid nodules are commonly seen in clinical practice. They can be detected by palpation in 5%1 of individuals and by ultrasound (US) in 19–68% of the general population.2 Most of them are benign, stable and asymptomatic, thus preferred treatments are usually non-invasive. These would include modalities ranging from percutaneous...
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 the fight against the disease. The safety and efficacy of these vaccines have been well demonstrated in clinical trials,1,2 and also against severe disease from...
Others
Shigella Septicaemia in Adults: Report of Two Cases and Mini-Review
Shigellosis is generally considered to be confined to the gastrointestinal tract. Septicaemic infections with Shigella species are extremely rare in adults.
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Original Article
Psychiatric Illness, Personality Traits and the Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder seen by gastroenterologists and has been found to account for 50% of referrals to a Gastroenterology clinic. It has an estimated prevalence of between 15% and 25% in the non-patient population.
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Others
Clinical Update on Helicobacter pylori
Helicobacter pylori is one of the commonest infections in human, affecting 30% to 50% of people worldwide. It is associated with the development of peptic ulcer, chronic gastritis and gastric cancer and may play a role in a small subset of patients with non-ulcer dyspepsia.
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Original Article
Perioperative Treatment with Bactericidal/Permeability-Increasing Protein (rBPI21) in Major Liver Surgery: A Concise Summary
Primary and secondary hepatic malignancies constitute a major health problem. Hepatocellular carcinoma accounts for 90% of all primary hepatic malignancies in the world. While relatively uncommon in Western countries, it is the most prevalent malignant neoplasm in Southeast Asia, South Africa, and many other regions.
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Others
Book Review
The third edition of this manual of gastroenterology by regional experts from Malaysia and Singapore consists of 27 short chapters packaged in 2 sections entitled “Luminal gastroenterology and “Hepatobiliary & Pancreas.” In his preface, the editor, Dr Richard Guan, states that “our goal is to provide a resource for...
Original Article
The Views of Mental Health Professionals Towards Psychotherapy—A Singapore Survey
There is a trend in Asia towards a greater application of psychotherapeutic approaches in multidisciplinary settings to emotional and behavioural disturbances. The inaugural issue of Asian Psychologist announced landmarks in the education and training of clinical psychology in two major Asian communities.
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Original Article
Aseptic Meningitis in Children—The Singapore Experience
Aseptic meningitis is a common diagnosis among infants admitted for fever without an obvious source. In cases where the aetiologic agent could be identified, more than 90% were due to enteroviruses.
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Review Article
Current Status in the Surgical Management of Adult Polycystic Liver Disease
Adult polycystic liver disease (APLD) is a rare benign condition that is characterised by the growth of multiple cystic lesions in the liver. More commonly, it occurs in close association with autosomal dominant polycystic kidney disease (ADPKD), where the prevalence increases from 25% in the third to 80% in...
Others
Boerhaave’s Syndrome Presenting as a Right-sided Pleural Effusion
A 79-year-old Chinese woman with no significant past medical history was admitted to another hospital with symptoms of abdominal pain and haemetemesis of approximately 200 mL of blood after a severe bout of vomiting. She declined a oesophago-gastro-duodenoscopy (OGD) and was clinically diagnosed to have Mallory-Weiss syndrome.
This article is...
Others
Modern Management of Colorectal Polyps: Are They All Premalignant?
Polyps of the colon and rectum are relatively common lesions. Most colorectal polyps are either adenomas or hyperplastic polyps.
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Others
Autoimmune Liver Disease in Children
Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1) and serologically by the presence of non-organ and liver-specific autoantibodies and increased levels of immunoglobulin G (IgG), in the absence of a known aetiology. They...
Review Article
Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
The practice of gastrointestinal (GI) endoscopy over the last 3 decades has seen both a rise in volume of routine procedures, and an increase in the breadth and complexity of procedures. Routine endoscopies have increased due to a growth in population size, and the introduction of guidelines is needed...
Original Article
The impact of deprescribing interventions on oral proton pump inhibitor utilisation in a Singapore tertiary hospital: A quality improvement initiative
The established efficacy of proton pump inhibitors (PPIs) in the treatment of upper gastrointestinal (GI) disorders, coupled with their perceived safety, have led to PPI overutilisation.1,2 Prescription of PPIs in absence of evidence-based indication, also known as low-value prescribing, is prevalent across the spectrum of healthcare settings.1-4 Within Singapore,...
Editorial
Ensuring safe sedation during gastroendoscopy
Gastrointestinal (GI) endoscopy started in Singapore in 1968 with diagnostic endoscopic gastric examination, using flexible fibre-optics GI endoscopy. Fibre-optic flexible sigmoidoscopy and colonoscopy were introduced later. Most of these procedures were performed then without sedation. The patients needed to cooperate with the endoscopists and inability to complete the endoscopic...
Others
Inflammatory Fibroid Polyp of the Caecum in a Patient with Neurofibromatosis
Inflammatory fibroid polyp is an uncommon nonneoplastic lesion found in the gastrointestinal tract. It is a benign, non-encapsulated submucosal lesion, composed mainly of loose connective tissues, vessels and with an eosinophilic inflammatory component.
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Original Article
Clinico-pathological Analysis of Myelodysplastic Syndromes According to French-American-British Classification and International Prognostic Scoring System
Myelodysplastic syndromes (MDS) are a heterogeneous group of acquired clonal haemopoietic stem cell disorders characterised by ineffective haematopoiesis and peripheral cytopenia. The natural history ranges from the indolent forms spanning years to those with rapid evolution to blast transformation.
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Original Article
Appropriateness of the Use of Parenteral Nutrition in a Local Tertiary-Care Hospital
Parenteral nutrition (PN) is an important supportive and often life-saving therapy for patients with gut failure. However, it is expensive and carries significant complications such as electrolyte disturbances, hyperglycaemia, hypertriglyceridaemia, hepatobiliary complications and line-related complications.
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Others
A Bolt Out of the Blue: A Case of Unexpected Acute Liver Failure
Acute hepatitis could result from viral, autoimmune or drug-reaction causes, among others. In areas endemic with hepatitis B, acute exacerbations of chronic hepatitis B (CHB) are the commonest cause. Hence, in Singapore where 4% of the population are hepatitis B carriers, when faced with acute hepatitis in a patient...
Review Article
Does the Advent of Endoscopic Ultrasound (EUS) Sound the Death Knell for Endoscopic Retrograde Cholangiopancreatography (ERCP)?
Endoscopic retrograde cholangiopancreatography (ERCP) has been the primary method of diagnosing and treating many pancreatic and biliary diseases (PBD) over the last 3 decades. The development of endoscopic ultrasound (EUS) since its introduction in the early 1980s has added a new dimension to the treatment of PBD.
This article is...
Others
Financing Newborn Screening Systems: US Experience
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Others
Considerations in Choosing Screening Conditions: One (US) Approach
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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 by atherosclerosis. Atherosclerosis (the hardening of the arteries) is the most common form of arteriosclerosis, in which the walls of arteries become thicker and less...
Letter to the Editor
Ceftriaxone-resistant Salmonella spp. in Singapore
The utility of ceftriaxone for the treatment of Salmonella typhi bacteraemia was first demonstrated in Singapore as early as 1985. Since then, ceftriaxone has become established as first-line treatment for typhoid fever and serious non-typhoidal Salmonella infections.
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Original Article
Ten-year Series of Splenic Abscesses in a General Hospital in Singapore
Splenic abscess is an uncommon clinical problem. Fewer than 800 cases have been reported in the literature.
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Review Article
Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children
Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share a bedroom, since the child is often unaware of what happens when he or she is asleep.
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Original Article
Concurrent Chemoradiotherapy followed by Surgery in Locally Advanced Squamous Cell Carcinoma of the Oesophagus: A Single Centre Experience
Carcinoma of the oesophagus is a relatively uncommon malignancy in Singapore and incidence rates have been declining since 1968. A total of 506 cases were diagnosed from 1993 to 1997. The age-standardised rate for the same period was 5.8 per 100,000.1 The predominant histologic type is squamous cell carcinoma,...
Others
Clinical Characteristics of Renal Infarction in an Asian Population
Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months.
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Original Article
Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined
Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications of osteonecrosis and chondrolysis, preventing further slips, and promoting physeal closure.
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Original Article
Charity Colonoscopy Event to Commemorate the 185th Anniversary of Singapore General Hospital
Colorectal cancer is now the cancer with the highest incidence in Singapore. Similar to many developed countries, individuals here have a moderate to high risk of developing colorectal cancer in their lifetime.
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Original Article
Application of the McDonald MRI Criteria in Multiple Sclerosis
Since its advent in 1982, magnetic resonance imaging (MRI) has become an important component in the evaluation of multiple sclerosis (MS). MRI is a highly sensitive tool for MS, with 95% patients with clinically definite MS (CDMS) demonstrating brain abnormalities.1 However, MRI is also known to be low in...
Original Article
Extracranial Non-vestibular Head and Neck Schwannomas: A Ten-year Experience
Schwannomas, also known as neurilemmomas, neuromas, or neurinomas, are uncommon nerve sheath neoplasms that may originate from any peripheral, cranial or autonomic nerve of the body with the exception of the olfactory and optic nerve. Malignant change is unusual. Some 25% to 45%1 of schwannomas are located in the...
Review Article
Hypoxic-ischaemic Brain Injury in Young Infants
In young infants, different types of hypoxic-ischaemic brain injury can occur.1-6 Brain injury can be localised or diffused.2-6 In localised brain injury, arterial or venous periventricular infarctions are encountered. Causes of arterial infarction in the paediatric population are coagulopathies, vasculopathies, polycythaemia, and emboli from cyanotic congenital heart disease.7 In...
Original Article
Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics
In recent decades, medical advances and economic pressures have shifted medical student training from hospital inpatient to ambulatory settings such as hospital outpatient and primary care clinics. Most studies have found that patients are agreeable to seeing medical students and value the opportunity to interact with them.
This article is...
Clinical Update
Guidelines for Endoscopic Ultrasonography
This guideline addresses the use of endoscopic ultrasound (EUS) as part of the diagnostic evaluation of certain conditions. In addition, issues of training and credentialing in EUS and complications of this procedure are also dealt with, within these guidelines. EUS combines features of endoscopy and ultrasonography in order to...
Images in Medicine
Diagnostic Challenge: A 79-Year-Old Woman with Calcified Lower Abdomen Mass
A 79-year-old woman presented with fever, diarrhoea, vomiting and abdominal pain for several hours. Her temperature was 39.2°C, pulse 102 beats/minute, respiratory rate 19 breaths/minute, and blood pressure 149/74 mmHg. A physical examination revealed diffuse abdominal tenderness.
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Original Article
Laparoscopic Common Bile Duct Exploration: Our First 50 Cases
Since its introduction a few decades ago, endoscopic retrograde cholangiopancreatography (ERCP) has brought about a significant change in the management of choledocholithiasis. With continual improvement in the technology and expertise in laparoscopic techniques, laparoscopic common bile duct exploration (CBDE) is becoming more popular and may be the next paradigm...
Original Article
Socio-demographic Profile and Psychiatric Comorbidity of Subjects with Pathological Gambling
Gambling has been defined as a wager of any type of item or possession of value upon a game or event of uncertain outcome in which chance, of a variable degree, determines the outcome. The failure to resist the impulse to gamble despite disruption to personal, family and vocational...
Original Article
Peutz-Jeghers Syndrome: Data from the Singapore Polyposis Registry and a Shifting Paradigm in Management
Peutz-Jeghers Syndrome (PJS) is an uncommon autosomal dominant hamartomatous polyposis syndrome associated with mucocutaneous melanocytic macules. Melanin deposition occurs most commonly in the perioral region and buccal mucosa, but these maccules may also be found on the hands, feet and perianal regions.
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Original Article
Thrombocytopenia and its Related Factors: A Hospital-based, Cross-sectional Study
Thrombocytopenia is a common clinical problem found in laboratory results during health examinations. Blood platelets play an essential role in haemostasis, thrombosis and coagulation of blood.
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Original Article
Normative Data for Quantitative Calcaneal Ultrasound in Asian Children
Dual energy X-ray absorptiometry (DEXA) is currently the gold standard for the assessment of bone mineral density (BMD). It is the commonest tool used to predict fracture risk in patients at risk of osteoporosis. The limitation of DEXA is that it only measures bone density in two dimensions, and...
Original Article
Supplementary Breast Ultrasound Screening in Asian Women with Negative But Dense Mammograms—A Pilot Study
Mammogram has been the gold standard for breast cancer screening and Magnetic Resonance Imaging (MRI) has been advocated for screening of high- risk individuals. However, there is currently no recommendation for supplementary ultrasound scan in breast cancer screening. Moreover, it is known that dense breasts, which are common in...
Original Article
Male Breast Cancer in Singapore: 15 Years of Experience at a Single Tertiary Institution
Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its incidence may be on the rise, although the clinical significance of this is unknown. This rarity has precluded large randomised controlled trials, and most treatment...
Original Article
Neonatal Outcome of the Late Preterm Infant (34 to 36 Weeks): The Singapore Story
Neonatologists were caught looking the other way in the early part of the millennium. While they were keenly following the progress of extreme preterms and their travails, preterms born at the other end of the spectrum were being quietly ignored as “well babies”. In July 2005, the National Institute...
Original Article
Fasting during Ramadan and Associated Changes in Glycaemia, Caloric Intake and Body Composition with Gender Differences in Singapore
Muslim individuals worldwide participate in obligatory abstinence from oral consumption of medications, food and liquid during the fasting month of Ramadan. Fasting during Ramadan is one of the 5 pillars of Islam. However, Islam exempts individuals whose health may be significantly affected from fasting. Despite this, up to 80%...
Letter to the Editor
Severe Vitamin B12 Deficiency in a 7-Month-Old Boy
Infantile vitamin B12 deficiency often affects children born to mothers whose nutritional intake is inadequate. We describe a 7-month-old boy with a 2-month history of recurrent vomiting, neurodevelopmental regression, failure to thrive (FTT) and macrocytic anaemia, who was diagnosed to have vitamin B12 deficiency.
This article is available only as...
Original Article
Assessment of Age in Ulcerative Colitis Patients with Ileal Pouch Creation—An Evaluation of Outcomes
A total proctocolectomy is considered the standard of care in patients with ulcerative colitis (UC). The indications for this operation in patients with UC include failure of medical treatment or dysplastic changes following endoscopic evaluation. The timing of the surgery could hence be highly variable among patients.
This article is...
Original Article
Risk Factors for Severe Adenovirus Infection in Children during an Outbreak in Singapore
Human adenoviruses (HAdVs) are well known pathogens that cause a variety of human illnesses. They are non-enveloped, linear double-stranded deoxyribonucleic acid (DNA) viruses. More than 50 distinct serotypes have been identified since the early 1950s. The wide spectrum of symptoms includes upper respiratory tract illness, pneumonia, conjunctivitis, cystitis and...
Letter to the Editor
Treatment of Ewing sarcoma in children: Results from a single centre
Dear Editor,
Ewing sarcoma is a malignant mesenchymal tumour that presents as a bone or soft-tissue sarcoma. Translocations involving the EWS gene on chromosome 22q12 are unique molecular signatures.1,2 Compared with the West where the annual incidence is 1–3 per million, incidence has been reported to be lower among Asians1...
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 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...
Images in Medicine
A rare case of thigh asymmetry in an infant
A 6-month-old baby boy presented with asymmetry of thighs since birth. On clinical examination, anteromedial aspect of the left thigh was bulky with pale yellow discolouration of the skin and no tenderness. The child was referred for high-resolution ultrasonography. On ultrasonography, there was evidence of a well-defined isoechoic soft...
Letter to the Editor
Prevalence of vitamin D deficiency and insufficiency in Malaysian infants
Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either vitamin D deficient or insufficient. In a study on the state of Kelantan in Malaysia (2010–2012), 60% of pregnant women were vitamin D deficient. Maternal...
Letter to the Editor
Impact of true fetal mosaicism on prenatal screening and diagnosis
Over the past decade, the non-invasive prenatal test (NIPT) has increasingly been used as a method for prenatal screening for trisomy 21 (T21) and other aneuploidies, complementing the traditional approach of first trimester screening (FTS). FTS comprises ultrasound of the nuchal thickness and blood test to measure the levels...
Original Article
A review of child sexual abuse cases presenting to a paediatric emergency department
Child sexual abuse (CSA) is a global public health issue with adverse short- and long-term repercussions. Formal definitions of CSA and the age for defining children differ around the world. In Singapore, CSA refers to any act where a child or young person below 16 years old is used...
Original Article
Prevalence of thyroid malignancy and hormonal dysfunction following radiation exposure in childhood
The incidence of thyroid cancer has been steadily increasing worldwide. Childhood radiation exposure is a known risk factor for thyroid malignancy. However, data on the incidence of thyroid cancer in this high-risk cohort in Singapore are limited. Thus, we assessed data from patients treated in our institution with a...
Letter to the Editor
Congenital adhesion band causing recurrent subacute intestinal obstruction in a virgin abdomen
Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB) in the elderly is rare. We report a case of a 63-year-old man who presented with acute-on-chronic intestinal obstruction due to CAB, which caused pseudointestinal...
Original Article
Accuracy of self-reported height, weight and BMI in a multiethnic Asian population
Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight has been directly linked to a number of debilitating diseases, including diabetes, heart disease and cancer, and has gained increased popularity as a measure of...
Letter to the Editor
Carbamazepine-induced toxic epidermal necrolysis in a patient despite testing negative for HLA B*15:02 allele
Carbamazepine (CBZ) has been used in Singapore since 19881 as an effective drug for the treatment of conditions such as epilepsy, neuropathy, neuralgia and psychiatric conditions. However, it is a high-risk drug for Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), particularly in Asians, and in 2004, a genetic marker human leukocyte...
Review Article
Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians
In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which have replaced open surgical high tie and stripping as the treatment of choice. CVI is common in the Western population and is reported to affect...
Original Article
Assessing the Content Validity of the EQ-5D Questionnaire Among Asians in Singapore: A Qualitative Study
EQ-5D is a tool to measure and value health status. It is a standardised questionnaire that comprises 2 components: a Descriptive System (DS) on the first page and a hash-marked visual analogue scale (EQ-VAS) on the second page. Importantly, responses to the DS can be converted into a utility...
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 (Ministry of Health, Singapore, unpublished data). Children generally have mild disease, although there is emerging literature on paediatric multisystem inflammatory syndrome temporally associated with COVID-19....
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 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...
Letter to the Editor
Importance of antenatal blood group typing and antibody screening in non-ABO/Rh haemolytic disease of the newborn
Haemolytic disease of the fetus and newborn (HDFN) is a severe, potentially fatal alloimmune condition where maternal antibodies are produced, transported across the placenta and react against fetal red blood cell (RBC) antigens, resulting in varying degrees of haemolytic anaemia. Although ABO and Rhesus D (RhD) incompatibility is responsible...
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 minor ailments, but these observations have yet to be evaluated in Singapore. We investigated ED attendances during the coronavirus disease 2019 (COVID-19) pandemic in Singapore.
This...
Letter to the Editor
Alternating hemiplegia of childhood presenting as recurrent apnoea in a term newborn infant
Recurrent apnoea in a term infant is usually pathologic, warranting a thorough aetiologic evaluation. An accurate diagnosis is essential in guiding subsequent management and understanding long-term prognosis.
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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 worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...
Original Article
Epidemiology and risk stratification of minor head injuries in school-going children
Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports and road traffic injuries are common causes in school-going children. Majority of paediatric head injury cases are mild traumatic brain injuries, defined as a Glasgow...
Editorial
The Singapore Cerebral Palsy Registry: An important new resource for cerebral palsy research
Cerebral palsy (CP) is a common, lifelong disorder of movement and posture resulting from an insult or maldevelopment of the developing brain. The movement disorders of CP are often accompanied by other associated sensory and cognitive impairments. For the majority of children (about 95% in high income countries), the...
Original Article
Causes, functional outcomes and healthcare utilisation of people with cerebral palsy in Singapore
Cerebral palsy (CP) describes a group of permanent, but often changing, disorders that affect movement and posture, causing activity limitation, attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The birth prevalence of CP is estimated to be 1.4–2.2 per 1,000 in high-income countries. It...
Original Article
Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury
The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range from USD5.9 billion–76.5 billion. Studies performed in the adult population reported that the direct cost of acute rehabilitation had been relatively similar over a 10-year...
Original Article
Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore
Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million by 2025, driven in part by marked economic and epidemiologic transition in recent decades.1 In China, the prevalence of diabetes rose from 1% in 1980...
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 prodromal fever, followed by pharyngitis, mouth ulcers and rash on the hands and feet. The disease is caused by numerous members of the Enterovirus genus...