Letter to the Editor
Strategic response to mpox in the Singapore Armed Forces: Military public health collaboration and preparedness
Dear Editor,
The Singapore Armed Forces (SAF) has long prioritised infectious disease management as a critical component of military readiness. Mpox, a zoonotic viral disease caused by the monkeypox virus, presents unique challenges due to its transmissibility, potential for severe outcomes, and the logistical vulnerabilities of military environments. With frequent...
Original Article
Omicron SARS-CoV-2 outcomes in vaccinated individuals with heart failure and ischaemic heart disease
Respiratory viral infections are a relatively common cause of heart failure (HF) exacerbations, with higher risk of adverse outcomes observed in HF episodes precipitated by infection.1 Multiple reports from the initial phase of the COVID-19 pandemic reported higher mortality and in-hospital complications associated with a history of HF and...
Letter to the Editor
Upper airway stimulation for obstructive sleep apnoea in Asians: A Singapore sleep centre experience
Dear Editor,
Obstructive sleep apnoea (OSA) is the most prevalent sleep-related breathing disorder, affecting approximately 15% of the global population.1 In Singapore, 30.5% of the population has moderate-to-severe OSA.2 The gold standard treatment, continuous positive airway pressure (CPAP) therapy, often has poor adherence, with only 13.8% of Singaporeans diagnosed with...
Editorial
Enhancing HIV pre-exposure prophylaxis using telehealth: Insights from the iPARTY study
Human immunodeficiency virus (HIV) infections are increasing globally despite significant advancements in preventive and treatment programmes.1 This alarming trend is particularly pronounced within high-risk populations, especially among young men who have sex with men (YMSM). Given these rising infection rates, studies such as the iPARTY study are highly pertinent...
Original Article
iPARTY study: Increasing pre-exposure prophylaxis access and reach via telehealth for young men who have sex with men in Singapore 2022–2023
Human immunodeficiency virus (HIV) infection remains a significant global health challenge worldwide, with 39 million people living with HIV as of 2022.1 In Singapore, there were 209 newly diagnosed cases of HIV infections in 2023, a 3% increase from 2022.2 Although highly active antiretroviral therapy (HAART) effectively suppresses viral...
Letter to the Editor
vNOTES hysterectomy with a homemade glove port: Initial experience in Singapore
Dear Editor,
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an established surgical method of performing hysterectomy via the vaginal route and is one of the latest editions to the realm of minimally invasive surgery. Since the first vNOTES performed by Su et al. in Taiwan in 2012, vNOTES has...
Letter to the Editor
Infected ovarian endometrioma: Case series and management outcomes
Illustration by LadyFingers Co.
Dear Editor,
Infected endometrioma, which is the superimposed infection and abscess formation of ovarian endometrioma, is increasingly understood to be a distinct clinical entity from tubo-ovarian abscess (TOA). The pathophysiology of infected endometriosis has been postulated to be a result of endometriotic fluid acting as a culture...
Original Article
Prevalence of complexity in primary care and its associated factors: A Singapore experience
As Singapore’s population ages, the incidence of non-communicable chronic diseases will rise in tandem.1 There exists a subset of individuals, oftentimes elderly with multiple chronic conditions, whose care needs are particularly complex.2 While there is no universal definition of a person with complex needs, these individuals have been found...
Original Article
Long-term survival and clinical implications of allogeneic stem cell transplantation in relapse/refractory lymphoma: A 20-year Singapore experience
Over the past few decades, a wide array of novel therapies has become available for the treatment of relapsed/refractory (R/R) lymphoma. Despite these advancements, outcomes and the durability of disease control remain poor for many patients. While autologous hematopoietic stem cell transplantation (auto-HSCT) may be appropriate for some lymphoma...
Original Article
Intrapleural fibrinolytic therapy for pleural infections: Outcomes from a cohort study
Pleural infection, defined as bacterial infection and replication in the pleural space,1 remains a significant cause of mortality.2 Over 80,000 cases of pleural infection are diagnosed each year in the US and the UK.3,4 Data from East Asia suggest that the annual incidence of pleural infections is 8.4 to...
Letter to the Editor
Prevalence and causes of rifampicin-resistance genotypic/phenotypic discrepancy detected on Xpert MTB/RIF in Singapore
Dear Editor,
The Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) (Cepheid, Sunnyvale, CA, US) has been pivotal in tuberculosis (TB) diagnostics, enabling the rapid detection of both TB and RIF resistance. Xpert, a nucleic acid amplification test (NAAT), is recommended by both the World Health Organization (WHO)1 and Singapore's clinical management guidelines2 as...
Letter to the Editor
Traction alopecia in women: An under-recognised cause of hair loss
Dear Editor,
Alopecia ranks among the most common clinical complaints encountered by dermatologists.1 In particular, affected women often experience great psycho-emotional stress leading to a reduction in quality of life.2
We conducted a prospective epidemiological study conducted over 77 weeks from 1 August 2022 to 23 January 2024 at an outpatient...
Editorial
Journey towards a smoke-free nation
“A journey of a thousand miles begins with a single step.” Singapore’s journey towards a smoke-free society started early in the 1970s when legislations were introduced to restrict smoking in certain public spaces and ban tobacco advertising.1 The National Smoking Control Programme was launched in 1986 with important objectives...
Original Article
Factors influencing smoking cessation: Insights from Singapore’s nationwide health and lifestyle survey
The global prevalence of smoking has declined over the years. According to authors utilising data from the Global Burden of Disease, Injuries, and Risk Factors Study, from 1990 to 2020, the number of male smokers fell by 27.2%, whereas female smokers fell by 37.9%.1 Moreover, the decline in smoking...
Letter to the Editor
Evolving landscape of sports injuries and recommendations on injury preventions: A retrospective analysis in Singapore
Dear Editor,
Sports have become increasingly integral to the daily lives of Singaporeans. According to the National Sport and Exercise Participation Survey, the percentage of Singaporeans exercising weekly rose from 54% in 2015 to 73% in 2023.1 While this surge in sports activities brings numerous health benefits, it also results...
Letter to the Editor
Isolated remote site musculoskeletal Mycobacterium bovis infections after BCG immunisation in immunocompetent children
Dear Editor,
The Bacillus Calmette–Guerin (BCG) vaccine, derived from wild-type Mycobacterium bovis, is administered in an attenuated form to prevent Mycobacterium tuberculous (MTB) infections in children residing in endemic regions. Since the introduction of the Singapore Tuberculosis Elimination Programme in 1997—specifying mandatory BCG-immunisation at birth—the incidence fell drastically to 32.6...
Letter to the Editor
The emergence of otter attacks in Singapore: A case series and strategies for management
Dear Editor,
Singapore is experiencing an unprecedented increase in the number of smooth-coated otters (Lutrogale perspicillata). Since 2017, the local otter population has more than doubled to at least 170. This has led to an increase in the number of otter-human attacks since 2021.1,2 While common animal attacks like dog...
Letter to the Editor
Gaps in primary care management of urinary tract infections in Singapore
Dear Editor,
Urinary tract infection (UTI) is a common presentation in primary care, but gaps of care have not been well established in Singapore. UTIs are one of the most common bacterial infections worldwide,1 constituting around 1% of all ambulatory clinic visits.2 The healthcare burden of UTIs remains highly significant,...
Letter to the Editor
Seroprevalence of cytomegalovirus over the last 2 decades (2001–2020): A retrospective data analysis from a single laboratory in Singapore
Dear Editor,
Cytomegalovirus (CMV) is ubiquitous and infects human of all ages, where it remains latent after primary infection and can reactivate upon various triggers.1 Reactivated CMV may cause complications and end organ damages in immunocompromised hosts, leading to increased morbidity and mortality.2 In addition, the presence of actively replicating...
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...
Original Article
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 of substances and SUDs varies widely across countries. This difference in prevalence can be attributed to factors such as study methodology (the substance included in...
Editorial
Illicit drug consumption in Singapore: Where are we in the fight against drugs?
Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be a growing problem worldwide. In 2021, 1 in 17 people aged 15–64 in the world had used a drug in the past 12 months. Notwithstanding...
Letter to the Editor
Patient’s degree of adherence, challenges & preferences towards medicine taking (PACT) in Singapore
Dear Editor,
Medication nonadherence is a prevalent public health problem that compromises patients’ health outcomes and increases healthcare expenditures.1 Studies in Singapore showed that 25.7%–38.9% of patients are nonadherent.2,3 Studies investigating the association between patients’ reasons for nonadherence and their preferences towards adherence enablers are limited. We aimed to (1)...
Review Article
Singapore tuberculosis (TB) clinical management guidelines 2024: A modified Delphi adaptation of international guidelines for drug-susceptible TB infection and pulmonary disease
Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis complex. For decades, it was the leading cause of death worldwide from a single infectious disease before being displaced by COVID-19 during the pandemic years.1
TB is endemic in Singapore, with over 2000 cases of TB disease (formerly active TB)...
Letter to the Editor
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 hypertension, who presented with a 7-day history of unrelenting fever, myalgia, confusion and unsteady gait. He worked as a shipyard engineer and travelled between Singapore...
Editorial
Direct oral anticoagulant: Looking beyond convenience
Since the 2010 Food and Drug Administration approval of Dabigatran as the first non-vitamin-K antagonist oral anticoagulants or direct oral anticoagulants (DOACs) as it is now more commonly referred to, there has been much development in the field with increasing availability of different DOACs and an expansion in indications...
Commentary
Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...
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...
Review Article
AL amyloidosis: Singapore Myeloma Study Group consensus guidelines on diagnosis, treatment and management
Amyloidosis refers to disorders characterised by the deposition of insoluble amyloid fibrils, which are pathogenic,1 resulting in organ dysfunction. Amyloidoses differ in the protein precursor undergoing aggregation and downstream target organs implicated. Consequently, clinical manifestations are varied, from localised amyloidosis in Alzheimer’s disease, to systemic amyloidosis such as immunoglobulin...
Original Article
Clinical utility of PET/MRI in multiple myeloma
Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and bone lesions. A sensitive method to detect bone lesions is crucial as it could determine the decision to start treatment. In this era, the International...
Editorial
Improving management of AL amyloidosis
In this issue of the Annals, Tan et al. on behalf of Singapore Myeloma Study Group presented the consensus guidelines on light chain (AL) amyloidosis.1 This is an encouraging effort as AL amyloidosis is a rare disease, with diagnostic and therapeutic challenges. A comprehensive review examining its pathophysiology, diagnostic...
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....
Editorial
Impact of pre-existing depression on severe COVID-19 outcomes
The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the lives of billions of individuals around the world.1 Public healthcare around the work have mainly focused on the clinical manifestations and treatment of the deadly...
Editorial
Incorporating assessment of fibrinogen gene polymorphisms and bleeding risk in patients treated with direct oral anticoagulants
Direct oral anticoagulants (DOACs) have become entrenched as the dominant anticoagulant over the last decade for patients with venous thrombosis and atrial fibrillation.1 Compared to warfarin, bleeding risk is similar or lower for patients on DOACs but clinically relevant bleeding is still a risk, especially for patients with impaired...
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...
Editorial
Self-esteem and positive body image to overcome female sexual dysfunction
Human sexuality is arguably one of the main pillars of health, like nutrition and sleep. Improvements in diagnostic and therapeutic biotechnologies have enabled focus on not only deadly diseases, but also on the quality of life and sexual functions of men and women. Digital media also play a considerable...
Letter to the Editor
Delayed treatment with nirmatrelvir/ritonavir could remain effective in patients with Omicron BA2.2 variant of COVID-19
Dear Editor,
In late February 2022, the Omicron BA.2.2 subvariant drove the outbreak of COVID-19 and rapidly spread through many parts of the world. Omicron-infected individuals aged ≥80 years who are unvaccinated are particularly at high risk of poor outcomes.
COVID-19 vaccines and antiviral therapeutics have protected individuals most at risk...
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....
Original Article
Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome
A spectrum of immune dysregulation has been described following SARS-CoV-2 infections—from the cytokine storm in the acute phase, to hyperinflammatory syndromes that occur after the resolution of the initial infection.1 Multisystem inflammatory syndrome (MIS) was first reported in children in April 2020 as a hyperinflammatory syndrome with features similar...
Letter to the Editor
Clinical outcome of bacterial endogenous endophthalmitis in 15 patients
Dear Editor,
Endophthalmitis refers to the inflammation of the ocular cavities and their immediate adjacent structures without extension beyond the sclera, usually secondary to infection. Endogenous endophthalmitis (EE) results from haematogenous spread of microorganisms in patients with bacteraemia or fungaemia into the eye and represents 2–15% of endophthalmitis cases.1-3...
Review Article
Combating a resurgence of poliomyelitis through public health surveillance and vaccination
Singapore was certified poliomyelitis (polio)-free by the World Health Organization (WHO) on 29 October 2000, together with 36 other countries in the Western Pacific Region.1 Prior to certification, there were multiple outbreaks in 1958, 1960 and 1963 with 415, 196 and 74 paralytic polio cases, respectively.2-4 The nationwide immunisation...
Original Article
Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients
The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with solid and haematological malignancies to SARS-CoV-2 infections.1,2 Global efforts to combat SARS-CoV-2 led to the unprecedented rapid development of multiple vaccines, with reported efficacies of...
Editorial
Early COVID-19 booster is beneficial in cancer patients
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in Wuhan, China, on 31 December 20191 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare systems around the world, and rendered...
Editorial
Vaccination and surveillance: Two basic tools for a final poliomyelitis eradication
Over the past 3 decades, the Global Polio Eradication Initiative (GPEI) has strived to achieve a poliomyelitis (polio)-free world. Wild poliovirus (WPV) types 2 and 3 were eradicated in 2015 and 2019, respectively. The World Health Organization (WHO) South-East Asia Region was declared free of poliovirus in 2014, and...
Editorial
Idiopathic inflammatory myopathies: Not nearly the end of the road
The clinical spectrum of idiopathic inflammatory myopathies (IIM) has broadened over the past half century from a simple disease characterised primarily by muscle and skin manifestations, to a potentially life-threatening complex condition of multiple organ involvement. In the recent decade, the discovery and addition of novel autoantibody profiles including...
Letter to the Editor
A strategy to make COVID-19 vaccination more accessible to the elderly
Dear Editor,
Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services.
While the...
Letter to the Editor
Erdheim-Chester disease: Imaging spectrum of multisystemic manifestations
Dear Editor,
Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis, usually affecting middle-aged to older adults. It is a multisystemic disease with protean clinical manifestations. It can involve single or multiple organs, and presentations range from asymptomatic lesions detected incidentally on imaging to severe organ dysfunction. Hence, accurate and timely...
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
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 unsafe recovery include sudden unpredictable emergence or delayed return of airway tone and reflex with risk of airway obstruction.1 Agitation includes straining, sitting up, screaming...
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....
Review Article
Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations
Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into an ongoing global pandemic.2 In May...
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...
Images in Medicine
TB or not TB? The axillary lump question
An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule with a central keratinous plug in the right axilla (Fig. 1). The surrounding skin was pigmented, non-tender and indurated. Sonography of the nodule demonstrated an...
Letter to the Editor
Safety and efficacy of combined antiplatelet and low-dose rivaroxaban in patients with chronic limb threatening ischaemia in Singapore
Dear Editor,
Peripheral artery disease (PAD) is characterised by the debilitating atherosclerotic occlusion of arteries in the lower extremities, with chronic limb threatening ischaemia (CLTI) representing the most advanced stage of this disease process. Left untreated, these sequelae will invariably progress to major lower extremity amputation (LEA) and premature death....
Letter to the Editor
Teaching and learning during the COVID-19 pandemic: Perspectives of medical students in Singapore
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has resulted in many changes to medical education, including the site and mode of teaching, conducting of examinations and a shift towards prioritising the mastery of clinical skills relevant to infection control. Hence, Ng et al.’s suggestions on how to maximise learning...
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,...
Editorial
The global emergence of monkeypox
Monkeypox is so named because the poxvirus was first identified in 2 outbreaks among cynomolgus monkeys housed at the Statens Serum Institut, Denmark, in 1958.1 Both outbreaks occurred approximately 2 months after the monkeys arrived by plane from Singapore.1 However, the natural reservoir of the virus is not monkeys...
Letter to the Editor
Perception of disease, well-being and financial burden by patients with chronic hepatitis B: A self-reported assessment
Dear Editor,
Chronic hepatitis B (CHB) infection affects approximately 248 million individuals in the world1 and 3.6% of the Singapore population.2 Given the natural history of CHB, regular surveillance with blood tests is necessary to ensure early detection of complications such as cirrhosis and hepatocellular carcinoma in patients. Our study...
Letter to the Editor
Neuralgic amyotrophy in COVID-19 infection and after vaccination
Dear Editor,
Various neurological manifestations associated with coronavirus disease 2019 (COVID-19) have been described,1 conditions which left a significant proportion of patients with permanent disability. Continued vigilance is crucial with emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants that cause the disease. Vaccination against COVID-19 remains the...
Letter to the Editor
Attitude towards screening for congenital cytomegalovirus infection in newborns in Singapore
Dear Editor,
Cytomegalovirus (CMV) infection is the most common congenital infection.1 A systematic review that included 77 studies from 36 countries reported that the overall prevalence of CMV was 0.67% in their newborn population.1 Among newborns with CMV, it was estimated that 15–20% will suffer from potentially deleterious effects including...
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...
Original Article
Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore
Within 3 weeks of the World Health Organization declaring the COVID-19 pandemic on 11 March 2020, the Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) developed a set of nutrition guidelines that addresses issues on nutrition assessment; timing and feeding route; caloric...
Editorial
Challenges and considerations in delivering nutritional therapy in the ICU during COVID-19 pandemic
Coronavirus disease 2019 (COVID-19) has created unprecedented challenges for healthcare workers in Singapore and across the world. Providing clinical nutrition and metabolic care to 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...
Letter to the Editor
BNT162B2 COVID-19 mRNA vaccination did not promote substantial anti-syncytin-1 antibody production nor mRNA transfer to breast milk in an exploratory pilot study
Dear Editor,
Vaccine hesitancy still threatens global efforts to end the COVID-19 pandemic caused by SARS-CoV-2 and its emerging variants. Social media-driven “conspiracy theories” cast doubts on vaccine safety for reproductive health,1 including concerns that vaccine-induced SARS-CoV-2-neutralising antibodies (NAb) cross-react with human syncytin-1—a protein involved in gamete fertilisation and...
Commentary
COVID-19 vaccination acceptance of healthcare workers in Singapore
The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end April 2022.1 With the introduction of vaccines that are effective in reducing severe COVID-19 illnesses and deaths, Singapore had since pivoted from a COVID-19 elimination...
Original Article
Prevalence and correlates of psychological distress and coronavirus anxiety among hospital essential services workers in Singapore
The Coronavirus Disease 2019 (COVID-19) has affected almost all geographies in the world since 2020. Many countries have imposed strict isolation measures to contain the spread of this disease. While the majority of the population has been working from home, essential workers continue manning the frontlines, facing risks such...
Letter to the Editor
Injection site reactions after COVID-19 mRNA vaccination
Dear Editor,
The Pfizer-BioNTech (BNT162b2 mRNA) and Moderna (mRNA-1273) COVID-19 vaccinations were approved for use in Singapore in December 2020 and February 2021, respectively. To date, over 10 million doses of mRNA vaccines have been administered for the primary series and booster doses.1 Initial studies have shown that 0.8% of...
Letter to the Editor
Haemoglobin H disease and outcomes in Singapore
Dear Editor,
Haemoglobin H (HbH) disease is a haemoglobinopathy affecting 3 of 4 α-globin genes on chromosome 16. It results from the deletion of 2 linked α-globin genes (α0-thalassaemia) on one chromosome and either a single α-globin gene deletion (--/-α) or non-deletional gene mutation (--/αTα) on the other chromosome. The...
Letter to the Editor
Change in hepatitis B virus DNA status in patients receiving chronic immunosuppressive therapy for moderate-to-severe skin disease
Dear Editor,
Hepatitis B virus (HBV) infection poses a global health burden. Clinically, patients may present with chronic HBV infection, occult HBV infection, and fulminant hepatic failure. In 2010, the hepatitis B surface antigen (HBsAg) seroprevalence in Singapore was 3.6%.1
Patients with dermatological conditions receive prolonged corticosteroid and other immunosuppressive therapy...
Letter to the Editor
Intravascular large B-cell lymphoma associated with sudden stridor arising from thyroid mucormycosis and concomitant bacterial infection
Dear Editor,
Mucormycosis is a life-threatening fungal infection that mainly affects immunocompromised patients. It typically has low prevalence, but fatality rate is as high as 50%.
We present a patient with intravascular lymphoma with secondary bacterial infection and invasive mucormycosis involving the thyroid gland, who experienced good outcomes following surgical...
Letter to the Editor
Evaluation of a health screening protocol for recovered COVID-19 patients before “return-to-play” and strenuous physical activity
Dear Editor,
We conducted a prospective, single-centre cohort study to develop guidance for military personnel returning to strenuous activities following SARS-CoV-2 infection. The patients underwent a clinical review followed by a protocol to screen for cardiac, respiratory, haematological, endocrine/renal and neurological complications after recovery from infection.
Both the study and screening...
Others
Cryptococcal Prostatic Abscess in an Immunocompromised Patient: A Case Report and Review of the Literature
Cryptococcosis is a well-recognised infection in immunocompromised patients, although its prevalence varies with the type of immune defect. We report a patient with myasthenia gravis (MG) on steroid therapy and non-insulin dependent diabetes mellitus (NIDDM) who developed cryptococcal meningitis and in whom a search for a persistent focus by...
Others
A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia
Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Case Series of Bronchoscopic Removal of Tracheobronchial Foreign Body in Six Adults
Gustav Killian reported the first case of bronchoscopic removal of foreign body (FB) from the trachea in 1897. Since then, rigid bronchoscopy under general anaesthesia by the cardiothoracic surgeon has remained the procedure of choice for FB removal in the airways, failing which thoracotomy and bronchotomy is performed.
This article...
Original Article
Glaucoma Pattern Amongst the Elderly Chinese in Singapore
Glaucoma is a major cause of world blindness in developing and developed nations. The WHO Global data on blindness show that over half of the blind due to glaucoma reside in Asia, the majority being Chinese.
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
A Study of Idiopathic Thrombocytopenic Purpura (ITP) Patients over a Ten-year Period
Idiopathic thrombocytopenic purpura (ITP) is an immunoregulatory disorder in which antibodies damage platelets leading to their removal by cells of the reticuloendothelial system (RES). This occurs mainly in the spleen which is also the primary site of synthesis of these antiplatelet antibodies.
This article is available only as a PDF....
Others
Emerging Therapies for Sepsis and Septic Shock
Septic shock remains a major cause of morbidity and mortality among hospitalised patients despite advances in antimicrobial therapy and medical support.
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Review Article
Bronchoscopy in the Intensive Care Unit (ICU)
Flexible fibreoptic bronchoscopy (FFB) has become an indispensable tool in the optimal management of intensive care unit (ICU) patients with both diagnostic and therapeutic goals. Its safety and usefulness, in well-trained hands with appropriate precautions, have led to its increasing use even in unstable and mechanically ventilated patients.
This article...
Original Article
One Hundred and Seventy Cases of Childhood Onset Rheumatological Disease in Singapore
Children with rheumatological disease form a small but important proportion of the ill paediatric population. Most of the published data available are based on studies on Caucasian, Black or Hispanic children with relatively little information on Asian children including Chinese and Malays.
This article is available only as a PDF....
Original Article
Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore
In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has focused especially on cancer and the possible link between immunology and psychological factors.
This article is available only as a PDF. Please click on “Download PDF”...
Original Article
Epidemiological Surveillance of Melioidosis in Singapore
Melioidosis was first described in 1911 among vagrants and morphine addicts brought into the mortuary in Rangoon, Burma. However, the disease received little attention until the Vietnam War when French and US military personnel were affected by it.
This article is available only as a PDF. Please click on “Download...
Others
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 optimum mode of support varies with individual patients, but none can reliably prevent progression of acute lung injury and high frequency ventilation (HFV) has been...
Review Article
Contributions of Respiratory Care Practitioners to Intensive Care: A Review
The intensive care unit (ICU) is a complex environment in which multidisciplinary expertise has been shown to enhance clinical outcomes. For example, the availability of full-time intensivists has been associated with improved survival.
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Review Article
Ventilatory Strategies for Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) was first described by Ashbaugh et al in 1967. The original authors detailed the presence of tachypnoea, hypoxaemia, decreased respiratory compliance, bilateral pulmonary infiltrates and reported a survival rate of 42%.
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Review Article
The Oxygen Delivery Debate—A Review
Multisystem organ failure occurs in a large proportion of critically ill patients and is a major cause of death in this group of patients. The mechanisms responsible for the development of multisystem organ failure in the critically ill patient are unknown.
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Review Article
Controlled Observations in Critical Care Medicine: The Therapeutic Trial
Central to the combined diagnostic and therapeutic approach to the critically ill subject is the evaluation of both the basal physiologic status and its subsequent change over time consequent to a therapeutic intervention.
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Original Article
Patients Admitted to an Intensive Care Unit for Poisoning
The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed only seven papers on the epidemiology of poisoning since 1975 (the earliest year covered by the database) and none targeting those severe enough to require...
Original Article
Impact on Quality of Patient Care and Procedure Use in the Medical Intensive Care Unit (MICU) Following Reorganisation
Critical care is costly as it is labour intensive and involves expensive life support technology. In the United States, the intensive care units (ICUs) use about 15% of the total hospital cost or about 1% of the gross national product.
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Editorial
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 arrived at different paradigms—open versus closed models, specialty-based intensive care units (ICUs) versus general ICUs, internist versus pulmonologist or anaesthetist, and so forth.
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Others
A Case Series of Paget’s Disease of Bone: Diagnosing a Rather Uncommon Condition in Singapore
Sir James Paget’s description in 1877 of “a form of chronic inflammation of bones” which now bears his name was based entirely on clinical and pathological observations in patients with advanced disease. Today, more than a century later, advanced imaging techniques and biochemical tests have allowed us to identify...
Others
Systemic Sclerosis in DRw52-positive Silica-exposed Males: A Case Report
Familial scleroderma was first documented in 1953 by Rees and Bennett who described the occurrence of a localised disease in a father and daughter. The first documentation of familial systemic disease was by Orabona and Albano who reported its occurrence in two sisters some five years later.
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Review Article
The Global Pandemic of Dengue/Dengue Haemorrhagic Fever: Current Status and Prospects for the Future
The world has experienced unprecedented population growth in the past 50 years that continues unabated in the waning years of the 20th century. It is projected that by the year 2025, the global population will be 8.3 billion people, and by 2050, 10 billion people.
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Commentary
Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) Syndrome: A Brief Review of a Rare Condition
The acronym SAPHO refers to a syndrome characterised by synovitis, acne, pustulosis, hyperostosis and osteitis. In 1961, a link between acne conglobata and arthritis was first described by Windom et al.
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Commentary
The Role of Occupational Therapy in Rheumatoid Arthritis Management
Rheumatoid arthritis is a systemic disease characterised by remissions and exacerbations that vary in severity and timing among people. Its chronic and degenerative course makes it imperative that a philosophy of maintaining the patient’s physical, psychological, and functional abilities as long as possible through an ongoing carefully planned treatment...
Others
A Case of Sulindac-induced Enteropathy Resulting in Jejunal Perforation
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of various rheumatic conditions including rheumatoid arthritis (RA). The adverse effects of NSAIDs on the upper gastrointestinal tract (GIT) are well known and well described.
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Others
Musculoskeletal Pain Clinic in Singapore—Sacroiliac Joint Somatic Dysfunction as Cause of Buttock Pain
Patient A, a 33-year-old male administrative coordinator presented with left buttock pain of 4 to 5 years duration which radiated down to the leg and lower back. There was no antecedent trauma.
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Review Article
Intra-Synovial Corticosteroid Injections in Juvenile Chronic Arthritis—A Review
Locally injected intra-synovial corticosteroids are useful to target selected joint, tendon sheath or bursal inflammation in children with pauciarticular or polyarticular juvenile chronic arthritis (JCA). Inflammation is decreased locally and with minimal systemic side effects.
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Review Article
Osteoporosis—The Need for a Paradigm Shift
Osteoporosis is becoming an increasing public health problem in most countries. Osteoporosis literally means “porous bones” and involves skeletal fragility leading to an increased risk of fracture.
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Review Article
Managing Problem Gout
Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval gout), followed in about 10% of patients by chronic tophaceous gouty arthritis. Gout is one of the better understood of the arthritic disorders, and certainly...
Review Article
Lipid Disorders and Rheumatic Diseases
The relationship between lipid disorders and arthritis is manifold. Hyperlipidaemia may manifest clinically in the musculoskeletal system. In 1968, Khachadurian studied 14 families of whom 18 homozygotes of Type II hyperlipidaemia were identified. Ten of these patients experienced a migratory polyarthritis resembling rheumatic fever.
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Review Article
Rheumatoid Arthritis—A Review
Rheumatoid arthritis (RA) is a chronic inflammatory arthritis which is occasionally associated with extraarticular manifestations. Although the first good clinical description was by Landre-Beauvais in 1800, the term rheumatoid arthritis was first used only in 1878 by Alfred Garrod.
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Review Article
Imaging of Thoracic Manifestations of Scleroderma
Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys, and heart. The American College of Rheumatology has proposed that for the purpose of clinical trials and surveys, the diagnosis is made if the patient...
Review Article
Overview of Imaging in Rheumatologic Diseases
Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations and advances in technology in imaging and interventional radiology today enable more precise and earlier detection, assessment and treatment.
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Review Article
Advances in Antiphospholipid (Hughes’) Syndrome
Phospholipids (PLs) are components of cell membranes. Their function is not only to maintain the structure of the membranes but also to modify the function of proteins present on cell surface.
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Review Article
The Appropriate Use of Antineutrophil Cytoplasmic Antibody (ANCA) Testing in Rheumatic Diseases
In 1982, Davies and co-workers in Melbourne described the presence of a serum factor that stained the cytoplasm of neutrophil leukocytes by indirect immunofluorescence in 8 patients with generalised illness associated with segmental necrotising glomerulonephritis. This was followed two years later by a report by Hall and co-workers of...
Review Article
Oral Tolerance: Mechanisms and Therapy of Autoimmune Diseases
Immunologic tolerance is a hallmark of the immune system whereby immune cells are tolerant of self antigen. Historically, this tolerance was thought to be secondary to the removal of self-reactive T cells during development and maturation in the thymus of the immune cells - clonal deletion.
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Review Article
The Genetics of Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a chronic rheumatic disease characterised by protean clinical manifestations as well as the presence of multiple autoantibodies. Tissue deposition of autoantibodies and immune complexes can lead to tissue injury.
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Review Article
Systemic Lupus Erythematosus in Singapore
Systemic lupus erythematosus (SLE) or lupus (“wolf” in Latin) in short, is an autoimmune disorder of unknown aetiology(ies) and characterised by diverse clinical manifestations as well as a plethora of autoantibodies in the sera of patients. The clinical features of SLE vary in different population groups. Ethnic and genetic...
Review Article
Murine Lupus: Pathogenic Mechanisms and Genetic Origins
The complex and non organ-specific nature of systemic lupus erythematosus (SLE) has made it difficult for researchers to unravel the genetic defects and pathogenic mechanisms underlying this disease. Over the past 30 years, several mouse models of lupus bearing differing sets of phenotypes and genotypes, have collectively contributed a...
Review Article
Education in Rheumatology
The fact that there is an increasing and growing need in societies for care of sufferers of rheumatic conditions can be shown from national statistics. In Australia, for example, arthritic and related musculoskeletal diseases may not dominate mortality statistics but they figure in the top three causes of acute...
Original Article
The Sensitivity and Specificity of Autoantibodies to the Sm Antigen in the Diagnosis of Systemic Lupus Erythematosus
The presence of multiple autoantibodies is the hallmark of systemic lupus erythematosus (SLE). Many of these autoantibodies target nuclear antigens e.g. histones, Sm, RNP, SSA, SSB and dsDNA may give rise to a positive antinuclear antibody (ANA) test.
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Original Article
Clinical Predictors of Nephritis in Systemic Lupus Erythematosus
Lupus nephritis is a common manifestation of lupus associated with significant morbidity and mortality. The use of cytotoxic agents has resulted in improved renal outcomes but is associated with considerable morbidity, and their role in the management of lupus nephritis is not universally accepted.
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Original Article
Adult-onset Still’s Disease in an Oriental Population: Manifestations, Course and Outcome in 16 Patients
Although George Still first described systemic onset juvenile rheumatoid arthritis (JRA) comprising fever, arthritis, lymphadenopathy and splenomegaly in 1897, it was not until 1971 that its nosologic entity presenting in adulthood was recognised by Eric Bywaters. Since then, well over 300 cases have been reported in the literature worldwide.
This...
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...
Others
A Case Report of Adult T-Cell Leukaemia/Lymphoma (ATLL)
Our patient was a 71-year-old Chinese man who presented with a 6-year history of recurrent papular erythematous eruptions to the dermatologist.
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Original Article
One-year Review of Pityriasis Rosea at the National Skin Centre, Singapore
Pityriasis rosea is a common, self-limited disorder of unknown but suspected viral aetiology, that develops abruptly with few or no prodromal symptoms. Classically, the first sign is the presence of a single lesion, 2 to 5 cm in diameter known as a “herald patch”.
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Letter to the Editor
Palm Printing on Agar Plates of Hands of Health Care Workers from the Intensive Care Units of the National University Hospital of Singapore
Nosocomial infections are one of the major causes of morbidity and mortality in hospitals resulting in increasing health care costs. The intensive care unit (ICU) is ideal for the acquisition of nosocomial pathogens.
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Others
Disseminated Penicillium marneffei Infection: A Report of Five Cases in Singapore
Penicillium marneffei is a dimorphic fungus that can cause infection in immunocompromised hosts. Reports on infection with this organism were initially uncommon, but after the first report of disseminated P. marneffei infection in a HIV-infected individual from Bangkok in 1989, the incidence has increased markedly, almost exclusively in patients...
Original Article
A Comparison of Antigen Dipstick Assays with Polymerase Chain Reaction (PCR) Technique and Blood Film Examination in the Rapid Diagnosis of Malaria
According to the 1996 epidemiological studies in Singapore done by the Ministry of the Environment, a total of 364 cases of malaria were reported in 1995. 90.4% of the cases were imported.
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Original Article
A Prospective Study of Infections with Atypical Pneumonia Organisms in Acute Exacerbations of Chronic Bronchitis
Chronic obstructive pulmonary disease (COPD) is a disease state characterised by the presence of airflow limitation that is generally progressive, partially reversible and caused by either intrinsic airway disease (bronchitis) or parenchymal destruction (emphysema). COPD is a leading cause of death and a major medical and economic problem.
This article...
Review Article
Newer Thrombolytic Agents
First-generation fibrinolytic agents (streptokinase and urokinase) are effective thrombolytic drugs, but are not fibrin specific as they also have the property to convert circulating plasminogen to plasmin when given at therapeutic doses. Because the plasminogen in the thrombus is in equilibrium with the plasminogen pool in plasma, the plasminogen...
Original Article
Hospitalised Low-risk Community-acquired Pneumonia: Outcome and Potential for Cost-savings
Community-acquired pneumonia (CAP) is a common illness with nearly 4 million adults diagnosed each year in USA with more than 600,000 hospita1isations. The associated cost of hospitalisation is enormous and approaches nearly US$4 billion per year.
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Original Article
Long-term Outcome and Disease Control in Near-fatal Asthma
Rising trends in mortality in asthma have been reported from many countries, including Asian countries such as Hong Kong. Asthma deaths have been associated with a number of avoidable factors such as deficiencies in personal and professional management that can potentially be remedied if identified.
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Others
8th Seah Cheng Siang Memorial Lecture: New Antithrombotic Agents
The tremendous interest in finding new anti-aggregating agents stems from the preeminent role that platelets play, not only in haemostasis and thrombosis, but also in atherogenesis and, be it less definitive, in arterial spasm. Compelling data from large-scale trials have established the role of platelet inhibitors in reducing coronary...
Original Article
Activated Protein C Resistance: A Study Among 60 Thromboembolic Patients in the Singapore Population
In 1993, Dahlback and colleagues described a new hereditary thrombophilia state-activated protein C resistance (AK-R). Further studies showed this to be the commonest genetic cause of thrombophilia.
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Original Article
Ethnicity, Obstructive Sleep Apnoea and Ischaemic Heart Disease
Obstructive sleep apnoea (OSA) is a condition whereby there is snoring associated with complete or partial cessation of breathing during sleep, associated with nocturnal oxygen desaturation and sleep fragmentation. This condition can lead to the effects of sleep fragmentation such as motor vehicular accidents, accidents in the workplace, social...
Original Article
Rapid Mycobacterial Tuberculosis Detection in Bronchoalveolar Lavage Samples by Polymerase Chain Reaction in Patients with Upper Lobe Infiltrates and Bronchiectasis
Pulmonary tuberculosis (PTB), the incidence of which is rising, poses a major health problem. It is caused by <i>Mycobacterium tuberculosis</i>. The isolation of <i>Mycobacterium tuberculosis</i> by culture has been the “gold standard” for the diagnosis of tuberculosis, as it gives a specificity that approaches 100% and permits susceptibility testing...
Others
Beneficial Effect of Combination Therapy with Ozagrel and Pranlukast in Exercise-induced Asthma Demonstrated by Krypton-81m Ventilation Scintigraphy—A Case Report
Exercise is a common stimulus of bronchoconstriction in subjects with asthma. Exercise-induced asthma is a temporary increase in airway resistance that occurs after several minutes of strenuous exercise, usually after the exercise has ceased.
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Original Article
Cross-Sectional Study of Near-work and Myopia in Kindergarten Children in Singapore
Myopia is the commonest eye disease worldwide, and is especially prevalent in certain Asian countries such as Taiwan, Japan and Hong Kong. Physiologic myopia is thought to be a multifactorial disease with both genetic and environmental factors.
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Original Article
Granuloma Annulare: A Review of 41 Cases at the National Skin Centre
Granuloma annulare (GA) is a benign, inflammatory disorder of the skin that has no proven aetiology or widely accepted theory of pathogenesis. There are several clinical manifestations, ranging from localised GA, which is the commonest form and is characterised by erythematous or flesh-coloured papules in an annular arrangement, to...
Original Article
Correlation of Baseline Quantitative Plasma Human Immunodeficiency (HIV) Type 1 RNA Viral Load with Clinical Status and CD4+ T-cell Counts in Treatment-Naïve HIV-Positive Patients in Singapore
Quantitative plasma human immunodeficiency virus type 1 (HIV-1) ribonucleic acid (RNA) viral load is used clinically as a predictor of progression of HIV-1 infection to acquired immunodeficiency syndrome (AIDS) and death, and as a marker of treatment response to anti-HIV agents. Higher viral load levels have been correlated with...
Others
A Case of Mycobacterium scrofulaceum Osteomyelitis of the Right Wrist
Whilst infections caused by Mycobacterium tuberculosis may be a common occurrence in this part of the world, those caused by atypical mycobacteria are rarely encountered. Many of the cases of atypical mycobacterial infections have been associated with underlying immunocompromised states.
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Others
Case Report of Staphylococcus lugdunensis Native Valve Endocarditis and Review of the Literature
Coagulase-negative staphylococci cause 5% of native valve endocarditis. Of the 30 species identified currently, Staphylococcus epidermidis is a well-recognised cause of native valve endocarditis; however, it more commonly causes prosthetic valve endocarditis.
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Others
Cardiopulmonary Exercise Testing in Patients with Chronic Obstructive Pulmonary Disease
Exercise intolerance is a hallmark of chronic obstructive pulmonary disease (COPD). Although exertional symptoms may be mild at the outset, exercise limitation is the most disabling and distressing consequence of COPD for the majority of patients.
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Others
Pseudomembranous Tracheobronchitis Caused by Aspergillus in a Patient after Peripheral Blood Stem Cell Transplantation
Pseudomembranous tracheobronchitis caused by Aspergillus is a rare and lethal variant of invasive aspergillosis. It has been reported in a few series of immunocompromised patients.
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Others
The Genetics of Spondyloarthropathies
The spondyloarthropathies (SpA) comprise a heterogenous group of conditions that include ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis/Reiter’s syndrome, arthritis associated with inflammatory bowel disease and pauciarticular, late-onset juvenile chronic arthritis. Undifferentiated forms of the disease are also present.
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Others
Ethnic Differences in Genetic Susceptibility to Atopy and Asthma in Singapore
Twin studies have indicated that both asthma and atopy are largely regulated by genetic factors. However, the genetics is complex, involving an interaction of multiple susceptibility genes and environmental factors.
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Others
Human Genetic Susceptibility to Tuberculosis
The World Health Organization has declared that the recent resurgence of tuberculosis (TB) is a global emergency. Southeast Asia, which is seeing the greatest increase in new TB patients, is at the epicentre of this pandemic.
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Others
Myopia: Gene-environment Interaction
Myopia affects up to 70% of adults in Singapore, Taiwan, Hong Kong and Japan. The prevalence rates in these Asian countries are higher than those among Caucasians and Blacks in the United States and Europe.
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Others
A Case Report of Aspergillus Hypersensitivity Syndrome with Obstructing Bronchial Aspergillosis
The spectrum of pulmonary aspergillosis includes saprophytic colonisation, hypersensitivity syndromes and invasive lung disease. There has been a tendency to classify these syndromes as separate entities but clinical overlap occurs.
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Others
Upper Airway Resistance Syndrome—Report of Three Cases
Sleep-related breathing disorders are widely recognised as important causes of morbidity and mortality over the past 3 decades. The obstructive sleep apnoea syndrome (OSAS) and the sleep hypopnoea syndrome are well-known and well-described breathing disorders during sleep.
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Original Article
Incidence of Ischaemic Heart Disease and Stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study
Comparisons of disease frequency in different ethnic groups help to unravel the contributions of nature and nurture in their aetiology and to identify environmental or lifestyle factors that may be involved. This is aided when the ethnic groups live in the same country, so that differences in completeness and...
Original Article
Audit of Oxygen Therapy in Acute General Medical Wards Following an Educational Programme
The rational basis for supplemental oxygen (O<sub>2</sub>) treatment is well established. Long-term O<sub>2</sub> therapy improves survival and quality of life in patients with chronic obstructive pulmonary disease who are severely hypoxaemic. Short-term supplemental O<sub>2</sub> is required in medical emergencies and various acute disease states such as respiratory failure, circulatory...
Original Article
Philadelphia Positive Acute Lymphoblastic Leukaemia (ALL): Clinico-Haematologic Characteristics, Molecular Analyses and 3-year Follow Up—A Single Institution Study
A number of specific chromosome abnormalities are associated with acute lymphoblastic leukaemia (ALL). The commonest in adults with B lineage ALL is the Philadelphia (Ph) chromosome t(9;22)(q34;q11).
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Others
Active Management of a Patient with Endstage Pulmonary Emphysema Using Lung Volume Reduction Surgery and Intensive Rehabilitation
A 65-year-old Chinese man with a 30-pack year history of cigarette smoking was referred to our institution for further management of chronic obstructive pulmonary disease (COPD). Despite smoking cessation for 5 years, and pharmacological treatment with oral theophylline, inhaled ipratropium bromide and ventolin, his dyspnoea had progressed to the...
Others
Case Reports of Nocardiosis in Patients with Human Immunodeficiency Virus (HIV) Infection
Nocardiosis is an infection caused by a soil-borne aerobic filamentous bacterium in the genus Nocardia and the order Actinomycetales. Within the genus Nocardia, N. asteroides, N. brasiliensis and N. caviae are responsible for nearly all nocardial infections in man.
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Others
Endobronchial Mass in a Patient with Burkholderia pseudomallei Infection
The diagnosis of Burkholderia pseudomallei infection is based on culture of clinical specimens such as blood or other body fluids, or serology using indirect haemagglutination (IHA) test and various antigen detection tests. Gram stain shows a bipolar “safety-pin” pattern or small gram-negative rods.
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Original Article
Thrombotic and Haemorrhagic Complications in Patients with Mechanical Heart Valve Prostheses Attending the Singapore General Hospital Anticoagulation Clinic
Patients with mechanical heart-valve prosthesis receive lifelong anticoagulation. The management of these patients taking oral anticoagulants is aimed at achieving and maintaining adequate levels of anticoagulation to prevent thrombotic manifestations and at the same time to keep the risk of severe haemorrhagic complications to the minimum.
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Original Article
Endobronchial Stenting in Patients Requiring Mechanical Ventilation for Major Airway Obstruction
Few things are as dramatic as respiratory arrest from major airway obstruction. Major airway obstruction frequently leads to well-defined clinical sequelae, namely shunt-associated hypoxaemia and post-obstructive pneumonia.
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Images in Medicine
Pericardial effusion and tamponade in a young woman
A young woman presented to the Singapore General Hospital with a history of cough in the 2 weeks prior. She had no significant past medical history and no history of immunocompromised state. Chest radiograph showed cardiomegaly. Electrocardiogram showed low voltages in precordial leads (Fig. 1A). A computed tomography scan...
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...
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
Histoplasmosis Presenting with Progressively Worsening Backache—A Case Report
A 55-year-old man presented with intermittent low back pain of 2 months’ duration which was progressively worsening, fever, anorexia and a 10-kg weight loss. He has travelled several times in the past few years to caves in Kuala Lumpur for worship.
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Original Article
In vitro Activity of Moxifloxacin against Local Bacterial Isolates
The introduction of newer generation fluoroquinolones has generated great interest, especially in this era of increasing antimicrobial resistance. Among gram-positive resistant bacteria, the most important are methicillin-resistant Staphylococcus aureus (MRSA), β-lactam resistant and multidrug-resistant Streptococcus pneumoniae, and vancomycin-resistant enterococci.
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Others
Clinical Update on Occupational Asthma
Occupational asthma is the most common occupational respiratory disease in the United Kingdom and also in Singapore. Recent estimates of the proportion of adult asthmatics where the cause could be occupational range from 4% to 9%.
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Original Article
Treatment of Acute Promyelocytic Leukaemia Using a Combination of All-trans Retinoic Acid and Chemotherapy
Acute promyelocytic leukaemia (APL), or acute myeloid leukaemia (AML)-M3 under the French-American-British (FAB) classification, is characterised by the following: a distinct expansion of promyelocytes and immature myeloblasts in the bone marrow; balanced reciprocal translocation between the long arms of chromosome 15 and 17, t(15;17) which results in apposition of...
Review Article
Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci: Emerging Problems and New Prospects for Management
The prevalence of nosocomial infections due to Gram-positive bacteria has increased dramatically over the last two decades. In North America, Gram-positive cocci now are responsible for nearly two thirds of all bloodstream and skin and soft tissue infections.
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Original Article
An Audit of Patients with Rheumatic Disease Requiring Medical Intensive Care
Patients with rheumatic disease are often immunocompromised as a result of either their disease or treatment. They may become ill either from a flare of their autoimmune disease or from complications of treatment, at times requiring intensive care.
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Original Article
Effect of Different Endotracheal Suctioning Systems on Cardiorespiratory Parameters of Ventilated Patients
Endotracheal suctioning is a routine procedure performed in the intensive care unit (ICU) to remove secretions from the tracheobronchial tree. This is to maintain patency and reduce the risk of pulmonary atelectasis in mechanically ventilated patients.
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Original Article
The Role of Early Tracheostomy in Critically Ill Neurosurgical Patients
In medical history, tracheostomy is one of the oldest operations performed. There are indications that the Egyptians first employed this procedure more than 3500 years ago when Asclepiades of Bithynia described it in the second century BC.
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Commentary
Bugs for the Next Century: The Issue of Antibiotic Resistance
Emerging antibiotic resistance is a global problem. Antibiotic resistance results in morbidity and mortality from treatment failures and increased health care costs.
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Review Article
New Disease Modifying Agents in Adult Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by symmetrical inflammatory arthritis. Most patients exhibit a chronic course.
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Review Article
New Cyclooxygenase Inhibitors
Cyclooxygenase inhibitors are non-steroidal anti-inflammatory drugs (NSAIDs). They have been used in the treatment of rheumatic diseases for several decades.
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Others
10th Seah Cheng Siang Memorial Lecture: Going Places—A Rheumatological Odyssey
I am greatly honoured to deliver the 10th Seah Cheng Siang memorial lecture. I came into direct contact with Professor Seah in January 1965 when I joined the then Thomson Road General Hospital as his senior registrar.
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Others
Melioidosis Splenic Abscess—An Unusual Presentation as Osteomyelitis of Rib
A 74-year-old Chinese gentleman first presented in February 1999 with an abscess over his left lower chest. He was treated for pulmonary tuberculosis in 1977.
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Original Article
Effects of a Pulmonary Rehabilitation Programme on Physiologic and Psychosocial Outcomes in Patients with Chronic Respiratory Disorders
Pulmonary rehabilitation is a multi-disciplinary programme of care for patients with chronic respiratory impairment that is individually designed to optimise physical and social performance and autonomy. In recent years, the efficacy and scientific foundation of pulmonary rehabilitation have been firmly established.
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Original Article
CD4 Lymphocyte Enumeration in Patients with Human Immunodeficiency Virus Infection Using Three-Colour and Four-Colour Dual-Platform Flow Cytometry: An Inter-Laboratory Comparative Evaluation
Clinical flow cytometry provides a precise technology for the multiparameter analysis of the morphological (scatter) and immunofluorescence properties of stained leukocyte populations, as well as their percentages and absolute counts, at the single-cell level. Flow cytometry is commonly used for the identification of human lymphocyte subsets, a process referred...
Original Article
Deep Vein Thrombosis is Not Rare in Asia—The Singapore General Hospital Experience
Deep vein thrombosis (DVT), pulmonary embolism (PE), the postphlebitic syndrome and recurrent venous thromboembolism (VTE) are important and often preventable causes of early morbidity or death and of long-term disability in western populations. The reported annual incidence of VTE is about 2 per 10,000 persons in Scotland.
This article is...
Original Article
High-dose Therapy followed by Autologous Haematopoietic Stem Cell Transplantation in Multiple Myeloma
Multiple myeloma (MM) is a disorder in which malignant plasma cells accumulate in the bone marrow and produce an immunoglobulin, usually monoclonal IgG or IgA. The incidence of MM in Singapore is 1 to 2 per 100,000 per year with a median age of 65 to 70 years at...
Review Article
Immunotherapy in Autoimmune Diseases
In the early 1700s, Lady Mary Wortley Montagu, wife of the British ambassador to Turkey, introduced the practice of variolation against smallpox into Western Europe. This act of immunisation had since been better understood.
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Review Article
Recent Advances in the Obstructive Sleep Apnoea/Hypopnoea Syndrome
The past decade has seen a rapid increase in the number of patients being referred for investigation for the obstructive sleep apnoea/hypopnoea syndrome (OSAHS). Indeed, in many centres, possible OSAHS is now the most common respiratory referral and OSAHS is the most common outpatient respiratory diagnosis.
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Review Article
New Aspects of the Blood Coagulation Cascade, Anticoagulants and Vein Thrombosis in Asia
Injury to blood vessels triggers haemostasis, a process that has evolved to achieve two superficially incompatible outcomes: arresting blood loss while protecting vessel patency and blood flow to distal organs. Contributors to haemostasis include subendothelial tissues and endothelial cells, blood platelets, tissue factor, plasma clotting factors and their physiological...
Others
All that Wheezes is not Asthma—Broncholithiasis, a Forgotten Disease
Asthma is a very common condition which presents clinically with cough, shortness of breath and wheezing. However, ‘all that wheezes is not asthma’, is an important adage not to be forgotten.
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Original Article
Fluconazole Susceptibility of Candida Species in Singapore by Disc Diffusion Test
Candida species is becoming increasingly important as a cause of serious infections particularly in immunocompromised patients. Surveillance in the USA between April 1995 and June 1996 revealed that Candida was the fourth leading cause of nosocomial bloodstream infections, accounting for 8% of such infections.
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Original Article
Sexually Transmitted Diseases in the Older Population in Singapore
Sexually transmitted diseases (STDs) in persons older than 50 years are rarely studied because STDs are more common in young people. There is very little published data focussing on this group of patients which is relevant to Singapore or this part of the world.
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Others
Asthma Disease Management: A Provider’s Perspective
The burden of asthma appears to be increasing worldwide, especially in societies undergoing rapid urbanisation, and both morbidity and mortality from asthma have increased in many parts of the world, making it a global health concern. In Singapore, asthma is a highly prevalent problem, with an increasing societal and...
Original Article
Emergency Department Asthma: Compliance with an Evidence-based Management Algorithm
Attendance at the emergency medicine department (EMD) for acute exacerbation is an important milestone in the natural history of patients with asthma. It is an indication of clinically severe disease, inadequate preventive treatment and failure of self-medication for acute symptoms.
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Others
Four Pregnancies in Two Patients with Essential Thrombocythaemia—A Case Report
Essential thrombocythaemia (ET) is a rare myeloproliferative disease which manifests with an elevated platelet count. It presents predominantly in the middle-aged population, occurring slightly more frequently in women than men.
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Review Article
Idiopathic Thrombocytopenia in Pregnancy
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which platelets are sensitised with an antiplatelet autoantibody and then destroyed by the reticuloendothelial system.1 Hence, it is also known as primary autoimmune thrombocytopenic purpura. There are two forms of ITP—acute and chronic.
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Review Article
Thrombophilia in Pregnancy
A clear understanding of thrombophilia is becoming increasingly important in the practice of high-risk obstetrics. In addition to their role in thromboembolic disease, there is increasing evidence linking thrombophilia and adverse pregnancy outcomes such as pre-eclampsia, intrauterine growth restriction, placental abruption and recurrent pregnancy loss.
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Review Article
Management of Haematologic Malignancies in Pregnancy
Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The most commonly diagnosed malignancies during pregnancy are breast cancer, cervical carcinoma, Hodgkin’s lymphoma and melanoma.
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Original Article
Outcome of Pregnancy in Asian Women with Systemic Lupus Erythematosus: Experience of a Single Perinatal Centre in Singapore
Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more commonly than men (ratio 9:1), particularly those in the child-bearing age (15:1).
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Original Article
Pregnancy in Women with Idiopathic Thrombocytopaenic Purpura
Idiopathic thrombocytopaenic purpura (ITP) is the most common autoimmune haematological disorder in pregnancy. The pathophysiology of the disease is peripheral destruction of platelets mediated by antiplatelet antibodies.
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Others
Clinical Update on Deep Vein Thrombosis in Singapore
Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It also contributes to significant morbidity in terms of post-phleblitic syndrome and chronic venous ulcers.
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Others
Case Report on Recombinant Coagulation Factor VIIa in the Treatment of Three Haemophilia A Patients with Inhibitors in Singapore
Development of inhibitors against factor VIII is one of the main complications in the treatment of haemophiliacs. Inhibitors block the procoagulant effects of factor VIII and prevent the successful arrest of bleeding episodes when administered to these haemophiliacs.
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Original Article
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours.
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Original Article
Influenza in Singapore: Assessing the Burden of Illness in the Community
Influenza is a major cause of morbidity and mortality worldwide. Morbidity in the working age group gives rise to frequent doctor visits and considerable sickness absence from work. Influenza in the elderly population and in high-risk groups results in hospitalisations and deaths due to complications of pneumonia.
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Original Article
Four-month Chemotherapy in the Treatment of Smear-negative Pulmonary Tuberculosis: Results at 30 to 60 Months
Patients with active pulmonary tuberculosis (PTB) are usually treated with a 6-month regimen in which chemotherapy is administered daily, intermittently or as a combined (daily and intermittent) regimen. However, patients with smear-negative PTB who have small lesions in the lung may not require the full duration of chemotherapy.
This article...
Original Article
Bullous Pemphigoid Seen at the National Skin Centre: A 2-year Retrospective Review
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder affecting mainly the elderly. It is characterised by autoantibodies to the basement membrane zone (BMZ), which are detectable on immunofluorescent studies.
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Original Article
Evaluation on the Use of a Portable Unit Versus the Laboratory for the Monitoring of International Normalized Ratio (INR) in Orally Anticoagulated Patients
Oral anticoagulation therapy is used for a number of conditions, namely deep venous thrombosis, pulmonary embolism, mechanical heart valves, embolic stroke as well as atrial fibrillation. Patients receiving this therapy are carefully monitored in order to maintain the intensity of anticoagulation in the appropriate therapeutic range.
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Original Article
Bacteriologically-negative Pulmonary Tuberculosis—The Singapore Tuberculosis Control Unit Experience
The management of a patient as for pulmonary tuberculosis (PTB) in the setting of negative bacteriology would have to take into account not only the likelihood that the patient has active PTB, but also the consequences of a mistaken diagnosis and the adverse effects of TB treatment. Patients with...
Others
Clinical Update on Osteoporosis
Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...
Commentary
The Bone and Joint Decade 2000-2010: For Prevention and Treatment of Musculoskeletal Disease
The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its multi-faceted, multidisciplinary approach, has been identified as one of the four clinical fields selected also for emphasis by the Bone and Joint Decade initiative.
This article...
Review Article
Steroid-induced Osteoporosis
Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed. The most important effects appear to be on bone formation due to direct effects on cells of the osteoblastic lineage although indirect effects related to...
Review Article
An Asian Perspective to the Problem of Osteoporosis
Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West.
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Others
Primary Meningococcal Arthritis and Endogenous Endophthalmitis: A Case Report
Primary meningococcal arthritis (PMA) and endogenous meningococcal endophthalmitis are both uncommon presentations of meningococcal infection that should be considered in the differential diagnosis of reactive arthritis and acute dermatitis-arthritis syndrome. We describe a case of PMA and meningococcal endophthalmitis occurring together.
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Others
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 secondary endpoint in clinical research and is essential in economic evaluation of new and often expensive therapies.
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Editorial
The Role of Influenza Vaccine in Healthcare Workers in the Era of Severe Acute Respiratory Syndrome
The new coronavirus responsible for severe acute respiratory syndrome (SARS) found its first victims in healthcare workers with attack rates of more than 50% before infection control measures were instituted; and this led to the near collapse of healthcare systems in some of the affected countries. In Singapore, healthcare...
Original Article
Asthma in Light of Patient Documents. A Factor Analytic Study
The lack of uniform criteria for asthma handicaps the diagnosis, the systematic documentation of cases and the consistent reporting of studies addressing asthma. It restricts also the use of patient documents of asthmatics especially in detailed causal analysis, although they could give important information for research and administration.
This article...
Original Article
Malignant Mesothelioma: Experience at the Singapore General Hospital
Malignant mesothelioma is a rare tumour and is typically associated with asbestos exposure. In endemic areas, it has an estimated incidence as high as 66 per million for men aged 35 and above.
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Editorial
Severe Acute Respiratory Syndrome (SARS) — 150 Days On
The Severe Acute Respiratory Syndrome (SARS) has been identified as a new clinical entity in the year 2003. It was on 12 March 2003 that the World Health Organization (WHO) issued a global health alert on the disease then known as atypical pneumonia.
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Others
HIV/AIDS in Children
The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major public health threat with wide-ranging medical, social and economic consequences. First gaining foothold among intravenous drug users and commercial sex workers, HIV quickly spreads to...
Others
Intermittent Epoprostenol Infusions in Systemic Lupus Erythematosus Associated Pulmonary Hypertension—A Series of Three Cases
Pulmonary hypertension (PHT) is seen in 0.5% to 14% of systemic lupus erythematosus (SLE) patients and is associated with a grave prognosis. The overall 2-year mortality is more than 50% despite vasodilators, anticoagulants, systemic corticosteroids and cytotoxic drugs.
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Review Article
Sexually Transmitted Infections in Singapore Teenagers
Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and changes. The transition from childhood to adulthood includes the formation of successful intimate relationships and avoidance of the pitfalls of sexually transmitted infections (STI), including...
Letter to the Editor
Patterns and predictors of sound levels in hospital rooms
Dear Editor,
Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also linked excessive sound levels with sleep disturbances and cardiovascular morbidity.2 While there have been data published regarding noise levels in the intensive care unit (ICU),3...
Letter to the Editor
Pressure injuries related to N95 respirator masks among healthcare workers during the COVID-19 pandemic
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic outbreak, which started in 2019, has affected millions of patients globally.1 Singapore is not spared, being one of the first countries to import COVID-19 cases from China.2 Nosocomial transmission of SARS-CoV-2 had been reported in various cohort studies of healthcare workers (HCWs),...
Review Article
Trauma-induced coagulopathy: Mechanisms and clinical management
Globally, trauma accounts for the highest number of mortalities in adolescents and young adults up to 49 years old.1 Of these deaths, a large percentage is attributable to exsanguination.2 Trauma-induced coagulopathy (TIC) occurs in 25–35% of hospitalised severe trauma patients and is associated with increased incidence of bleeding, blood...
Editorial
Coagulopathy related to trauma: Is it time for a goal-directed approach?
Trauma represents a leading cause of death globally, and post-traumatic haemorrhage accounts for 40% of early mortality in spite of recent improvements in modern trauma care.1 Post-traumatic haemorrhage occurs primarily from direct injury to blood vessels, leading to exsanguination and hypovolaemic shock depending on the type and calibre of...
Original Article
Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey
Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an area of considerable interest, and many unanswered questions surround this organism and the types of diseases it causes.
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Original Article
A Clinical Audit of Presentation and Outcome of Salmonella Septicaemia
Salmonella infection occurs globally and has diverse presentations including enteric fever, gastroenteritis, localised infection, chronic enteric or urinary carrier state and bacteraemias. Enteric fever, caused by Salmonella typhi (S. typhi) and Salmonella paratyphi (S. paratyphi), occurs mostly in developing tropical countries but is increasingly seen as imported infections in...
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
In vitro Biological Characteristics of Human Cord Blood-derived Megakaryocytes
Haematopoietic stem cell transplantation (HSCT) is now a well-established therapeutic modality for a broadening spectrum of medical problems. Umbilical cord blood (CB) has emerged as an alternative source of HSCT in recent years due to the lack of a human leukocyte antigen (HLA)-identical sibling donor in the majority of...
Review Article
Unrelated Umbilical Cord Blood Transplantation in Children and Adults
Allogeneic haematopoietic stem cell transplantation (HSCT) is an established form of treatment for many high-risk haematological malignancies and marrow failure syndromes. The use of HSCT is still limited by the availability of human leukocyte antigen (HLA) matched donors, even though unrelated donor registries have markedly improved the chances of...
Review Article
Haematopoietic Graft Engineering
Haematopoietic stem cell transplantation (HSCT) has become an established modality for the treatment of cancer and diseases of the bone marrow and immunological system. Such transplants effect their cures through 3 main avenues: namely, eradication of disease through intensive chemo/radiotherapy, replacement of defective blood-forming cells with normal haematopoietic progenitors...
Editorial
Stem Cells: Current Usage and Future Potentials
In recent years, the term “haematopoeitic stem cell transplantation” has replaced “bone marrow transplantation”. It is more precise and emphasises the “haematopoeitic stem cell” as the key element.
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Others
Pulmonary Hypereosinophilia
Eosinophilic lung diseases encompass a heterogenous spectrum of lung disorders defined by increased eosinophils in blood and/or tissue. In 1952, Crofton et al proposed the term “pulmonary eosinophilia” for disorders characterised by chest radiographic infiltrates and peripheral eosinophilia.
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Original Article
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 15% had arthritis and 6% had eye complications with no other systemic manifestations. These findings are different from epidemiological studies from other countries published in...
Others
An Unusual Cause of Pulmonary Haemorrhage in a Patient with Rheumatoid Arthritis
Strongyloides stercoralis is an intestinal nematode which causes a chronic but usually asymptomatic infection in humans. However, in immunocompromised patients, parasitic larvae can develop rapidly and re-invade the host.
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Others
A Rare Case of Porphyria
Porphyrias are a rare and intriguing group of metabolic disorders. We report a case of congenital erythropoietic porphyria, one of the infrequent forms of porphyria.
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Others
A Case Report of Occupational Asthma due to Gluteraldehyde Exposure
Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been attributed to an occupational cause. Yet, only 3 cases were reported and confirmed in Singapore in the year 2000 – an incidence of only 0.14/100,000...
Review Article
Laboratory Safety Aspects of SARS at Biosafety Level 2
In Singapore, the majority of patients suffering from the severe acute respiratory syndrome (SARS) were cared for at Tan Tock Seng Hospital. The dramatic and serious nature of this outbreak in 2003 focussed unprecedented attention on laboratory safety practices.
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Original Article
Varicella Screening and Vaccination for Healthcare Workers at KK Women’s and Children’s Hospital
Due to the increased morbidity and mortality of varicella zoster (VZ) in adults and increased exposure to chickenpox in hospitals, especially in paediatric hospitals, healthcare workers (HCWs) are encouraged to be vaccinated against varicella. Pregnant HCWs who are exposed to chickenpox also face the risk of transmitting VZ to...
Original Article
Twin Births in Singapore: A Population-Based Study Using the National Birth Registry
Twin studies are regarded as one of the better ways to study the effects and significance of gene, environment and interactions of both. The study of monozygotic (MZ) and dizygotic (DZ) twins allows for an estimation of the relative importance of genes and environment.
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Others
Extensive Calcinosis Cutis in Relapsed Acute Lymphoblastic Leukaemia
Calcinosis cutis is characterised by the aberrant deposition of calcium salts in the skin. In metastatic calcinosis cutis, calcium salts are precipitated in normal tissue as a result of an underlying defect in calcium and/or phosphate metabolism.
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Others
Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context
Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44 per 100,000 in the year 2001.
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Others
Severe Adult Chickenpox Infection Requiring Intensive Care
Chickenpox (varicella) in adults can be severe. It is frequently associated with pneumonia and immunosuppression as well as increased mortality rates.
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Commentary
The Haze and Health: A Blog About the Fog
The haze is an atmospheric phenomenon where pollutant particles accumulate in the air and obscure the normal clarity of the sky. In Singapore, this usually happens when the prevailing southwest monsoon winds blow the smoke from regional forest fires to Singapore.
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Others
Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article
Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital setting, such as nebulisers, water baths, dialysis machines and intravenous fluids.
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Original Article
Early Dengue Infection and Outcome Study (EDEN) – Study Design and Preliminary Findings
Dengue fever/dengue haemorrhagic fever (DF/DHF) is a re-emerging disease that is endemic in the tropical world. It is caused by 4 closely-related dengue viruses which are transmitted by the Aedes mosquitoes, principally the Aedes aegypti mosquito.
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Original Article
Seroepidemiology of Pertussis in the Adult Population of Singapore
Pertussis is a highly communicable, vaccine-preventable respiratory disease and is a frequent but often underestimated cause of prolonged cough illness in adults. Whereas in children pertussis is characterised by paroxysmal cough, whooping cough and post-tussive vomiting, in adults the disease is often atypical, sometimes manifested only by a protracted,...
Original Article
Eye Injuries in Singapore – Don’t Risk It. Do More. A Prospective Study
The issue of ophthalmic trauma is a major cause for concern. An estimated 55 million eye injuries occur each year worldwide, leaving 1.6 million patients blind from their injuries.
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Original Article
Travel Characteristics and Health Practices Among Travellers at the Travellers’ Health and Vaccination Clinic in Singapore
The South-east Asian region has seen recent increases in travel, and pre-travel health advice is important in protecting these travellers from risks. Travellers now travel to destinations with high disease risks.
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Review Article
Community-associated Methicillin-resistant Staphylococcus aureus: Overview and Local Situation
The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates from the community that are distinct from their archetypal healthcare-associated counterparts (HA-MRSA) marked a critical evolutionary milestone for the organism. In less than 2 decades, particularly in the last 3 years, this initially sporadic phenomenon of community-associated methicillin-resistant Staphylococcus...
Original Article
Understanding the Super-spreading Events of SARS in Singapore
Severe acute respiratory syndrome (SARS) was the first emerging infectious disease of this century with true epidemic potential. Worldwide, the virus caused a total of 8098 reported infections and 774 deaths before it was brought under control.
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Commentary
SARS Plague: Duty of Care or Medical Heroism?
SARS has been described as a Chinese plague because it emerged from the colourful markets of wild animals and the exotic kitchens of Guangdong, southern China in mid-November 2002. In late February 2003, the Metropole Hotel in Hong Kong became the epicentre where SARS crossed intercontinental boundaries through rapid...
Commentary
SARS: How to Manage Future Outbreaks?
Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV), which crossed from wild animals at live markets to man in mid-November 2002 in Guangdong, southern China. SARS was the first pandemic of the 21st century.
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Review Article
SARS Revisited: Managing “Outbreaks” With “Communications”
In the short span of 3 years since SARS first appeared on the Asian landscape, terms like “risk communications” and “outbreak communications” have assumed greater import and found common usage in the lexicon of governance by public health systems in our part of the world.
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Review Article
Laboratory Containment of SARS Virus
Severe acute respiratory syndrome (SARS) emerged in November 2002 in Guangdong Province in China and quickly spread to 26 countries/areas with local transmission in Hong Kong, Singapore, Vietnam and Canada. The causative agent was identified as SARS coronavirus (SARS-CoV), not seen before in human.
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Review Article
SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity above National Sovereignty
The majority of the world’s information about infectious disease outbreaks no longer comes from voluntary reporting by countries, the willingness of which is influenced by fears of severe decreases in travel, tourism and trade as a result of aggressive protective measures undertaken by other countries. It now comes from...
Review Article
SARS in Singapore – Key Lessons from an Epidemic
The 2003 severe acute respiratory syndrome (SARS) outbreak represented the most severe communicable disease challenge to the public health system and the government and people of Singapore. The SARS outbreak in Singapore began on 1 March 2003 and the last case of the outbreak was isolated on 11 May...
Original Article
Clinical and Laboratory Findings of SARS in Singapore
An outbreak of atypical pneumonia was recognised in Singapore soon after the release of a global alert by the World Health Organization (WHO) on 12 March 2003. This disease was later named severe acute respiratory syndrome (SARS).
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Original Article
SARS in Singapore – Predictors of Disease Severity
Severe acute respiratory syndrome (SARS) is a recently defined illness caused by a novel coronavirus. The outbreak in Singapore originated from Hong Kong via mainland China.
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Original Article
The Outbreak of SARS at Tan Tock Seng Hospital – Relating Epidemiology to Control
Severe acute respiratory syndrome (SARS) is an emerging infectious disease caused by a novel coronavirus. Worldwide, the virus caused a total of 8098 reported infections and 774 deaths before it was brought under control.
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Original Article
Epidemiology and Control of SARS in Singapore
Since the 1990s, a number of infectious diseases have emerged in Singapore, despite its high standard of environmental hygiene, comprehensive childhood immunisation programme and strict control of imported food and livestock. These emerging diseases include Bengal cholera caused by a new cholera biotype, Vibrio cholerae O139, multi-drug-resistant salmonellosis caused...
Editorial
Lessons From the SARS Crisis – More Relevant Than Ever
This issue of the Annals contains articles on the severe acute respiratory syndrome (SARS). One might wonder what else there is to write about SARS.
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Original Article
Modelling the Utility of Body Temperature Readings From Primary Care Consults for SARS Surveillance in an Army Medical Centre
There has been increasing interest in building surveillance systems capable of detecting outbreaks of infectious diseases, at the stage where clinical presentation would still be undifferentiated. The thrust of such systems is to detect both intentionally induced and naturally occurring outbreaks in their earliest stages, and if possible, at...
Others
Septic Monoarthritis and Osteomyelitis in an Elderly Man Following Klebsiella pneumoniae Genitourinary Infection: Case Report
Despite improved antimicrobial therapy over the past 30 years, there has been little change in the incidence, outcome, or, causative organisms in septic arthritis. Staphylococcus aureus is the commonest cause of septic arthritis and various series reported rates of 17% to 80%.
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Original Article
Clinical Experience with Three Combination Regimens for the Treatment of High-risk Febrile Neutropenia
Cancer patients who become severely neutropenic as a result of intensive myelosuppressive chemotherapy are at high risk for developing life-threatening infections, and unless they are treated at the first sign of infection, the rate of mortality is high. Because of the defect in the inflammatory response, the classic signs...
Original Article
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 studies have helped identify the risk factors for identifying sleep apnoea, particularly in the Western population.
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Letter to the Editor
Sarcoidosis with Granulomatous Hepatitis and Autoimmune Endocrine Involvement
Sarcoidosis is a systemic granulomatous disease of unknown aetiology. It emerges in the form of hiler adenopathy and interstitial pulmonary disease in most cases.
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Original Article
Anaerobic Culture of Diabetic Foot Infections: Organisms and Antimicrobial Susceptibilities
Singapore has a relatively high prevalence of diabetes mellitus, with a recent survey showing an age-standardised prevalence of 7.8% in 2004. Diabetic soft-tissue infections result in significant morbidity in this population of patients.
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Original Article
A Review of Clinical Pathway Data of 1663 Total Knee Arthroplasties in a Tertiary Institution in Singapore
Total knee arthroplasty (TKA) has been established as an effective treatment modality for patients with symptomatic knee arthritis. It provides predictable decrement in pain, correction of deformity and improved functional outcomes.
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Others
Infection Control Practices at the Singapore General Hospital: From a Swedish Point of View
Methicillin-resistant Staphylococcus aureus (MRSA) is the most common antibiotic resistant pathogen in many parts of the world, and is associated with significant in hospital morbidity and mortality. The majority of MRSA infections are hospital acquired, and the prevalence of such cases can be affected by infection control practices such...
Others
Methicillin-resistant Staphylococcus aureus Control in Singapore – Moving Forward
The significance of methicillin-resistant Staphylococcus aureus (MRSA) is indisputable. Its successful establishment and maintenance as the most important endemic healthcare associated infection (HCAI) results from its reservoir in up to 20% of inpatients and 16% of healthcare workers plus its ability to survive on surfaces for over 12 days.
This...
Commentary
“Future” Threat of Gram-negative Resistance in Singapore
Gram-negative bacteria are important causes of urinary tract infections, bloodstream infections, healthcare-associated pneumonia, and intra-abdominal infections. The increasing resistance of Enterobacteriaceae is a significant challenge.
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Review Article
Polymyxins: A Review of the Current Status Including Recent Developments
Polymyxins are polypeptide antibiotic that becomes available for clinical use in the 1960s, but was replaced in the 1970s by antibiotics considered less toxic. Presently, polymyxins have re-emerged as a “no choice” alternative for treatment of multidrug-resistant (MDR) gram-negative bacilli infections, which are not infrequent, in Singapore and Asia...
Review Article
Vancomycin-resistant Enterococcus – A Review From a Singapore Perspective
The first isolates of high-level vancomycin-resistant enterococci (VRE) were reported from the United Kingdom in the late 1980s. Since then rates of VRE infection and colonisation have been steadily rising.
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Review Article
Methicillin-resistant Staphylococcus aureus Control at the National University Hospital, Singapore: A Historical Perspective
The National University Hospital (NUH) was established in 1985 as the first restructured hospital and medical centre in Singapore. At its official opening in 1986, the then Director of Medical Services, Dr Kwa Soon Bee, Chairman NUH, hoped that the new teaching hospital would set the pace for “an...
Review Article
Gram-negative Resistance in Singapore: A Historical Perspective
Standardised antimicrobial susceptibility testing was first introduced to Singapore in the mid-1970s. The earliest Singapore antibiogram the author is aware of was published in 1974 by Tan et al (Fig. 1) based on a limited number of isolates from sterile and non-sterile sites at the Department of Pathology, Ministry...
Original Article
In vitro Activities of Antifungal Drugs Against Yeasts Isolated from Blood Cultures and Moulds Isolated from Various Clinically Significant Sites in Singapore
Fungaemia carries with it high mortality rates and appropriate as well as timely antifungal therapy has been shown to be life saving. Amphotericin B has the broadest coverage amongst the antifungal drugs against fungal infection, and was regarded the gold standard treatment for severe fungal infection.
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Original Article
A Retrospective Analysis of Antifungal Susceptibilities of Candida Bloodstream Isolates From Singapore Hospitals
Nosocomial infection with Candida species is increasing in significance worldwide. A recent review of positive blood cultures noted the relative increase in importance of fungal bloodstream infections (BSI), and Candida was reported as the fourth most common blood stream pathogen in the United States.
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Original Article
Ertapenem for Treatment of Extended-spectrum Beta-lactamase-producing and Multidrug-resistant Gram-negative Bacteraemia
Extended-spectrum beta-lacatamase (ESBL)-producing gram-negative bacteraemia is optimally treated with carbapenem. In our institution, Escherichia coli and Klebsiella pneumoniae are the most common and third most common causes of bacteraemia, and 21% of E. coli and 51% K. pneumoniae produced ESBL.
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Original Article
Independent Predictors for Mortality in Patients with Positive Stenotrophomonas maltophilia Cultures
Stenotrophomonas (formally Pseudomonas or Xanthomonas) maltophilia is a gram-negative bacillus emerging as an opportunistic, nosocomial pathogen associated with a high mortality rate. Although it was previously considered to have limited pathogenicity, recent reports suggested that infection with S. maltophilia was associated with significant morbidity and mortality, particularly in severely...
Original Article
Antibiotic Resistance in Gram-negative Bacilli: A Singapore Perspective
In contrast to recent media reviews on gram-positive pathogens such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and Clostridium difficile, the increasing complexity and multiplicity of antibiotic resistance in gram-negative bacilli has generally gone unnoticed by the general public. Antimicrobial resistance in gram-negative bacilli has increased worldwide over the past...
Editorial
Antimicrobial Resistance: A New Beginning and the Need for Action
In this issue, the articles (historical, original and review papers) highlight the extent and problem of antimicrobial resistance in Singapore. The authors should be congratulated on their efforts.
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Original Article
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) worldwide, with 8.2% of Singapore adults between the ages of 18 and 69 having diabetes and there is little data on the prevalence of diabetic...
Review Article
Cardiovascular Changes in Children with Snoring and Obstructive Sleep Apnoea
Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the prevalence of childhood OSA diagnosed by varying criteria was 1% to 4%.
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Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty.
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Review Article
Sleep Disorders in Children: The Singapore Perspective
Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in 1% to 3% of children.
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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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Review Article
The Scope of Paediatric Sleep Medicine
Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of sleep develops and matures, resulting in changing patterns of normal behaviours and of sleep disorders.
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Original Article
Obstructive Sleep Apnoea in Singapore: Polysomnography Data From a Tertiary Sleep Disorders Unit
Overnight attended polysomnography (PSG) in the sleep laboratory has been the gold standard to confirm the presence and severity of obstructive sleep apnoea (OSA). Standard PSG scoring rules using the criteria of Rechtschaffen and Kales have recently been revised and updated by the American Academy of Sleep Medicine.
This article...
Review Article
Healthcare Workers and HIV Health Issues
This paper aims to present a comprehensive review of issues related to HIV testing in healthcare workers (HCWs) and proposes appropriate measures in response to implications of a positive test result. It reflects an attempt to address the need to protect patients, preserve public confidence in the healthcare system...
Original Article
The 2005 Dengue Epidemic in Singapore: Epidemiology, Prevention and Control
Dengue is the most important human viral disease transmitted by arthropod vectors. Some 2500 million people – two-fifths of the world’s population – are now at risk from dengue.
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Review Article
Antiviral Drugs for the Control of Pandemic Influenza Virus
Over the past 100 years there have been 3 major influenza virus pandemics, which have among them claimed millions of lives. In 1918 the first of these pandemics occurred suddenly, and without warning.
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Review Article
Vaccines for Pandemic Influenza. The History of our Current Vaccines, their Limitations and the Requirements to Deal with a Pandemic Threat
The ongoing epizootic of avian influenza due to A (H5N1) viruses, the growing count of associated human fatalities, and the fear that this may be the forerunner to a severe human pandemic have focussed new attention on the status, and in particular the shortcomings, of our current human influenza...
Review Article
Prevention and Control of Avian Influenza in Singapore
Avian influenza (AI) or “bird flu” is a highly infectious disease of birds. AI viruses are negative single-stranded enveloped RNA viruses that belong to the influenza A genus of the Orthomyxoviridae family.
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Review Article
Preparing for an Influenza Pandemic in Singapore
The last influenza pandemics occurred in 1957 and 1968. Few remember the pandemic in 1968 in Singapore as it was relatively mild.
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Review Article
Avian Influenza and Pandemic Influenza Preparedness in Hong Kong
In 1997, Hong Kong became reputed by identifying the first instance of human infection with avian influenza H5N1. A total of 18 cases occurred that year resulted in 6 deaths. The outbreak was completely terminated after the culling of over 1.5 million chickens.
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Review Article
Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia
Since July 2005 to December 2007, Indonesia has reported the highest number of influenza A (H5N1) human cases in the world, i.e., 116 cases with an extremely high fatality proportion of 81% . Those patients were reported from 12 out of 33 provinces (Fig. 1).
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Review Article
A Global Perspective on Avian Influenza
The world is confronted by many important public health challenges, some of which constitute potentially devastating global threats. Prime among these is the threat of a influenza pandemic.
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Review Article
Twentieth Century Influenza Pandemics in Singapore
Tropical countries such as Singapore, although without well-defined influenza seasons, are also affected by influenza epidemics and pandemics. Twenty per cent of Singapore’s population is clinically infected by seasonal influenza annually, and excess mortality over the past decade was about 14.8 per 100,000 person-years – comparable to temperate United...
Original Article
The Efficacy of Influenza Vaccination in Healthcare Workers in a Tropical Setting: A Prospective Investigator Blinded Observational Study
Influenza causes significant morbidity, mortality and economic impact in Singapore. According to a recent report, there are about 4.2 million cases of influenza-like illness (ILI) annually in Singapore, leading to 3.5 million doctor visits and 2.1 million days of documented medical leave.
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Original Article
A Cross-sectional Study of Primary-care Physicians in Singapore on Their Concerns and Preparedness for an Avian Influenza Outbreak
Outbreaks of avian influenza (AI) caused by the H5N1 subtype in several Asian countries have raised concern all over the world. AI is endemic in several parts of Asia. To date, there have been more than 200 human cases of AI virus infection, mainly as a result of poultry-to-human...
Original Article
Clinical and Epidemiological Features of Patients With Confirmed Avian Influenza Presenting to Sulianti Saroso Infectious Diseases Hospital, Indonesia, 2005-2007
The first human cases of H5N1 avian influenza (AI) virus infection were reported in Indonesia in July 2005. On 19 September 2005, the Ministry of Health of Indonesia confirmed an established outbreak of AI in humans in Indonesia.
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Editorial
To Kill a Mocking Bird Flu?
Why devote an entire issue of the Annals to pandemic influenza when there are so many other pressing health needs around us? With a potential mortality comparable to tuberculosis, malaria or HIV/AIDS but occurring within a much shorter timeframe, pandemic influenza remains a real possibility.
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Original Article
Impact of the Singapore National Asthma Program (SNAP) on Preventor-Reliever Prescription Ratio in Polyclinics
According to the World Health Organization/Global Initiative on Asthma (WHO/GINA) report on the global burden of asthma, Singapore is an intermediate-risk country for asthma prevalence, which is about 5% of the population. But has one of the highest rates of asthma deaths in the world.
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Original Article
Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care
The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the threat of an avian influenza (AI) pandemic is imminent. Healthcare institutions are expected to be key players during a pandemic, with healthcare workers (HCWs) at...
Letter to the Editor
Laboratory-acquired Brucellosis
Brucellosis is a serious disease seen worldwide and has been historically known as undulant fever, Bang’s disease, Gibraltar fever, Mediterranean fever, and Malta fever. Brucellosis has a limited geographic distribution but remains a major problem in Mediterranean and Middle Eastern countries.
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Letter to the Editor
The Utility of Liver Function Tests in Dengue
Dengue infection is endemic in many countries along the tropical and subtropical belt, with more than 100 million cases and 24,000 deaths annually worldwide. Hepatic dysfunction is common in dengue infection, and is attributed to a direct viral effect on liver cells or as a consequence of dysregulated host...
Original Article
Use of Antibiotics in a Haematology Ward – An Audit
Rising rates of antibiotic resistance prompted a review of antibiotic use policies hospitalwide. The Department of Haematology established a new set of consensus guidelines in 2002 for antibiotic use in febrile neutropenia. We were tasked by the hospital’s Pharmacy and Therapeutics Committee to audit adherence to the guidelines.
This article...
Editorial
Treatment Gets Better, but Leprosy Remains a Global Problem
Rising standards of living and the provision of effective medical treatment have resulted in good control of leprosy in many parts of the world, but WHO-led efforts for the global elimination of leprosy by 2000 did not succeed. In several countries, however, ambitious and ill-advised attempts to meet the...
Original Article
Survival of Small-cell Lung Cancer and its Determinants of Outcome in Singapore
Lung cancer is the leading cause of cancer mortality around the world.1 Small-cell lung cancer (SCLC) constitutes about 15% to 25% of all lung cancer cases in North America and Europe.2,3 In contrast, SCLC constitutes a smaller percentage of lung cancer cases in Asian countries. In a Taiwanese hospital,...
Original Article
The Value of Joint Aspirations in the Diagnosis and Management of Arthritis in a Hospital-based Rheumatology Service
Joint aspiration with synovial fluid analysis can provide information which complements that which is available from the history and physical examination of the patient, and can help to differentiate various causes of arthritis. It is most useful in monoarthritis, where septic arthritis as a medical emergency needs to be...
Original Article
Lack of Awareness amongst Community Patients with Diabetes and Diabetic Retinopathy: The Singapore Malay Eye Study
Diabetes is a major public health problem, and diabetic retinopathy is the leading cause of blindness in working-aged people.1 Previous studies have documented poor attainment of guidelines of glycosylated haemoglobin (HbA1c) and blood pressure control2 and eye care utilisation3-6 in the prevention of diabetic retinopathy. Studies have also documented...
Original Article
Pain Prevalence in Singapore
Population studies on pain prevalence are useful in determining the impact that chronic pain has on the society. It draws the attention of healthcare administrators to chronic pain as a problem and direct healthcare spending accordingly. Previous studies performed using variations in definitions and methodology, yielded rates between 10%...
Original Article
An Update of Paediatric Intussusception Incidence in Singapore: 1997-2007, 11 Years of Intussusception Surveillance
This is an update to the previously published paper by Boudville et al1 on 8 years of intussusception (IS) surveillance in Singapore. IS is a rare but serious gastrointestinal disease in infants and young children.2,3 The focus on natural rotavirus infection as a potential cause of IS followed the...
Images in Medicine
An Unusual Cause of Lymphadenopathy and Rash
A 38-year-old Chinese man who was previously well, presented with one month of fever and a non-pruritic rash involving the face, trunk and upper limbs. There was no oral, ocular or genital involvement. He denied weight loss, night sweats, fatigue or easy bruising and there was no history of...
Letter to the Editor
Development of Ceftazidime Resistance in Burkhoderia pseudomallei in a Patient Experiencing Melioidosis with Mediastinal Lymphadenitis
Melioidosis caused by Burkholderia pseudomallei is endemic to Southeast Asia and Northern Australia. Melioidosis was nicknamed the “greater mimicker” because of its diverse clinical manifestations. We report a case of melioidosis manifested as mediastinal lymphadenitis and ceftazidime-susceptible B. pseudomallei bacteremia.
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Letter to the Editor
Forestier’s Disease Presenting as a Retropharyngeal Mass in an Elderly with Dysphagia
Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a non-inflammatory enthesopathy of unknown etiology. Affecting predominantly men, it results in flowing, robust ossification of the anterior longitudinal ligament of the spine.
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Commentary
Human Rights as a Cornerstone of AIDS Prevention, Treatment and Public Health Measures
The International AIDS Conference (IAC) and the Singapore AIDS Conference (SAC) are biannual meetings held on even years. Both these meetings are occasions for discussion and sharing of updated information on epidemiology, biomedical advances, behavioural and social science, and to provide a platform for broadcasting results of research and...
Original Article
Changing Epidemiology of Enteric Fevers in Singapore
Typhoid and paratyphoid fever – collectively referred to as enteric fevers - are serious systemic infections caused by Salmonella enterica serovar Typhi (S. Typhi) and Salmonella enterica serovar Paratyphi (S. Paratyphi), respectively. Humans are the reservoir of infection and transmission occurs through food and water contaminated by acute cases...
Editorial
Expanding the Scope of Antiretroviral Therapy for HIV Infection
The 2010 Global Report on AIDS contains some welcome news: the number of annual AIDS-related deaths has continued to decrease from a peak of 2.1 million in 2004 to an estimated 1.8 million in 2009. This is mainly attributable to the huge expansion in access to anti-retroviral therapy (ART).
This...
Original Article
T Lymphocyte Activation Profiles in Peripheral Blood of Long-Versus Short-Term Residents of Kuwait: Comparison with Asthmatics
The Gulf Wars of 1991 and 2003 exposed the residents of Kuwait and several neighbouring countries to high levels toxicants with the capacity to cause long-term deleterious alterations in the immune reactivity. The impact of these influences on the epidemiology and pathogenesis of chronic illness in affected populations is...
Editorial
Lung Cancer: Recent Advances
Lung cancer is the leading cause of cancer related mortality in the world. It accounts for almost a million deaths annually and resulted in more deaths than prostate, breast and colon cancers combined.
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Original Article
Difference in Asthma Control Test™ (ACT) Scores in Three Different Clinical Practice Settings
The prevalence of asthma ranges from 1% to 18% worldwide and it remains a significant cause of morbidity and economic burden despite advances in its knowledge, detection and treatment. Asthma is very common in Singapore and it consumes a considerable amount of healthcare service resources.
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Original Article
A Cross-Sectional Study on Reference Ranges of Normal Oral Temperatures Among Students in Singapore
Severe acute respiratory syndrome (SARS), an infection caused by the SARS Coronavirus (SARS-CoV), was imported into Singapore in late February 2003 by a local resident who came back to Singapore from a holiday in Hong Kong. The 2003 SARS outbreak in Singapore began on 1 March 2003 and the...
Original Article
Venous Thromboembolism at the National Healthcare Group, Singapore
Venous thromboembolism (VTE) is a potentially fatal disease which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). About 30% of patients with VTE die within 30 days while 20% suffer sudden death from pulmonary embolism.1 Risk factors commonly seen in hospitalised patients, include immobilization, acute medical illness and...
Original Article
Bone Marrow Cytogenetics Workup: Application of Lean Management System to Determine if Additional Cell Workup is Helpful and Necessary to Analysis
Cytogenetic studies are important to the diagnosis and monitoring of various haematopoietic disorders such as myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), lymphoproliferative disease (LPD), and multiple myeloma (MM). It can also provide a prognosis to a...
Images in Medicine
A Case of Congenital Haemolytic Anaemia and Thrombocytopenia
A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to thrive since birth.
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Original Article
Clinical Features of Allergic Rhinitis and Skin Prick Test Analysis Based on the ARIA Classification: A Preliminary Study in Malaysia
Allergic rhinitis (AR) is a common disease worldwide and is known to cause serious implications to the physical and mental health status of the individual sufferer. It also impacts significantly on healthcare expenditure. For instance, the direct costs of allergic rhinitis in the United States (US) alone were approximately...
Original Article
Changing Seroprevalence of Hepatitis B Virus Markers of Adults in Singapore
In Singapore, epidemiological surveillance and research on hepatitis B virus (HBV) infection were initiated when acute viral hepatitis was made a notifiable disease under the Infectious Diseases Act in 1976. Based on the findings of epidemiological investigations of reported cases and the results of seroepidemiological studies, a national hepatitis...
Original Article
Evaluation on the Effectiveness of the National Childhood Immunisation Programme in Singapore, 1982-2007
Singapore has a comprehensive National Childhood Immunisation Programme (NCIP) which first covered smallpox (1862), followed by diphtheria (1938), tuberculosis (TB) (1957), poliomyelitis (1958), pertussis and tetanus (1959) and measles and rubella (1976). In October 1985, hepatitis B vaccination was introduced into the programme for babies born to hepatitis B...
Original Article
Epidemiological Characteristics of Cholera in Singapore, 1992-2007
Cholera is an acute diarrhoeal disease that usually presents as abrupt massive watery diarrhoea and vomiting. The causative organism is Vibrio cholerae which is divided into serogroups based on the somatic O antigen. Only O1 and O139 serogroups are known to cause epidemic and pandemic disease.
This article is available...
Original Article
Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore
Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A study analysing pooled FN data from 115 US academic medical centres between 1995 and 2000 showed that the overall in-hospital mortality was 9.5%, whereas pooled...
Original Article
Influenza B Outbreak among Influenza-vaccinated Welfare Home Residents in Singapore
Influenza has a major impact on the health of residents of long-term residential care facilities (LTCF). Residents of LTCFs are especially vulnerable to influenza infections, due to the closed proximity that they live in. A number of influenza outbreaks involving residents in LTCFs have been reported in the medical...
Editorial
Beyond Blood Safety
World Blood Donor Day takes place on 14 June each year. Established in 2005 by the World Health Assembly, it aims to raise global awareness of the need for safe blood and blood products for transfusion and of the critical contribution made by voluntary unpaid blood donors to national...
Letter to the Editor
Inadvertent Haemodialysis in a Pulmonary Tuberculosis Patient with Hypercalcaemia
Malaysia is a country with an intermediate burden of tuberculosis (TB) with a prevalence of 121 cases per 100,000 population per year. TB usually presents with fever, chronic cough, weight loss and lack of appetite, dypsnoea and night sweats.
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Others
Afterword
My first involvement with pandemic influenza preparedness planning began in January 2004, when I attended an urgent meeting organised by the Ministry of Public Health in Thailand in response to infections caused by the influenza A (H5N1) avian virus. A number of countries together with the World Health Organization...
Letter to the Editor
Use of Healthcare Worker Sickness Absenteeism Surveillance as a Potential Early Warning System for Influenza Epidemics in Acute Care Hospitals
The global spread of emerging infectious diseases can strain resources and result in healthcare staff absenteeism, as was the case during the severe acute respiratory syndrome (SARS) outbreak in Singapore in 2003. The recent emergence of a novel influenza A (H1N1-2009) pandemic has again reminded us of the potential...
Letter to the Editor
Streptococcus pneumoniae Bacteraemia in a Young Man with Pandemic Influenza A (H1N1) 2009
The contributory role of bacterial infection to severe influenza illness during a pandemic is not entirely clear. The post-mortem samples of those who died between 1918 and 1919, the pre-antibiotic era, exhibited severe changes indicative of bacterial pneumonia; these are less well substantiated in the subsequent 2 pandemics in...
Commentary
Surveys of Knowledge, Attitudes and Practices on the Influenza A (H1N1) Pandemic
Statistical surveys are in general an efficient and flexible means of collecting a wide range of information from large numbers of respondents. These are now the method of choice to study knowledge, attitudes, values and beliefs.
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Commentary
2009 Pandemic Influenza H1N1: Paediatric Perspectives
The pandemic H1N1 influenza virus, containing genes from avian, human and swine influenza viruses, emerged in North America, and caused illness in more than 190 countries and resulted in more than 4500 deaths worldwide. According to Taiwan Centres for Disease Control (Taiwan CDC) data, among 2,089 typed influenza isolates...
Others
Severe Infection with H1N1 Requiring Intensive Care – Lessons for Preparedness Programmes
Severe cases of influenza have traditionally generated much interest. The pandemic of 1957 provided instructive materials on the subject, with publications on the pulmonary complications and histopathologic features.
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Others
International Health Regulations: Lessons From the Influenza Pandemic in Singapore
By virtue of the International Health Regulations (IHR) which came into force on 15 June 2007, countries are required to report specific infectious diseases and public health events to the World Health Organization (WHO). The first novel Influenza A (H1N1) patient in the US was confirmed by laboratory testing...
Review Article
Influenza A (H1N1-2009) Pandemic in Singapore – Public Health Control Measures Implemented and Lessons Learnt
The novel influenza A(H1N1) outbreak was officially declared a pandemic by the World Health Organization (WHO) on 11 June 2009. We describe the public health control measures instituted in Singapore to limit the spread of H1N1-2009 and mitigate its effects on our society.
This article is available only as a...
Original Article
Attitudes of Patients, Visitors and Healthcare Workers at a Tertiary Hospital Towards Influenza A (H1N1) Response Measures
Following the announcement by the World Health Organization (WHO) that outbreaks of a novel influenza virus had occurred in Mexico and several parts of the United States of America,1 the Emergency Preparedness Teams of the Singapore General Hospital and its sister institutions on the Outram Campus were activated. Measures...
Original Article
Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club
Influenza A (H1N1-2009) is a novel strain of influenza virus. The infection is thought to have first occurred in Mexico in March 2009, and then spread worldwide, resulting in the first influenza pandemic of the 21st century.
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Original Article
Obstetric Outcomes of Influenza A H1N1 (2009) Infection in Pregnancy – Experience of a Singapore Tertiary Hospital
Influenza A H1N1 (2009) is a new viral strain containing gene segments from human, swine and avian lineages. Soon after reports of human cases of the infection in April 2009, the World Health Organization declared the situation a public health emergency of international concern.
This article is available only as...
Original Article
Tracking the Emergence of Pandemic Influenza A/H1N1/2009 and its Interaction with Seasonal Influenza Viruses in Singapore
The global preparedness that followed the severe acute respiratory syndrome (SARS) outbreaks of 2003 and the re-emergence of a potentially pandemic avian influenza A/ H5N1, was still found to be inadequate to deal with the rapid spread of pandemic influenza A/H1N1/2009 as it emerged from the Americas in March/April...
Original Article
An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza Admitted to Singapore Hospitals from July to September 2009
On 17 April 2009, the US Centers for Disease Control (CDC) determined that febrile respiratory illness occurring in 2 children residing in adjacent counties in southern California was caused by a novel influenza A (H1N1) virus. The virus is thought to be a re-assortment of 4 known strains of...
Original Article
Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009
The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas in the United States in late April 2009. This was linked to outbreaks of influenza in Mexico, which included reports of large numbers of cases...
Original Article
Pandemic (H1N1) 2009: Clinical and Laboratory Findings of the First Fifty Cases in Singapore
Just over a year ago, the swine-origin influenza A (H1N1) virus emerged in Veracruz, Mexico, and rapidly alarmed public health and influenza experts by the rapidity of its spread as well as by its novel genomic structure. The latter consisted of a triple re-assortment of swine, avian and human...
Editorial
The Influenza A (H1N1) 2009 Pandemic in Singapore
Just over a year ago, the swine-origin influenza A (H1N1) virus emerged in Veracruz, Mexico, and rapidly alarmed public health and influenza experts by the rapidity of its spread as well as by its novel genomic structure. The latter consisted of a triple re-assortment of swine, avian and human...
Commentary
Tuberculosis – An Under-appreciated Disease
Tuberculosis (TB, as usually abbreviated) is a major cause of morbidity and mortality in many countries, and a significant public health problem worldwide. The World Health Organization (WHO) estimates that there are about 8.8 million new cases of TB and 1.6 million deaths from TB every year.
This article is...
Original Article
Prevalence of Metabolic Syndrome by the Adult Treatment Panel III, International Diabetes Federation, and World Health Organization Definitions and their Association with Coronary Heart Disease in an Elderly Iranian Population
Coronary heart disease (CHD) is one of the most common causes of morbidity and mortality in different communities.1,2 Despite the lack of accurate data, there is evidence to indicate that CHD is increasing in magnitude in Iran.3 While age-adjusted mortality from CHD is gradually decreasing in developed countries,2,4 this...
Others
Sir John Wenman Crofton
Sir John Crofton, a world famous expert on the treatment of tuberculosis died in Edinburgh at the age of 97. John Crofton was born in Dublin in 1912, the son of a doctor. His earliest recollection was of hearing the bullets hitting the ceiling of his nursery in the...
Others
Knowledge and Practice of Household Mosquito Breeding Control Measures between a Dengue Hotspot and Non-Hotspot in Singapore
Dengue is the most common mosquito-borne viral disease in the world and its severity is reflected by a 30-fold increase over the last 50 years. Today, 2.5 billion people over 100 endemic countries remain susceptible to this disease with an estimated annual incidence of 50 million leading to 22,000...
Images in Medicine
Rapidly Vanishing Pulmonary Pseudotumour
A 51-year-old male ex-smoker with a history of pulmonary tuberculosis was referred for exertional dyspnoea for 5 days. He had no fever, cough or constitutional symptoms. Physical examination revealed stony dullness to percussion over the right lower thorax posteriorly.
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Original Article
Immunophenotypic, Cytogenetic and Clinical Features of 113 Acute Lymphoblastic Leukaemia Patients in China
Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with abnormal proliferation and accumulation of immature lymphoblasts within the bone marrow (BM), peripheral blood and lymphoid tissues, and is composed of different genetic, biological, and clinically relevant subtypes. Morphological and cytochemical methods were the main tools for diagnosis and classification...
Original Article
Non-haem Iron-mediated Oxidative Stress in Haemoglobin E Beta-thalassaemia
Thalassaemia is a genetic haemoglobinopathy in which the production of normal haemoglobin is partly or completely suppressed because of a defective synthesis of 1 or more of its component globin chains. In haemoglobin (Hb) E beta-thalassaemia, an individual inherits 1 gene for Hb E from 1 parent and 1...
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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Editorial
Challenges Facing the Control of Leprosy in the Indian Context
Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects the skin, peripheral nerves, the eyes and the mucosa of the upper respiratory tract. There has been a decline in the global annual new case detection rate (NCDR) for leprosy since 2001.
This article is available only...
Commentary
Policy Implications of The Singapore Mental Health Study
Mental health issues have taken on greater importance with the growing awareness among policy makers of the importance of mental health for the development of human, social and economic capital of a country and the realisation that it is illogical to introduce health-sector reforms without paying due attention to...
Letter to the Editor
Plasma IP-10 could identify early lung disease in severe COVID-19 patients
Dear Editor,
The global pandemic of SARS-Coronavirus-2 (SARS-CoV-2) infection has imposed tremendous strain on healthcare resources worldwide, as a significant proportion of patients require intensive care. Although the majority have mild infections, up to 20% are estimated to become critically ill from severe disease.1 Age, concurrent comorbidities, more severe...
Images in Medicine
Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?
A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron
emission tomography/computed tomography (PET/CT) for staging. Figure 1 demonstrates a whole body maximal intensity projection image while Figures 2 and 3 show cross-sectional images through the elbows...
Images in Medicine
An Interesting Finding in a Patient with Chronic Diarrhoea
A 25-year-old man presented with intermittent selflimiting episodes of diarrhoea for 5 months. At times, he opened his bowel 8 times a day with small stool volume. His stool consistency ranged from soft to watery. Apart from a weight loss of 3 kg, no other constitutional or extraintestinal symptoms...
Original Article
Outcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study
Despite its widespread adoption, rapid response systems (RRS) and rapid response teams (RRT) vary significantly in composition and set-up.1-3 While implementation of RRSs appear to be associated with reduced cardiac arrest rate and improved mortality,4,5 their optimal composition, activation criteria and how they should be evaluated, remain controversial.6-9 It...
Original Article
Adverse reactions and safety profile of the mRNA COVID-19 vaccines among Asian military personnel
The COVID-19 pandemic has led to significant changes in the way of life for many around the world.1,2 After more than a year, many countries continue to struggle with rising infection rates, and economic and social impact of the pandemic.3-5 COVID-19 vaccines have become available since the end of...
Letter to the Editor
An Unusual Cause of Severe Pulmonary Hypertension in a Young Woman
Dear Editor,
A 25-year-old Cambodian lady diagnosed with pulmonary hypertension in her native country came for second opinion on the further management of her condition. She had become increasingly breathless in the last 2 years, with further deterioration from New York Heart Association (NYHA) II to III in the last...
Review Article
Cognitive Aspect of Diagnostic Errors
It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were constant distractions from the other
things he needed to attend to quickly. The patient, Madam Sumar was referred by her family doctor for chest pain with...
Letter to the Editor
Re: An Alternative Diagnosis: Bartonella Neuroretinitis
I would like to thank the authors for the reply to our case report. The differential diagnosis of Bartonella neuroretinitis in this patient was considered, but it would definitely not be on the top of my list due to the following reasons.
This article is available only as a PDF....
Letter to the Editor
An Alternative Diagnosis: Bartonella Neuroretinitis
We refer to the letter ‘Lyme Neuroretinitis in Singapore: A Diagnostic Dilemma’ published in the April 2012 Vol. 41 No. 4 issue of the Annals, Academy of Medicine. We propose a differential diagnosis of Bartonella neuroretinitis for the case reported.
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Original Article
Is the Apprehension Test Sufficient for the Diagnosis of Anterior Shoulder Instability in Young Patients without Magnetic Resonance Imaging (MRI)?
A good history and a detailed physical examination is often sufficient to make a diagnosis of a recurrent anterior dislocation of the shoulder, even in the absence of a radiologically documented dislocation of the joint. The anterior apprehension test has recently been supplemented with the relocation, crank, and load...
Editorial
MERS-CoV: Where Are We Now?
Prior to 2002, coronaviruses were known mainly for causing mild human upper respiratory tract infections (URTIs) and enteric and respiratory infections in many animals. However, their full pathogenic potential was only realised when an outbreak of severe pneumonia with a high fatality rate occurred in southern China, and they...
Letter to the Editor
Diagnosing Bacteraemia Early in Older Adults
Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop severe sepsis each year. Of this, more than 60% are patients older than 65 years. Morbidity and mortality remain high in spite of advances in...
Letter to the Editor
Acute Onset Polyarthritis with Pitting Edema: Is it RS3PE?
A 48-year-old female presented with pain and swelling in the bilateral proximal interphalangeal (PIP), metacarpophalangeal (MCP) and wrist joints for the past 20 days. It was acute in onset, severe in intensity to such an extent that she was unable to make a fist. It was associated with acute...
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...
Original Article
Anaerobic Bacteraemia Revisited: Species and Susceptibilities
Over the last 2 decades, the importance of anaerobic bacteraemia has undergone various shifts in opinion. Early studies in the 1970s reported that anaerobes accounted for 2% to 20% of bacteraemia. However, by the mid 1980s, multiple centres reported declining rates of anaerobic bacteraemia, and several authors suggested that...
Editorial
The Greying Pandemic: Implications of Ageing Human Immunodeficiency Virus-Positive Population in Singapore
Human immunodeficiency virus (HIV) remains a global public health issue. It is estimated that there are 37.9 million people living with HIV (PLHIV) today. With advances made in efficacy and tolerability of combination antiretroviral therapy (ART) and increased access to health services in developed and developing countries, PLHIV are...
Letter to the Editor
The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown
Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties in the care of patients with communicable diseases like COVID-19. PPE is also worn by ancillary staff such as security personnel, porters, medical transport crew...
Original Article
Heterogeneity of non-cystic-fibrosis bronchiectasis in multiethnic Singapore: A prospective cohort study at a tertiary pulmonology centre
Bronchiectasis is a chronic lung disease of significant morbidity and mortality. The pathological hallmarks of the disease are abnormal dilatation of airways resulting from recurrent inflammation, airway obstruction and mucous plugging. The past 2 decades have seen a significant increase in its prevalence, exceeding the threshold of 5 per...
Commentary
ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series
Coronavirus disease 2019 (COVID-19) has been associated with thromboembolic phenomenon in the early phase of disease. Growing evidence suggests a hypercoagulable state as well 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,...
Original Article
Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study
Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health...
Editorial
Medical management of PAD: Expand or consolidate?
In this issue of the Annals, a rapid review of adherence to evidence-based medical treatment highlights an important and underappreciated aspect of the management of patients with peripheral arterial disease (PAD). It is easy, upon meeting a patient, to prescribe appropriate medication in an outpatient setting and believe that...
Images in Medicine
Pelvic mass mimicking advanced tubo-ovarian malignancy with hepatic metastasis
A 49-year-old woman presented with mild pain in her lower abdomen and changes in bowel habits for 2 months. She also experienced 20kg of weight loss over 7 months. She previously had an intrauterine device (IUD) for 5 years, removed 2 years prior to presentation. Vital signs were stable,...
Letter to the Editor
Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 Panel for early diagnosis of COVID-19
An effective response to the SARS-CoV-2 that has caused the coronavirus disease 2019 (COVID-19) pandemic1 requires rapid and accurate diagnostic testing. We evaluate the QIAstat-Dx® Respiratory SARS-CoV-2 Panel—a multiplex real-time polymerase chain reaction (RT-PCR) assay—against an E-gene RT-PCR assay2 that successfully identified cases at the start of the COVID-19...
Letter to the Editor
Antibiotic stewardship algorithm to rationalise antibiotic use among hospitalised COVID-19 patients
As presentation of COVID-19 may mimic that of bacterial pneumonia, antibiotics are often prescribed. Concerns regarding overuse of antibiotics are now being raised particularly as we learn of the low rates of bacterial and fungal co-infection. To limit unnecessary antimicrobial exposure, we posit an algorithm for antibiotic guidance.
This article...
Letter to the Editor
Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore
The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during COVID-19-related lockdowns. Notably, there have been reports that patients with acute emergencies such as strokes and heart attacks are either not seeking treatment, or are...
Letter to the Editor
Impact of pulmonary rehabilitation in patients with interstitial lung disease in Singapore
Interstitial lung diseases (ILD) encompass a heterogeneous group of lung parenchymal disorders. ILD-related symptoms impact significantly on quality of life (QoL). Dyspnoea is the most important factor determining health-related QoL in ILD; contributing factors include reduced exercise capacity, loss of mental well-being and social isolation.
This article has been updated...
Letter to the Editor
Radiological changes on chest CT following COVID-19 infection
COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution computed tomography (HRCT) features of the lungs during the onset of COVID-19; however, few studies have described the radiological changes and outcome of residual lesions...
Review Article
Severe COVID-19 and coagulopathy: A systematic review and meta-analysis
Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications. Our understanding of the pathophysiology of the disease process is still evolving. As part of the host response to viraemia, it has been postulated that...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work pass issued to semiskilled workers, comprise 26.0% of Singapore’s entire labour force. Two other work passes held by FWs, “S pass” and “employment pass”, are...
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...
Original Article
Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry
Ophthalmic cancers are commonly encountered in clinical practice and are an important cause of morbidity and mortality. Globally, the incidence of ophthalmic cancers have been increasing in the past 2 to 3 decades.3-6 Data on recent incidence of primary ophthalmic cancers, comprising intraocular and extraocular cancers, have not been...
Editorial
Estimating the impact of COVID-19-induced coagulopathy
The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...
Letter to the Editor
Impact of COVID-19 on mental health and occupational burnout in a surgical unit in Singapore
In this study, we assessed the impact of COVID-19 on the psychological well-being and burnout among staff who manage critically ill general surgery and trauma patients as part of the Acute Care Surgery (ACS) service at the Singapore General Hospital, Singapore. The ACS team may be exposed to COVID-19...
Commentary
Optimum early orthopaedic surgery in COVID-19 patients
Multiple guidelines have been established regarding the management of COVID-19 patients. However, there remains a paucity regarding specific guidelines on the optimal timing for surgeries in COVID-19 patients requiring early orthopaedic surgery. This paper aims to provide evidence-based recommendations regarding the timing to proceed with early orthopaedic surgeries in...
Original Article
Vulnerability to rumours during the COVID-19 pandemic in Singapore
The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found to be elevated among healthcare workers and the general population. Others have reported a higher incidence of stress-related symptoms or post-traumatic stress disorder. These findings...
Original Article
Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore
In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community transmission began early in the outbreak, the government started emphasising the role that individuals had to play by adopting health-preventive behaviours.
This article is available only...
Editorial
The impact of COVID-19 pandemic on global mental health: From the general public to healthcare workers
The COVID-19 pandemic began in late 2019 and was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. To decrease the spread of the virus and demand on the healthcare system, governments globally executed multiple public health measures including lockdown, social distancing, significant closure of...
Editorial
The Novel Coronavirus (SARS-CoV-2) Pandemic
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and was reported to the World Health Organization (WHO) on 31 December 2019. An outbreak of unknown aetiology was suspected because many early cases were linked...
Review Article
Precautions When Providing Dental Care During Coronavirus Disease 2019 (COVID-19) Pandemic
Coronavirus disease 2019 (COVID-19) is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported to the World Health Organization (WHO) as pneumonia of unknown aetiology in the Chinese city of Wuhan on 31 December 2019. Since then, COVID-19 has spread across the globe and...
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....
Letter to the Editor
Cross-reaction of Sera from COVID-19 Patients with SARS-CoV Assays
SARS-CoV-2 is a new zoonotic coronavirus (CoV) that emerged in Wuhan, China, which was first reported to the World Health Organization (WHO) on 31 December 2019. This coronavirus disease (COVID-19) causes mild to moderate respiratory illness in the majority of patients, but can cause serious complications in the elderly...
Review Article
COVID-19 and Singapore: From Early Response to Circuit Breaker
The COVID-19 pandemic first broke out in Wuhan, China, in December 2019, where a cluster of pneumonia cases was reported and the novel coronavirus later identified. Since then, the virus has spread rapidly across the world, registering a total of 85000 reported cases across 53 countries/territories by 29 February...
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...
Review Article
Controversies in Sepsis Management—What is the Way Forward?
Sepsis is a common and life-threatening medical condition which has high incidence and mortality rates. Health care professionals are increasingly familiar with this syndrome, and the public is increasingly conscious of its burden to society. A population survey conducted in Singapore in 2010 showed that 53 out of 1067...
Review Article
Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months
Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...
Original Article
Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore
Since the first cases of coronavirus disease 2019 (COVID-19) in pregnancy were described, significant concerns have been raised about the potentially increased susceptibility of pregnant women to severe disease, and the unquantified risk of mother-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the fetus and neonate....
Letter to the Editor
Resuming otolaryngology services following a COVID-19 lockdown in Singapore
When the COVID-19 outbreak first occurred, we tweaked our department workflows to cope with the various demands of our practice and the pandemic. When Singapore’s Multi-ministry Taskforce on COVID-19 deemed that it was safe to begin reopening the economy in 3 phases,3,4 our department adopted a gradual resumption of...
Letter to the Editor
COVID-19: Lessons from Thailand
The COVID-19 pandemic has massively disrupted the social and economy of many countries. Thailand has been successful in controlling the spread of the disease and treating COVID-19 patients. We discuss Thailand’s strategy in containing the disease, management of severe COVID-19 patients, as well as future perspectives of COVID-19.
This article...
Letter to the Editor
Herpes zoster-associated aseptic arthritis in adult patients: A case report
Aseptic arthritis can often be associated with viruses— in the Singapore context—dengue or chikungunya viruses. The association of varicella-zoster virus (VZV) with arthritis however, is rare. Few cases of aseptic arthritis associated with VZV have been documented in the paediatric literature in the past 50 years and fewer still...
Letter to the Editor
Hypervirulent Klebsiella pneumoniae carriage in polyclinic attendees and national servicemen presenting with diarrhoea
Klebsiella pneumoniae liver abscess is an invasive syndrome that mainly affects people living in East Asia. It especially affects adults with diabetes and is caused by hypervirulent strains that possess the rmpA gene (regulator of mucoid phenotype A), iron sequestering genes, and usually belong to capsule types K1 and...
Commentary
Videoconsultation to overcome barriers during COVID-19
Since February 2020, Government Restructured Hospitals in Singapore began deferring non-urgent outpatient appointments. This aimed to facilitate physical distancing and reallocate healthcare resources to combat the pandemic. As the pandemic becomes increasingly prolonged, this strategy is unsustainable. There is increasing interest in using videoconsultations to ensure that patients receive...
Letter to the Editor
Positive RT-PCR detected in patients recovered from COVID-19
Positive real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acid following 2 consecutive negative RT-PCR tests have been reported in China and Korea. This has led to speculation regarding “persistent carrier states”, “re-infections” or “re-activations” and raises questions about using negative RT-PCR as part of de-isolation criteria. We...
Letter to the Editor
Cerebral venous thrombosis in a patient with mild COVID-19 infection
Emerging reports suggest venous and arterial thromboembolic diseases can complicate recovery from COVID-19. Postulated mechanisms include hypercoagulability, hypoxia, immobilisation, excessive inflammation and diffuse intravascular coagulation, especially in patients with severe COVID-19 infection. Nauka et al. provided vital insight that thrombotic complications can happen in a patient with non-critically ill...
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...
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...
Review Article
Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review
Coronavirus disease 2019 (COVID-19) has spread rapidly from China to other countries around the world, with the World Health Organization characterising it as a global pandemic on 12 March 2020. The number of fatalities owing to COVID-19 is escalating rapidly. COVID-19 is caused by the Severe Acute Respiratory Syndrome...
Original Article
Emergency airway management in a Singapore centre: A registry study
Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to most intubations performed in the operating room (OR). Additionally, difficult airways are more prevalent in emergency department (ED) populations due to acute conditions such as...
Review Article
Obesity in COVID-19: A Systematic Review and Meta-analysis
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is established that increasing age and comorbidities such as cardiovascular diseases are associated with risk of infection, more severe disease and adverse outcomes. Obesity is an epidemic globally, causing...
Commentary
Mental Health Strategies to Combat the Psychological Impact of Coronavirus Disease 2019 (COVID-19) Beyond Paranoia and Panic
On 30 January 2020, the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) an international public health emergency after the number of cases soared across 34 regions in Mainland China and surpassed that of severe acute respiratory syndrome (SARS) in 2003. The virus was believed...
Original Article
Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection
In this report, we describe a patient who developed acute respiratory distress syndrome (ARDS) with rapid clinical deterioration. Unfortunately, not much is known about the clinical features and risk factors for ARDS and critical illness even as the number of COVID-19 cases continues to climb at an alarming rate...
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...
Editorial
Development of Rheumatology in Singapore
Patients with rheumatic diseases frequently consult primary care physicians, internists and orthopaedic surgeons. In the past, few doctors took interest in these diseases.
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Original Article
Clinical Presentation and Disease Associations of Gout: A Hospital-based Study of 100 Patients in Singapore
Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate monohydrate crystals in the joints and soft tissue giving rise to an acute inflammatory response.
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Original Article
Ankylosing Spondylitis in Singapore: A Study of 150 Patients and a Local Update
Back pain is a common but often self-limiting problem. However, it is important to recognise causes of chronic backache such as ankylosing spondylitis which are potentially disabling but treatable.
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