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Healthcare burden of cognitive impairment: Evidence from a Singapore Chinese health study

Individuals with cognitive impairment (CI) are predisposed to injuries, infections and treatment complications,1 have poorer treatment compliance, and face greater difficulties with post-discharge care.2...

Prevalence of consumption of illicit drugs and associated factors from a nationwide epidemiological survey: The Singapore Health and Lifestyle Survey

Substance use disorders (SUDs) are characterised by the uncontrolled use of a substance by an individual despite its harmful consequences.1,2 The prevalence of consumption...

Validating two international warfarin pharmacogenetic dosing algorithms for estimating the maintenance dose for patients in Singapore

Dear Editor, Predicting optimal warfarin dosing is difficult due to complex pharmacodynamics and pharmacokinetics, narrow therapeutic index and susceptibility to many factors.1 Genetic variations of...

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

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

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...

Outcomes of patients admitted for drowning

Dear Editor, According to the latest Utstein-style consensus, drowning is defined as the primary respiratory impairment resulting from submersion or immersion in a liquid medium.1...

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...

Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency department

Dear Editor, Nitrous oxide (N2O) produces dissociative euphoria, amnesia and analgesia, and is a common sedative for procedural sedation in paediatric emergency departments (EDs) due...

Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial

Dear Editor, Emergence from anaesthesia and deep sedation is the transition from unconsciousness to the return of awareness and airway reflexes. The chief patterns of...

White precipitate in a dialysis circuit

An 81-year-old man who had been fully vaccinated against COVID-19 was admitted to the medical intensive care unit on day 5 of his COVID-19-induced...

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...

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...

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...

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...

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...

Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore

Functional gastrointestinal (GI) disorders, such as colic, gastroesophageal reflux (GER) and constipation, are common in infants under 1 year. They are a frequent cause...

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...

Pericardial Injury Following Severe Sepsis from Faecal Peritonitis—A Case Report on the Use of Continuous Cardiac Output Monitoring

The intermittent manual bolus thermodilution method is the most common means of determining cardiac output in critically ill patients. Although widely used, there are...

An Overview of Anaesthetic Issues in Phaeochromocytoma

New developments in technology, monitoring and pharmacology over the last decade have improved our understanding of phaeochromocytoma and its management. This review summarises the...

Is it Feasible to Use Magnesium Sulphate as a Hypotensive Agent in Oral and Maxillofacial Surgery?

Although deliberate hypotension during surgery may potentially cause organ ischaemia, in particular of the myocardium and cerebrum, it is widely used as an adjuvant...

Postanaesthetic Shivering—A Comparison of Thiopentone and Propofol

The incidence of shivering following general anaesthesia varies from 5% to 65%. Postanaesthetic shivering may increase tissue oxygen demand by as much as 500%...

Sudden Profound Hypoxaemia in the Intensive Care Unit—A Case Report

Significant arterial hypoxaemia is defined as a partial pressure of oxygen (PaO2) that is less than 60 mmHg or a percentage of oxyhaemoglobin (%...

Management Training in Critical Care Medicine

Critical care medicine as a specialty has grown rapidly, both clinically and academically, over the past 25 years. In the USA, certification of competence...

Combined High-frequency Ventilation (CHFV) in the Treatment of Acute Lung Injury—A Case Report

The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The...

Critical Care Medicine in the Western Pacific Region

The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and...

Critical Care—The Worldwide Perspective

Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s....

Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...

Predictors of Long-term Outcome in Severe Head Injury

Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993. This article is available only...

Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team

Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute...

Audit of 2431 Admissions to the Surgical Intensive Care Unit, Singapore General Hospital

The Singapore General Hospital is a 1700-bedded tertiary hospital with subspecialty intensive care units (ICUs), i.e. Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU, Medical ICU,...

Intensivists for the Intensive Care Unit—Do They Make a Difference?

Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have...

Epidural Analgesia in Obstetrics

Most obstetric anaesthetists have their favourite epidural concoction for use in labour, This paper surveys the variation in techniques of drug delivery and types...

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...

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...

An In vitro Evaluation of Epidural Catheters: Tensile Strength and Resistance to Kinking

In the current era of increasing economic and medicolegal pressures, it is imperative that equipment-related limitations and complications be reduced to a minimum. Epidural...

Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks

Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good...

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...

The Use of Magnesium Sulphate in the Intensive Care Management of an Asian Patient with Tetanus

A 29-year old Thai construction worker, previously well, was admitted to our Orthopaedic Department for sudden onset of lower back pain. Physical examination showed...

Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report

A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior...

Changing the Institutional Practice of Prolonged Mechanical Ventilation after Coronary Artery Bypass Graft Surgery to Early Extubation

In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists...

Controversies in Anaesthesia—Designer Drugs

The discovery of new drugs in anaesthesia previously relied completely on chance. Chemical compounds produced by pharmaceutical companies were screened by a variety of...

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...

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....

Radial Nerve Injury after Intravenous Cannulation at the Wrist—A Case Report

A 44-year-old male, right-handed and ASA 1 bus driver presented for elective mastoidectomy under general anaesthesia. Preoperative venous cannulation with a 20G cannula (Angiocath™)...

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...

Dissemination of Respiratory Secretions During Tracheal Tube Suctioning in an Intensive Care Unit

Tracheal tube suctioning is frequently performed in critically ill patients. This procedure often results in dissemination of droplets from the patient’s respiratory tract with...

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...

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...

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,...

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...

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...

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,...

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...

Perioperative Wheezing—A Report of Three Cases

Perioperative “wheezing” can be due to upper or lower airway obstruction. The signs and sounds of upper airway obstruction are typically worse during inspiration,...

The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report

A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral...

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...

Clinical Drug Trials: Practical Problems of Phase III

There has been a rapid increase in clinical trial activity in Singapore and other parts of Asia. Randomised clinical trials are the “gold standard”...

A Case Report of the Use of Magnesium Sulphate during Anaesthesia in a Patient who had Adrenalectomy for Phaeochromocytoma

Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells of the body derived from neural crest tissue. They may secrete both adrenaline and noradrenaline in...

Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery

Both intubation and extubation are processes associated with blood pressure and heart rate flux. While many studies have been carried out on the changes...

Deep Vein Thrombosis after Total Knee Replacement

Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis,...

Transurethral Surgery and the Adductor Spasm

Bladder tumours frequently arise from the posterolateral wall of the bladder1 over the course of the obturator nerve. It is during transurethral resection of...

Subcutaneous Emphysema and Pneumomediastinum after Endotracheal Anaesthesia

Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes. This article is available only as...

Total Intravenous Anaesthesia Using 3-in-1 Mixture of Propofol, Alfentanil and Mivacurium

Total intravenous anaesthesia (TIVA) implies achieving the 3 components of anaesthesia (hypnosis, analgesia and muscle relaxation) by the administration of anaesthetics via the intravenous...

The Predictive Value of Intraoperative ST-segment Monitoring as a Marker of Myocardial Injury

Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1...

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...

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...

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...

Fibre-optic Aided Bougie (FAB) for Simulated Difficult Tracheal Intubation

Difficult intubation remains a key problem1 and the value of a flexible introducer (gum elastic or wire) as a first approach is well recognised...

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. This article is available...

A Case Report on the Treatment of Intractable Anal Pain from Metastatic Carcinoma of the Cervix

Unremitting pain remained a primary therapeutic challenge in cancer patients. Both opioids and non-opioids are often the main stay of therapy for many. This 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...

Intravenous Regional Anaesthesia Using Lignocaine and Tramadol

Intravenous regional anaesthesia (IVRA) has a reported success rate of between 94% and 98% for upper limb surgery. Limitations to its use include the...

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...

Catheter-related Infection: Diagnosis, Prevention and Treatment

Intravascular catheters are indispensable for patient care. Despite advances in catheter technology and patient care, catheter infection remains a significant clinical problem. This article is...

Introduction of Problem-based Learning in a Traditional Medical Curriculum in Singapore—Students’ and Tutors’ Perspectives

The National University of Singapore was started in 1905. Since then, it has trained many generations of medical practitioners. This article is available only as...

Book Review

This handbook serves an important function for Intensive Care Units in Singapore. It is a collective effort of 35 specialists in 5 different institutions...

Intra-abdominal Hypertension—Implications for the Intensive Care Physician

Although the detrimental effects of raised intra-abdominal pressure have been known for over 100 years, it is only in the last two decades that...

Anaemia in the Critically Ill—The Optimal Haematocrit

The function of haemoglobin (Hb) is to transport oxygen to the tissues. Approximately 97% of oxygen is transported via Hb, while 3% is transported...

Quality of Life in Long-Term Survivors of Intensive Care

Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying...

Limitation of Life Support in the Critically Ill: The Hong Kong Perspective

Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly...

Simulation-based Training at the University of Pittsburgh

In the domain of medical education of both the general public and healthcare professionals, the next decade will present both challenges and opportunities centred...

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...

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...

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...

Pulse Dye Densitometry: A Novel Bedside Monitor of Circulating Blood Volume

The monitoring of circulating blood volume (CBV) is important in the care and management of critically ill patients. Progressive blood volume depletion, if unmonitored...

Case Report: Catheter-Related Epidural Abscess

Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to...

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...

A Case of Pulmonary Haemorrhage Following Jet Ventilation for Vocal Cord Surgery

Laryngospasm occurring at extubation is not an uncommon complication seen with use of endotracheal tubes and laryngeal mask airway. We report a case of...

Subdural Block—From a Spinal? A Case Report

There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an...

Problems Related to Epidural Analgesia for Postoperative Pain Control

Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with...

Measuring Health-related Quality of Life in Singapore: Normal Values for the English and Chinese SF-36 Health Survey

Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many...

Clinical Update on Managing the Obstructed Airway

Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians...

Anaesthetic Considerations for Lung Volume Reduction Surgery—A Case Report

Only until a few years ago, the only surgical alternative for patients with severe emphysema was lung transplantation. However, with transplantation, there are problems...

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...

Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma – Case Reports

The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to...

A Prospective Audit of Critical Incidents in Anaesthesia in a University Teaching Hospital

Despite the highest standards of training, practice and equipment, morbidity and mortality due to anaesthesia still occur. These risks are difficult to quantify, and...

Validity and Reliability of the EQ-5D Self-report Questionnaire in Chinese-speaking Patients with Rheumatic Diseases in Singapore

Health-related quality of life (HRQoL) refers to patients’ perceptions of their own functioning and well-being. HRQoL is increasingly being used as a primary or...

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...

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...

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. This article is available only as...

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)...

Eating Disorders in Singapore: A Review

Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms...

Youth Suicide and Parasuicide in Singapore

The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or...

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...

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...

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...

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...

Behcet’s Disease: Experience in a Tertiary Rheumatology Centre in Singapore and a Review of the Literature

The only published study on Behcet’s disease in Singapore by Tan E et al (34 patients at the National Skin Centre) found that only...

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...

Marijuana in Pregnancy

Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include...

Characteristics and Acute Rehabilitation of Guillain-Barré Syndrome in Singapore

The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is...

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...

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...

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...

An Unexpected Left Hydrothorax after Left Internal Jugular Venous Catheterisation for Total Parental Nutrition and Antibiotics

Percutaneous indwelling central venous catheters are commonly used for a variety of medical and surgical indications. There are various complications associated with the insertion...

The Impact of Experiential Learning on NUS Medical Students: Our Experience With Task Trainers and Human-patient Simulation

The realisation that students have different cognitive and learning styles has had major implications on medical curriculum design efforts. If the student’s learning style...

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...

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...

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 Clinical Predictors of Hypertension and Sleepiness in an Asian Population with Sleep-disordered Breathing

Sleep physicians have only recently began to learn much about the epidemiology of sleep-disordered breathing (SDB) from large, well conducted prospective community-based studies. These...

Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis

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

The Future of Medical Education: The Second 100 Years

This is a proud year for the medical profession in Singapore, as we celebrate 100 years of medical education. As the oldest faculty in...

The Medical Students’ Societies and Medical Students’ Publications

For a very long time, King Edward VII (endearingly abbreviated “KE”) was synonymous with the medical school and its associated hall of residence. The...

The Teaching of Radiology

A record of Diagnostic Radiology would be incomplete without reference to Wilheim Roentgen, who discovered the rays that he could not comprehend; hence, X-rays....

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...

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...

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...

The Media and Suicide

Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former...

Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme

Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM)...

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. This article is available only as a PDF....

A Doctor’s Duty is to Heal the Unhealthy: The Story of Tun Dr Mahathir Mohamad

Mahathir Mohamad was born in 1925 in Alor Setar, Kedah. In 1947, after living through the turbulent times of the Second World War, he...

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...

Acceptance of Prophylactic Surgery and Chemoprevention of Cancer in Singapore – A Survey

The Singapore healthcare philosophy aims to establish a healthy population through preventive healthcare programmes and public health education. Public education usually emphasises the adverse...

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...

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...

Concomitant Use of Midazolam and Buprenorphine and its Implications Among Drug Users in Singapore

Benzodiazepines (BDZs) (commonly known as “sleeping pills”) are routinely and successfully used in the treatment of sleep and anxiety disorders. However, studies have indicated...

A Brief History of Pathology and the Chapter of Pathologists

A history of the Chapter of Pathologists would be incomplete without a history of the specialty of Pathology in Singapore. Pathology is in fact...

From the Chapter of Physicians, Academy of Medicine, Singapore to the College of Physicians, Singapore

The transformation of the previous Chapter of Physicians, Academy of Medicine, Singapore to the current College of Physicians, Singapore in 2004 was the outcome...

From the Chapter of Anaesthetists to the College of Anaesthesiologists, Singapore

The arrival of Sir Stamford Raffles in 1819 herald the birth of western medicine in Singapore. Doctors were then sent here from Britain. These...

Academy of Medicine, Singapore – The Next Twenty-Five Years (1982-2007)

The Academy of Medicine was founded in 1957 as the professional corporate body of medical and dental specialists in Singapore. From a modest beginning...

Epidemiology, Management and Treatment Outcome of Medulloblastoma in Singapore

Medulloblastoma (MBL) is the most common type of malignant brain tumour in childhood. It belongs to the group of tumours known as primitive neuroectodermal...

Timing of Hospital Presentation After Acute Cerebral Infarction and Patients’ Acceptance of Intravenous Thrombolysi

Intravenous thrombolysis in acute cerebral infarction has been proven to be efficacious in improving functional outcome if given within 3 hours from stroke onset.1...

Demographic and Clinical Features of 150 Pathological Gamblers Referred to a Community Addictions Programme

Pathological gambling has been defined as a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and work life. The diagnosis is not...

Successful Rehabilitation With Cochlear Implant in Post-irradiation Induced Hearing Loss in Nasopharyngeal Carcinoma Patient

Nasopharyngeal carcinoma (NPC) is a common disease in Asia.1 Radiotherapy is the mainstay of treatment. Following radiotherapy, complications like profound sensorineural hearing loss may...

A Prospective Cohort Study on the Impact of a Modified Basic Military Training (mBMT) Programme Based on Pre-enlistment Fitness Stratification Amongst Asian Military Enlistees

Basic military training (BMT) is seen as a vital initiation phase into military service when new recruits are conditioned to the rigours of military...

Where the Elderly Die: The Influence of Socio-Demographic Factors and Cause of Death on People Dying at Home

The subject of place of death was brought to the forefront of the medical community in July 2004 when 2 important publications were released;...

Reply from Author: Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters

We thank Dr Nicholas Chua et al for their interest in our review article. We agree and appreciate the experience and comments by the...

Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters

We thank the authors for a comprehensive review on the role of interventional pain therapies used in cancer pain as well as a informative...

Trends in Importation of Communicable Diseases into Singapore

Singapore is a city-state in Southeast Asia, with a total population in 2007 of 4,839,400, of which 3,642,700 (75.3%) are Singaporean residents. The remaining...

Acceptance of Information and Communication Technologies for Healthcare Delivery: A SingHealth Polyclinics Study

Information and communication technologies, such as internet portal and short message system (SMS), are increasingly used in healthcare delivery worldwide.1,2 Typically, these technologies are...

Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later

Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom...

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...

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...

Diagnostic Accuracy of Anthropometric Indices for Obesity Screening Among Asian Adolescents

Obesity or excess body fat is strongly associated with enhanced risks of morbidity and mortality, and its prevalence is rapidly escalating worldwide. Despite these...

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...

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...

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...

Health-related Quality of Life is Associated with Diabetic Complications, but not with Short-term Diabetic Control in Primary Care

Type 2 diabetes mellitus is a major chronic disease globally. With increasing life expectancy, long-term complications of diabetes mellitus leading to significant morbidity and...

Quality of Life in Pathological Gamblers in a Multiethnic Asian Setting

Pathological gambling is categorized under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) as an impulse control disorder not elsewhere classified....

Causes of Death in Hospitalised Human Immunodeficiency Virus (HIV)-infected Patients at a National Referral Centre in Singapore: A Retrospective Review from 2008 to 2010

The advent of the highly active antiretroviral therapy (HAART) era has greatly reduced the mortality and incidence of new diagnoses of acquired immune deficiency...

Causes of Death and Factors Associated with Early Death Among Human Immunodeficiency Virus (HIV)-Infected Persons in Singapore: Pre-Highly Active Antiretroviral Therapy (HAART) and Peri-HAART

Since the first case of human immunodeficiency virus (HIV) was diagnosed in Singapore in May 1985, a total of 4845 cases and 1389 HIV/acquired...

Melanoma: Differences between Asian and Caucasian Patients

Cutaneous melanoma is the most common cause of mortality amongst skin cancer in Caucasian populations and incidence rates per 100,000 patient years vary between...

Overcoming Barriers to Mammography Screening: A Quasi-randomised Pragmatic Trial in a Community-based Primary Care Setting

Breast cancer is the leading cancer among women in Singapore, accounting for 29% of all cancers occurring in women between 2006 and 2010. Evidence...

Hoarding in an Asian Population: Prevalence, Correlates, Disability and Quality of Life

Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value, leading to...

Clinical Outcome and Cost Comparison Between Laparoscopic and Open Appendicectomy

Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. The traditional operation of choice was the open...

Osteogenic Sarcoma in Children and Young Adults

Osteogenic sarcoma (OS) is a primary malignant tumour of the bone, derived from primitive bone-forming mesenchyme and characterised by the production of osteoid tissue...

Recommendations for standards of neuromuscular monitoring during anaesthesia

Dear Editor, We presented recommendations for neuromuscular monitoring during anaesthesia, which were approved by the Council of the College of Anaesthesiologists, Singapore in September 2019...

Evidence-Based Guidelines on the Use of Opioids in Chronic Non-Cancer Pain—A Consensus Statement by the Pain Association of Singapore Task Force

Studies show that the incidence of chronic pain is approximately 18% in Australia and developed countries in Europe. In Asia, data from Hong Kong...

The Use of Complementary and Alternative Medicine in Chronic Pain Patients in Singapore: A Single-Centre Study

Chronic pain is a prevalent disease that is often diffi cult to manage. According to a World Health Organisation survey, the worldwide prevalence of...

Management Plan to Reduce Risks in Perioperative Care of Patients with Obstructive Sleep Apnoea Averts the Need for Presurgical Polysomnography

A significant proportion of patients with underlying obstructive sleepapnoea (OSA) remain undiagnosed when they present for surgery. Epidemiologic data have placed the prevalence in the...

Single Centre Experience of Transjugular Liver Biopsy in 152 Patients

The first reported case of liver biopsy was recorded in 1883 by Ehrlich. Since then, the technique of liver biopsy has been modified tremendously...

Projecting the Number of Older Singaporeans with Activity of Daily Living Limitations Requiring Human Assistance Through 2030

Similar to other developed countries in Asia, including Japan, South Korea and Taiwan, the population of Singapore is ageing rapidly. In 2011, 9.3% of...

Determinants of Health-Related Quality of Life Among Community Dwelling Elderly

Singapore is experiencing an unprecedented age shift as the post-war baby boomers turn 65 years in 2012. Currently there are 378,700 people aged 65...

A Review of Back Injury Cases Notified to the Ministry of Manpower from 2011 to 2012

Work-related low back disorders consist of both low back pain (LBP) and low back injuries. They are a significant and increasing problem all over...

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...

Academic Medicine Education Institute (AM∙EI): Transforming the Educational Culture of Health Professionals

In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their...

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...

Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases

Over the past few decades, the introduction of laparoscopic surgery has been the biggest game changer in abdominal surgery.1 However, although the first laparoscopic...

A survey of Singapore anaesthesiologists for practice and prevention of peri-operative hypothermia in adult surgical patients

Core temperature is the temperature of blood and internal organs; influenced by biorhythm, metabolism, activity and hormones. It is regulated within a narrow range,...

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)...

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...

Transcatheter Aortic Valve Implantation in Singapore: Reflecting on the First Decade

Transcatheter aortic valve implantation (TAVI) has markedly changed the way aortic valve stenosis is treated. It is 18 years since the first patient was...

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...