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Impact of family and caregiver factors on development and behaviours in maltreated young children

Child maltreatment is defined as the neglect and abuse of children under 18 years old. It encompasses physical/emotional ill-treatment, sexual abuse, negligence and/or exploitation...

Assessing the impact of frailty in elderly patients undergoing emergency laparotomies in Singapore

The ageing population is a growing global phenomenon. In 2019, 14.4% of the population in Singapore, equivalent to 3.9 million people, were aged 65...

The value of frailty assessments in older surgical patients undergoing emergency laparotomies in Singapore

Mortality in emergency laparotomy (EL) far exceeds that of elective bowel surgery, and standards for the National Emergency Laparotomy Audit (NELA) in the UK...

Fluid management in renal transplantation: Is it time to move towards goal-directed directed therapy?

Achieving optimal fluid balance for a patient undergoing major surgery, especially transplant surgery, has always been the lofty goal of peri-operative care,1 which often...

Frailty-aware surgical care: Validation of Hospital Frailty Risk Score (HFRS) in older surgical patients

Frailty is a clinically recognisable state of vulnerability in older people, resulting from age-associated decline in physiological reserves and function across multiple organ systems,...

Outcomes of COVID-19 infection in patients on dialysis and kidney transplant recipients: A single-centre audit

Dear Editor, Patients with end-stage kidney disease (ESKD) are at increased risk of adverse outcomes following COVID-19 infection. Their vulnerability stems from multiple factors including...

The practice patterns and perceptions of surgeons in Singapore regarding breast-conserving surgery

Dear Editor, Breast-conserving surgery (BCS) is often the preferred treatment in operable breast cancer.1 While tumour biology and systemic therapy are major determinants of disease...

Value the patient as a person: Answering the call for a person-centred model of care

There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm....

Thiazide and thiazide-like diuretics associated with improved cardiovascular and renal outcomes for chronic kidney disease patients

Chronic kidney disease (CKD) is an increasingly pressing global health issue due to its strong link to serious complications such as end stage renal...

Thiazide diuretics in chronic kidney disease: Is there still a role?

“The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.” —...

Breast conservation treatment and frozen section analysis of margins

Dear Editor, Re. Surgical margins assessment reduces re-excision rates in breast-conserving surgery I read with interest the article by Woon et al. published in a...

Plasma selenium and zinc alter associations between nephrotoxic metals and chronic kidney disease: Results from NHANES database 2011–2018

Chronic kidney disease (CKD) is a clinical condition comprising persistent changes in kidney function or structure, or both. It is characterised by irreversible and...

Association of anticoagulation use during continuous kidney replacement therapy and 90-day outcomes: A multicentre study

Acute kidney injury (AKI) affects 21.6% of critically ill adult patients,1 with 5–7% requiring kidney replacement therapy (KRT).2 AKI carries significant prognostic and socioeconomic...

Micronutrients and kidney health

Chronic kidney disease (CKD) is a structural and functional disorder of the kidney caused by many diseases, such as diabetes, hypertension and glomerular disease.1...

A perfect match: The story of robotics in gynaecology

Dear Editor, The first use of surgical robotics started in the domain of orthopaedic and urological surgery. However, it was the initial concept of using...

Robotic surgery in morbidly obese women with endometrial cancer in Singapore

Dear Editor, The standard of care for endometrial cancer is a total hysterectomy with bilateral salpingo-oophorectomy, and pelvic lymph node dissection (THBSO-PLND). Obesity is a...

Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients

Chronic kidney disease (CKD) is a global public health problem with an estimated prevalence of 13.4%.1 One of the key drivers of the global...

Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore

Approximately 422 million people worldwide have diabetes and 1.6 million deaths are attributed to diabetes each year,1 contributing to high economic costs worldwide. Diabetes...

Surgical margins assessment reduces re-excision rates in breast-conserving surgery

Dear Editor, Breast-conserving surgery (BCS) followed by radiation therapy for breast cancer offers improved cosmetic results and comparable long-term survival rates as mastectomy.1 However,...

National surgical antibiotic prophylaxis guideline in Singapore

Surgical antibiotic prophylaxis (SAP) refers to the administration of antibiotics prior to clean and clean-contaminated surgeries to prevent postoperative surgical site infections (SSIs). An...

Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis

Non-alcoholic fatty liver disease (NAFLD) is a growing epidemic and has become a major cause of liver-related mortality and indication for liver transplantations globally....

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)...

White precipitate in a dialysis circuit

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

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...

Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction

With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction...

Iatrogenic atrial septal defect after catheter ablation—to close or not to close?

Dear Editor, Transseptal access to the left heart is increasingly performed for electrophysiological procedures and for structural heart disease interventions such as balloon mitral valvuloplasty...

Palliative dialysis in hospice: A paradox or promising answer?

Dear Editor, End-stage renal disease (ESRD) patients have higher mortality, hospital admissions and invasive procedures towards the end of life.1 However, many of them (82%)...

Comparison of planned-start, early-start and deferred-start strategies for peritoneal dialysis initiation in end-stage kidney disease

Peritoneal dialysis (PD) is a well-established long-term dialysis modality for patients with end-stage kidney disease (ESKD).1 It is recommended that a PD catheter should...

Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation

In-hospital cardiopulmonary resuscitation (CPR) for chronic kidney disease (CKD) patients is shown to have lower survival1 and a higher proportion of survivors on maintenance...

Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis

End-stage renal failure (ESRF) is a major cause of morbidity and mortality worldwide, including Asia.1 In Singapore, incidence of chronic kidney disease (CKD) stage...

Survival outcome of haemodialysis and peritoneal dialysis

End-stage renal disease (ESRD) is a challenging and growing health issue, with number of patients increasing globally. The use of dialysis has greatly improved...

Current Management of Early Vulvar Cancer

Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although...

Traumatic Dislocation of the Testes

Traumatic dislocation of the testes is uncommon. The first case was reported by Claubry in 1818 in Paris, when a 20-year-old soldier was run...

Percutaneous Needle Aspiration in the Treatment of Hepatic Abscess: Factors Influencing Patients’ Outcome

Liver abscess traditionally has been treated by open surgical drainage, mortality rates being as high as 80% to 100% if left untreated. However, with...

The Role of Multiple Segment Osteotomies in Orthognathic Surgery

Multiple segment osteotomy (MSO) orthognathic surgery serves to combine total or segmental maxillary and mandibular correction of dentofacial deformities with concurrent diastematic procedures to...

Direct Mucosal Targeting of Colonic Receptors by Prokinetic Drugs in an Experimental Model

The direct intraluminal (IL) administration of drugs into the intestine may have an important regional action and therefore clinical implications in the effective management...

Diabetic Retinopathy

Diabetes mellitus affects some 9% of Singaporeans. Studies had shown that virtually all insulin dependent diabetes mellitus (Type 1) and 85% of non-insulin dependent...

Hypoglycaemia from Islet Cell Hyperplasia and Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus—A Case Report

A 57-year-old woman was admitted to our hospital for perforated left tubo-ovarian abscess and found to have newly diagnosed diabetes with an admission blood...

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...

A Rational Alternative for the Diagnosis of Diabetes Mellitus in High Risk Individuals

The “gold standard” for the diagnosis of diabetes mellitus has all along been the oral glucose tolerance test (OGTT). As diabetes mellitus defines a...

Traditional Indian Systems of Medicine

Traditional medicine includes the knowledge and practices that rely exclusively on practical experience and observations handed down from generations to generations, either verbally or...

Impact of COVID-19 infections among kidney transplant recipients

Dear Editor, More than 2 years since the start of the COVID-19 pandemic, cases continue to climb despite global efforts at viral control. This is...

Paediatric living-donor liver and kidney transplantation during COVID-19

Dear Editor, The coronavirus disease 2019 (COVID-19) pandemic has impacted global healthcare including paediatric solid organ transplantation (SOT). We report our experience of resuming paediatric...

Incidence and risk factors of delirium in post-anaesthesia care unit

Post-anaesthesia care unit (PACU) delirium is defined as a disorder in thought processes that affect cognition in terms of memory, comprehension and attention.1 It...

A Rare Cause of Syncope in a Patient with Diabetes Mellitus—A Case Report

Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma...

Malignant Melanoma Seen in a Tertiary Dermatological Centre, Singapore

Unlike in Caucasians, primary malignant melanoma is an uncommon skin malignancy in Singapore. There have been little published data on cutaneous melanoma in Southeast...

Current Therapeutic Strategies for Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on...

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

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

A Case of a Diaphragmatic Rupture Complicated With Lacerations of Stomach and Spleen Caused by a Violent Cough Presenting With Mediastinal Shift

Diaphragmatic rupture is a recognised consequence of high-velocity blunt trauma to the abdomen and chest and also has been reported in 0% to 5%...

How Much do Diabetic Patients Know About Diabetes Mellitus and its Complications?

Diabetes mellitus (DM) is a common and growing healthcare problem in Singapore with a prevalence of 9% in 1998. Since the 1990s, the Ministry...

Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations

Diabetes mellitus (DM) is a common and growing global health problem. It is highly prevalent in Asian communities. Hong Kong, Pakistan, and Singapore are...

Diabetic Retinopathy in Type II Diabetics Detected by Targeted Screening Versus Newly Diagnosed in General Practice

The epidemic of type II diabetes mellitus is now recognised worldwide. In India, it has been estimated that the population with type II diabetes...

Infected Pancreatic Necrosis – An Evaluation of the Timing and Technique of Necrosectomy in a Southeast Asian Population

The management of necrotising pancreatitis has improved significantly over the last 2 decades, with a corresponding improvement in mortality rates. This improvement is largely...

Retardation of Kidney Failure – Applying Principles to Practice

By 2010 there will be more than 2 million patients worldwide on maintenance dialysis, a 400% increase in 20 years.1 This increase, occurring predominantly...

The Relationship between Postoperative Complications and Outcomes after Hip Fracture Surgery

Hip fractures constitute a major health concern for older persons and are associated with significant morbidity and mortality, with 1-year mortality rates ranging from...

Induction Concurrent Chemoradiotherapy Using Paclitaxel and Carboplatin Combination Followed by Surgery in Locoregionally Advanced Non-Small Cell Lung Cancer – Asian Experience

Lung cancer is the leading cause of cancer mortality in Singapore. The age standardised incidence rate is 45 per 100,000/year. This article is available only...

Surgical Training in Singapore: Will Patients Consent to Trainee Surgeons Performing Their Operations?

Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future.1 In most hospitals, trainee...

Sociodemographic Factors Influencing the Effectiveness of Public Health Education – A Comparison of Two Studies in Singapore

Public health education is a cornerstone in the primary prevention of chronic diseases. In the United States, for example, studies have shown that cardiovascular...

The Role of Electrophysiology in the Diagnosis and Management of Cervical Spondylotic Myelopathy

Cervical spondylosis is an extremely common condition managed by both physicians and surgeons in daily clinical practice. Cervical spondylotic myelopathy (CSM), resulting from longstanding...

An End to “See One, Do One and Teach One” Residency Training Programme – Impact of the Training, Education, Surgical Accreditation and Assessment (TESA) Programme on Medical Care and Patients’ Safety†

The delivery of good medical care and the safety of patients are of utmost importance in all healthcare systems. Indeed, healthcare providers need to...

From a “Generalist” Medical Graduate to a “Specialty” Resident: Can an Entry-level Assessment Facilitate the Transition? Assessing the Preparedness Level of New Surgical Trainees

Undergraduate medical education is considered a continuum leading into postgraduate training and ultimately medical practice.1 To this effect, it has been suggested that measures...

The Role of Surgery in High-grade Glioma – Is Surgical Resection Justified? A Review of the Current Knowledge

High-grade glioma (malignant glioma) is the most common primary intra-axial tumour of the central nervous system (CNS). Despite recent therapeutic advances in glioma treatment,...

Diabetes and Associated Cardiovascular Risk Factors in Iran: The Isfahan Healthy Heart Programme

The incidence and prevalence of diabetes mellitus (DM) worldwide is increasing, due almost exclusively to an increase in non-insulin-dependent (type 2) DM, which represents...

Beware the anterior lying recurrent laryngeal nerve in a retro-oesophageal goitre

A 36-year-old woman presented with a 4-month history of right neck lump. She had mild shortness of breath, but no dysphagia or voice changes....

Mohs micrographic surgery in Singapore: A long-term follow-up review

Dear Editor, Mohs micrographic surgery (MMS) has become the treatment of choice for high-risk non-melanoma skin cancers (NMSC) worldwide.1 Unlike wide local excision, MMS...

Nephrologists-led intervention increases utilisation of peritoneal dialysis in Singapore

Dear Editor, Over the past decade, the utilisation of peritoneal dialysis (PD) among end-stage kidney disease (ESKD) patients in Singapore has been persistently low...

Impact of Depression on Health Related Quality of Life in Patients with Diabetes

Diabetes Mellitus (DM) is a serious chronic illness that imposes significant morbidity and mortality and has a major impact on the quality of life...

5th College of Surgeons Lectureship: Surgery beyond Scalpels

The training of surgeons composed of two aspects: (1) Clinical skill and competence; (2) The ‘soft’ skill and ‘art’ of surgery. With the gradual...

Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure

Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have...

Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases

The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent...

Renojejunal Fistula: An Extremely Rare Form of Renoenteric Fistula

Obstructive calculous disease of the kidney often results in infectious complications such as pyelonephritis and perinephric abscesses. Renojejunal fistula formation may occur as the...

Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis

Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the...

Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study...

The Relevance of the Metabolic Syndrome

Metabolic syndrome describes a constellation of interrelated metabolic risk factors, in which components coexist more frequently in a given individual than could be expected...

Submandibular Mass Excision in an Asian Population: A 10-year Review

Submandibular masses are common presenting complaints in the outpatient setting. The differential diagnosis of a submandibular mass lesion can be salivary gland pathology, lymph...

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

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

Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation

The development of new-onset diabetes after transplantation (NODAT) is a serious metabolic complication of kidney transplantation that predisposes patients to graft dysfunction, cardiovascular disease...

Early Outcome Following Emergency Gastrectomy

Emergency gastrectomy has been associated with high morbidity and mortality rates. These complications arise as a direct consequence following the procedure, such as duodenal...

National Health Survey on the Prevalence of Urinary Abnormalities in the Population: then and now (1975 to 2012)

In the planning of a tuberculosis prevalence survey in Singapore in 1975, it was decided to include a urine examination of the respondents using...

Geriatric Syndromes and Depressed Mood in Lower-income Singaporeans with Diabetes: Implications for Diabetes Management and Health Promotion

The prevalence of diabetes mellitus (henceforth referred to as diabetes) has increased significantly in the last decade and it is reaching epidemic levels worldwide...

Managing buccal space tumours

Dear Editor, The buccal space is an infrequently addressed fascial space of the head and neck region. Intrinsic tumours of the buccal space are...

Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan

Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer...

Get “Real” with Hysteroscopy Using the Pig Bladder: A “Uterine” Model for Hysteroscopy Training

Hysteroscopy is an important surgical component of any training programme in gynaecology. Traditionally, surgical training in hysteroscopy occurred in the operating room where trainees...

A Novel “Box Lesion” Minimally Invasive Totally Thoracoscopic Surgical Ablation for Atrial Fibrillation

  Atrial fibrillation (AF) is the most common and severe cardiac arrhythmia. It affects 0.4% to 1% of the general population, and the prevalence of...

A maxillary sinus mass

A 55-year-old Chinese woman presented to the ear, nose and throat clinic with a 6-month history of left-sided blood-stained mucus. It was dark brown...

Rapidly progressive ulcer in an older woman

A fit and well 78-year-old woman with no significant past medical history presented to the Emergency Department with large painless perianal ulcers. It started...

Joint preserving surgery for osteoarthritis of the big toe using a cartilage-like implant

Dear Editor, Osteoarthritis of the big toe (hallux rigidus) is a common arthritic condition of the first metatarsophalangeal joint (MTPJ), beginning with stiffness, pain...

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

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

Pilot study of single-session radiofrequency ablation of benign thyroid nodules in Singapore

Radiofrequency ablation (RFA) has been shown to be safe and efficacious in the treatment of benign thyroid nodules. Ion agitation during RFA generates high...

Empagliflozin-induced severe osmotic nephrosis and acute renal injury in advanced chronic kidney disease

Diabetic kidney disease remains a significant disease burden globally and is associated with increased medical costs once chronic kidney disease (CKD) ensues. Therefore, optimisation...

Survival and Predictors of Mortality in Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis

Approximately one in ten patients admitted to an intensive care unit (ICU) develops acute kidney injury (AKI), an important complication of ICU patients, and...

Impact of Chronic Kidney Disease on Outcomes in Transcatheter Aortic Valve Implantation

With improvements in device technology as well as increasing experience, transcatheter aortic valve implantation (TAVI) has replaced open surgical aortic valve implantation as the...

Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre

As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up...

PLA2R1 and HLA-DQA1 gene variations in idiopathic membranous nephropathy in South China

Membranous nephropathy is an organ-specific autoimmune disease and is the most common cause of adult-onset nephrotic syndrome. The diagnosis of membranous nephropathy mainly depends...

Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore

Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million...

Recurrent vascular events in ischaemic stroke patients with diabetes

Stroke is a major cause of death and disability globally, with 6.55 million deaths (95% uncertainty interval 6.00–7.02 million), 101 million prevalent cases...

Adipsic diabetes insipidus and SGLT2 inhibitor: A perplexing conundrum

A 70-year-old man with poorly controlled type 2 diabetes mellitus (DM), hypertension, hypercholesterolemia and alcohol dependence presented intoxicated, with occipital scalp lacerations after a...

Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review

Diabetes is a chronic disease characterised by elevated levels of blood glucose. The most common type of diabetes is type 2 diabetes mellitus (T2DM)....