Pharmacotherapy has been the mainstay of atrial fibrillation (AF) treatment. As AF progresses from paroxysmal to persistent, electrical and structural remodelling of the atria may become irreversible, rendering future rhythm-control therapies less effective. Results of earlier trials on rhythm control were disappointing and failed to establish the superiority of...

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...

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 patients with COVID-19 has been highly challenging. In this issue of the Annals, Lew et al.1 reported the results of a multicentre retrospective observational study...

Dear Editor, Atrial fibrillation (AF) is frequently encountered in the emergency department (ED) and is a major risk factor for thromboembolic events. The clinical decision for anticoagulation is guided by risk scoring systems that include factors such as age, sex and comorbidities.1,2 AF can sometimes occur in patients with active...

Circular RNAs (circRNAs) are a group of endogenous RNAs characterised by their covalently closed-loop structures. These molecules are part of a large class of non-coding RNAs that includes microRNAs (miRNAs) and long non-coding RNAs (lncRNAs). CircRNAs were initially thought to be of low abundance and represent errors in splicing....

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...

The incidence of mortality is higher among psychiatric patients than among the general population and the cause of which may be the psychiatric disorder itself or other related factors like life-style and medications. Reports of sudden deaths among patients taking psychotropic drugs have raised concerns that some of the...

Acute coronary syndrome (ACS) refers to a continuum of clinical entities ranging from unstable angina pectoris (UAP) to Q-wave myocardial infarction. Mortality rates from acute myocardial infarction (AMI) have seen a worldwide decline in recent years. This article is available only as a PDF. Please click on “Download PDF” on...

Cerebrovascular disease is the fifth commonest cause of hospitalisation in Singapore, and accounts for 2.7% of all hospital discharges. Neurogenic dysphagia is a common complication of stroke disease and it has been shown that post stroke dysphagic patients have 6.95 times higher risk of developing pneumonia when compared to...

In the light of the Cardiac Arrhythmia Suppression Trial (CAST) which suggested that class I antiarrhythmics may be linked to an increase in mortality, attention has been turned towards the use of class III drugs for the management of both atrial and ventricular arrhythmias. While the adverse effects of...

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...

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...

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

Botulinum toxins (BTX) have revolutionised the management of focal spastic hypertonia in a variety of neurologic diseases. Prior to the introduction of BTX for this purpose in the early 1990s, clinicians were limited to oral spasmolytic agents and nerve blocks using phenol or alcohol. All these interventions are effective...

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.

Acute myocardial infarction (AMI) is an important cause of mortality and morbidity worldwide. It typically occurs in middle-aged or elderly people with cardiovascular risk factors, such as cigarette smoking and diabetes mellitus. Although uncommon, AMI does occur in pregnant women. From the physiological perspective, pregnancy has been shown to...

Primary percutaneous coronary intervention (PPCI) has been shown to be superior to thrombolysis in patients presenting with ST-segment elevation acute myocardial infarction (STEMI), with regard to reduction of death, stroke and re-infarction. However, bleeding and thrombotic complications can occur despite successful PPCI and slow flow/no-reflow or poor microvascular reperfusion...

Acute coronary syndrome (ACS) encompasses the clinical spectrum of unstable angina (UA) and acute myocardial infarction (AMI). Most ACS are precipitated by luminal thrombi within coronary arteries, which may arise from 3 different atherosclerotic plaque morphologies: plaque rupture, plaque erosion or calcified nodules. This article is available only as a...

Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for a physician not to consider it as a possible diagnosis in any patient presenting with acute symptoms of chest tightness or discomfort, palpitations, dyspnoea, diaphoresis,...

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...

Following orthopaedic surgery, approximately 5% of patients sustain cardiac complications which leads to increased morbidity and mortality. The mortality rate after hip fracture is as high as 10% to 26% at 6 months and cardiac-related death are common. Cardiac injury is potentially treatable and therefore early detection of myocardial...

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...

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 as abnormal platelet activation, impaired fibrinolysis, and endothelial dysfunction in COVID-19 patients, resulting in thrombosis. The lungs are thought to be the epicentre of thrombosis,...

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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...