Commentary
A person-centred approach to decision-making and care for persons living with dementia
Assessing mental capacity in persons living with dementia (PLWDs) in high-stakes decision-making is becoming more frequent amid an ageing population with a rising prevalence of cognitive impairment and dementia. A study estimated that the population of PLWDs globally will almost triple by 2050.1
Among the 4 ethical principles—autonomy, beneficence, non-maleficence...
Review Article
Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore
Persons living with dementia experience chronic and progressive cognitive decline in 1 or more cognitive domains, affecting their everyday activities.1 Globally, the number of persons living with dementia is expected to rise from 55 million in 2019 to 139 million in 2050, with an estimated two-thirds in lower- and...
Commentary
Transforming medical education in the AI era: Balancing technological expertise with humanistic care in tomorrow’s doctors
Standing at the precipice of a new era in healthcare, the integration of artificial intelligence (AI) into clinical practice is progressing at an unprecedented pace. From AI algorithms detecting tumours with remarkable accuracy to predictive models forecasting patient outcomes, these technological marvels are not only changing how we practice...
Letter to the Editor
Cost-effectiveness and clinical outcomes of artificial intelligence-enhanced screening for diabetic foot ulcers: A simulation study
Dear Editor,
Diabetic foot ulcers (DFUs) are a serious complication of diabetes mellitus, with a lifetime risk estimated to be between 19% and 34%.1 Without timely prevention and management, DFUs can lead to lower extremity amputations (LEAs) and premature death.2,3 DFUs also impose significant healthcare and societal costs, especially in...
Letter to the Editor
Automated Cobb angle measurement in scoliosis radiographs: A deep learning approach for screening
Dear Editor,
Adolescent idiopathic scoliosis is the most common paediatric spinal deformity, impacting 1 in 300 children.1 In Singapore and other countries, national screening programmes have been established to detect scoliosis early, with the aim of using bracing to prevent progression to moderate or severe scoliosis, which may require surgical...
Original Article
Enhancing guidelines for managing cognitively impaired drivers: Insights from Western evidence for Asian adaptation
Licensing authorities rely on medical certifications of fitness-to-drive when renewing licence for drivers who are at higher risk of crashes. Drivers with cognitive impairment are 2 to 8 times more likely to be involved in a crash compared to those without such impairments,1 and studies show they have a...
Original Article
Long-term outcomes of subthalamic nucleus deep brain stimulation for Parkinson’s disease in Singapore
Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disorder characterised by motor symptoms such as limb bradykinesia, rigidity and resting tremor.1 Non-motor symptoms, including mood disturbances, cognitive impairment, autonomic dysfunction, and sleep disorders, are also common. Disease progression often leads to motor fluctuations and dyskinesias, along with worsening...
Original Article
Trends in fluid overload-related hospitalisations among patients with diabetes mellitus: The impact of chronic kidney disease
Diabetes mellitus (DM) is a major global health problem, contributing to significant clinical disease burden, healthcare expenditure and societal costs.1 In Singapore, DM accounts for 2.9% of disability-adjusted life years and 4.3% of years lived with disability.2,3 By 2030, it is projected to cost approximately USD 1.89 billion in...
Letter to the Editor
Using artificial intelligence as an ethics advisor
Dear Editor,
Ethical dilemmas are common in the practice of medicine and can lead to an array of seemingly reasonable decisions unless policies or regulations mandate certain actions. Choosing the appropriate solution requires not only biomedical evidence, but also requires the balancing of possibly divergent preferences, values, contextual factors and...
Letter to the Editor
A consensus survey of neurologists and clinical geneticists on spinal muscular atrophy treatment in Singapore
Dear Editor,
Just a decade ago, spinal muscular atrophy (SMA) was considered a debilitating, progressive neuromuscular disease that inevitably led to chronic disability and a shortened lifespan. Now, it is treatable with nusinersen, onasemnogene abeparvovec (OAV) and risdiplam—the 3 disease-modifying drugs approved by the US Food and Drug Administration, the...
Letter to the Editor
Comparing the effectiveness, safety and cost of teleconsultation versus face-to-face model of pharmacist-led anticoagulation clinic: A single institution experience
Dear Editor,
Teleconsultation-based (TELE) anticoagulation clinic (ACC) is an alternative modality, but its use in Singapore’s clinical setting has not been well studied. In Tan Tock Seng Hospital (TTSH), the TELE ACC service was established to enrol patients who (1) perform self-testing using a loaned point-of-care (POC) international normalised ratio...
Review Article
Clinical performance of automated machine learning: A systematic review
In medicine, machine learning (ML) has been applied in a wide variety of contexts ranging from administration to clinical decision support, driven by greater availability of healthcare data and technological development.1-5 Automated ML (autoML) enables individuals without extensive computational expertise to access and utilise powerful forms of artificial intelligence...
Editorial
Bridging expertise with machine learning and automated machine learning in clinical medicine
In this issue of the Annals, Thirunavukarasu et al.'s systematic review on the clinical performance of automated machine learning (autoML) highlights its extensive applicability across 22 clinical specialties, showcasing its potential to redefine healthcare by making artificial intelligence (AI) technologies accessible to those without advanced computational skills.1 This enables...
Commentary
Artificial intelligence in medicine: Ethical, social and legal perspectives
“Our future is a race between the growing power of our technology and the wisdom with which we use it. Let's make sure that wisdom wins.” — Stephen Hawking
The tsunami of artificial intelligence (AI) has arrived in medicine, penetrating every clinical specialty. Deep learning algorithms enable highly sensitive and...
Original Article
Risk of dementia in the elderly with non-alcoholic fatty liver disease: A nested case-control study in the Republic of Korea
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease affecting about 25% of the general population.1,2 NAFLD has a broad disease spectrum ranging from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH)/liver cirrhosis, resulting in increased risk of developing not only liver-related complications but also extrahepatic morbidities.3...
Letter to the Editor
Treatment outcomes of micropulse cyclophototherapy in uveitic glaucoma
Dear Editor,
We present a case series, describing the utility of micropulse cyclophototherapy in the treatment of uveitic glaucoma.
Prevalence of glaucoma in patients suffering from uveitis was estimated to be 7.6% at 12 months after acute uveitis, and 11.1% at 5 years with chronic uveitis.1,2 Uveitic glaucoma is usually associated...
Commentary
Transforming radiology to support population health
The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery of health services in Singapore.1 Part of it involves a shift away from tertiary hospital-based to community-based care, to improve diagnostic imaging services in the...
Commentary
Leveraging ChatGPT to aid patient education on coronary angiogram
Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of healthcare communication comprised the use of chatbots, which is limited by a predetermined set of queries and matched answers.2 However, natural-language AI models prompt a...
Editorial
Promise and pitfalls of ChatGPT for patient education on coronary angiogram
The past decade has seen extraordinary and rapid progress in the field of artificial intelligence (AI), which produces computer systems capable of performing tasks that typically require human intelligence. These advancements have yielded wide-ranging applications across various domains that are revolutionising industries and transforming the way humans live and...
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...
Commentary
Artificial intelligence innovation in healthcare: Relevance of reporting guidelines for clinical translation from bench to bedside
Artificial intelligence (AI) and digital innovation have revolutionised many sectors and industries, prominently including healthcare during the coronavirus disease 2019 (COVID-19) pandemic.1 For example, deep learning, which is a subset of the state-of-the-art machine learning techniques, has shown robust performance in image recognition, speech recognition and natural language processing.2...
Editorial
The eye as a window to the brain
Over the last 20 years, it has become evident that the age-old expression, “the eye is the window into the soul”, might in fact hold more truth than previously thought. We are currently able to distinguish a variety of systemic diseases by funduscopic inspection. Following the dawn of high-resolution...
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...
Letter to the Editor
Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders
Dear Editor,
Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based patient-centric care.1
We have developed and implemented a deep-learning model using bidirectional long short-term memory (Bi-LSTM) neural network to enable automated triage of unstructured free-text...
Review Article
The Omicron-transformer: Rise of the subvariants in the age of vaccines
The emergence and evolution of SARS-CoV-2 have been publicly tracked in unprecedented detail through a combination of intensive genomic sequencing and open-access sharing of data.1 This surveillance information describes how waves of COVID-19 infections have been driven by the emergence of new variants of concern (VOCs) and their subvariants....
Review Article
National surgical antibiotic prophylaxis guideline in Singapore
Surgical antibiotic prophylaxis (SAP) refers to the administration of antibiotics prior to clean and clean-contaminated surgeries to prevent postoperative surgical site infections (SSIs). An optimal SAP should be highly effective in preventing SSI. An ideal prophylactic antibiotic regimen is: (1) effective against pathogens—generally skin flora—most likely to contaminate the...
Review Article
Exploring loss and grief during the COVID-19 pandemic: A scoping review of qualitative studies
As of mid October 2022, the World Health Organization recorded that more than 620 million people worldwide have been infected by SARS-CoV-2, the virus causing COVID-19, while over 6.5 million have succumbed to the disease. Many have lost family members and friends as well as jobs and familiar lifestyles,...
Original Article
Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation
The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and major adverse cardiac events (MACE) seen in this group of patients even after surgical aortic valve replacement (SAVR).1,2
In recent times, the role of transcatheter aortic...
Review Article
Periodontal disease and systemic health: An update for medical practitioners
Care for the oral cavity lies in the intersection of dentistry and medicine. As the oral cavity serves as an entry to the gastrointestinal tract and the point where the digestion process begins, it is often recognised as an important gateway to dietary and nutritional health. Oral health, however,...
Review Article
Barriers to breast cancer screening in Singapore: A literature review
Breast cancer is a major public health concern and a leading cause of cancer death among women worldwide, including Singapore.1 According to the 2018 Singapore Cancer Registry report, breast cancer has been consistently ranked as a leading cancer (29.3% of all cancers in Singapore) among women in Singapore for...
Original Article
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,...
Original Article
Treating acutely ill patients at home: Data from Singapore
Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations age, and hospitals are expensive to build and run.1 There is increasing recognition of the risk of hospitalisation from potent nosocomial infections2,3 (exacerbated by the...
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...
Review Article
Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents
The World Health Organization’s Global action plan for the prevention and control of noncommunicable diseases 2013–2020 provided guiding principles for national efforts in controlling and reducing non-communicable diseases (NCDs).1 The major NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes—they form a major public health challenge, and are...
Original Article
Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore
Functional gastrointestinal (GI) disorders, such as colic, gastroesophageal reflux (GER) and constipation, are common in infants under 1 year. They are a frequent cause of concern for parents and result in a significant healthcare burden1,2 due to their negative impact on feeding behaviours, caregivers’ mental wellbeing and quality of...
Images in Medicine
A 52-year-old woman with beading of intracranial arteries
A 52-year-old woman of Indian ethnicity with a history of well-controlled hypertension, hyperlipidaemia and recurrent transient ischaemic attacks presented with altered mentation and slurred speech. Physical examination revealed generalised weakness. Initial blood tests showed raised total white cell count, raised erythrocyte sedimentation rate at 35mm/h and fasting low-density lipoprotein...
Original Article
Comparison of planned-start, early-start and deferred-start strategies for peritoneal dialysis initiation in end-stage kidney disease
Peritoneal dialysis (PD) is a well-established long-term dialysis modality for patients with end-stage kidney disease (ESKD).1 It is recommended that a PD catheter should be placed at least 2 weeks prior to the anticipated need of long-term PD treatment for a planned-start PD.2 Despite wide-spread promotion of planned-start dialysis for...
Others
Creutzfeldt-Jakob Disease Presenting with Visual Blurring, Diplopia and Visual Loss: Heidenhain’s Variant
The electroencephalographic pattern is distinctive in many but not in all patients with Creutzfeldt-Jakob disease (CJD). Often, it is one of diffuse and non-specific slowing in the background with stereotypical generalised periodic high-voltage slow and sharp wave complexes.
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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.
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Original Article
The Profile of Hospitalised Patients with Parkinson’s Disease
Prevalence studies in various parts of the world have shown that Parkinson’s disease (PD) is relatively common among the aged in all countries. Crude prevalence rates range from 10 to 450 per 100 000 population.
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Others
Frontal Sinus Mucoceles Causing Proptosis—Two Case Reports
Frontal mucoceles are collections of inspissated mucus which occur when there is obstruction to the outflow of the frontal sinuses. The obstruction may be due to congenital anomalies, infection, trauma, allergy, neoplasms or surgical procedures in the nose.
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Others
The Alien Hand Sign–Case Report and Review of the Literature
The alien hand sign or “strange hand sign”, first coined by Brion and Jedynak in 1972, refers to a feeling that the hand is foreign, together with autonomous activity which is perceived as independent of voluntary control, as if the hand is driven by an external agent.
This article is...
Others
A Case Series of Ocular Disease as the Primary Manifestation in Sarcoidosis
Sarcoidosis is an idiopathic, systemic, non-caseating, granulomatous disease with protean clinical manifestations. Although the first description of sarcoidosis was attributed to Hutchinson, its ocular features received little attention until 1936 when Heerfordt’s syndrome of uveitis, salivary gland enlargement and cranial nerve palsies was recognised as a sign of sarcoidosis.
This...
Review Article
Trends in the Pattern of Blindness and Major Ocular Diseases in Singapore and Asia
Singapore’s population has grown rapidly since 1965, the year in which it gained independence. The total population enumerated at its first census in 1970 was 2 074 507, compared to 3 103 500 in 1997.
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Original Article
Electrophysiological Features in the Management of Meralgia Paraesthetica
Meralgia paraesthetica is a condition resulting from entrapment of the lateral femoral cutaneous nerve at the region of the anterior superior iliac spine, when the nerve angulates sharply over the inguinal ligament. It presents classically with pain, paraesthesia and sensory loss over the anterolateral surface of the thigh.
This article...
Others
A Case of Accelerated Development of Proliferative Diabetic Retinopathy in a Woman with Type 2 Diabetes Mellitus after Pregnancy
Diabetic retinopathy is the leading cause of blindness in persons between the age of 24 and 64 years both in the US and the UK. Peak fertility and childbearing years correspond to the first half of this period.
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Others
Trilateral Retinoblastoma—A Case Report
Retinoblastoma is the third most common tumour in childhood. It is inherited genetically.
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Original Article
A Retrospective Review of Patients with Clinically Definite Multiple Sclerosis
Genetic susceptibility and environmental factors influence the prevalence and clinical manifestations of multiple sclerosis (MS). Since MS is rare in Southeast Asia, descriptions of this disease particularly as it occurs in Singapore have been sparse.
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Others
Chronic Subdural Haematoma Presenting with Transient Ischaemic Attacks— A Case Report
Transient ischaemic attacks (TIA) are commonly seen in neurologic practice. They are most commonly associated with cerebrovascular insufficiency, either from a thrombotic or embolic occlusion of a cerebral artery.
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Others
Palatal Myoclonus—A Case Report
Palatal myoclonus is a rare movement disorder characterised by rhythmic recurring jerky movements of the soft palate, pharynx, larynx and rarely diaphragm, trunk and limb muscles. It usually develops secondary to brainstem or cerebellar disease (symptomatic palatal myoclonus) interrupting the central tegmental tract or dentato-olivary fibres.
This article is available...
Original Article
Potentiation of Acetylcholine-induced Smooth Muscle Contraction in Rat Ileum by Lead
It is known that exposure of animals and humans to heavy metals such as lead can result in neurological dysfunction. Pharmacodynamic effects of lead (Pb++) on tension of smooth muscles, interaction with catecholaminergic function and neuromuscular transmission have been described.
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Others
Extensor Pollicis Longus Paralysis Following Thoracoscopic Sympathectomy
A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla.
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Original Article
Retinopathy of Prematurity in Very Low Birth Weight Infants
Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship between the risk of this disease with birth weight and gestational age had been well-documented, in particular, in infants with birth weight ≤1500 g (very...
Original Article
Role of Magnetic Resonance Imaging and Magnetic Resonance Angiography in Patients with Hemifacial Spasm
Hemifacial spasm (HFS), characterized by intermittent twitching of muscles supplied by one facial nerve is commonly due to compression of the facial nerve by blood vessel(s) adjacent to its root exit zone (REZ). The facial nerve REZ refers to the part where facial nerve exits from the pons.
This article...
Review Article
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 diabetes mellitus (Type 2) patients would develop retinopathy after 20 years of disease.
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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
The Reliability and Validity of the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the Elderly Chinese in Hong Kong
The Alzheimer’s Disease Assessment Scale (ADAS) is a 21-item scale designed to assess the severity of cognitive and non-cognitive impairment in patients with Alzheimer’s disease (AD).
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Original Article
The Correction of Oriental Lower Lid Involutional Entropion Using the Combined Procedure
Involutional entropion is a frequent cause of ocular irritation in the local elderly patients. The inturning of the lid margin and the eyelashes result in corneal epithelial damage that may predispose to vision-threatening infection and irreversible corneal scarring.
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Others
The Current State of Multiple Sclerosis Genetic Research
It was Charcot (1868) who first made the formal pathological correlation between lesions in the central nervous system (CNS) and a disorder termed, ‘la sclérose en plaques’. Today, a number of other immune-mediated, demyelinating CNS diseases have been recognised and hence, classical multiple sclerosis (MS) is now specified as...
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
The Genetics of Human Epilepsies
Epilepsies are one of the most common neurological disorders, affecting about 3% of individuals at least once in a lifetime. It thus represents a major health care problem. Socio-economical and educational issues are well known.
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Review Article
Sleep/Wake Cycle and Circadian Disturbances in Shift Work: Strategies for Their Management—A Review
Humans have primarily been active/awake during the day and inactive/asleep at night. The discovery of artificial light and introduction of electric power generator have made available a continuous and reliable source of light throughout day and night.
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Review Article
The efficacy and safety of high-intensity focused ultrasound in the treatment of benign thyroid nodules: A systematic review and meta-analysis from 1990 to 2021
Thyroid nodules are commonly seen in clinical practice. They can be detected by palpation in 5%1 of individuals and by ultrasound (US) in 19–68% of the general population.2 Most of them are benign, stable and asymptomatic, thus preferred treatments are usually non-invasive. These would include modalities ranging from percutaneous...
Original Article
Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting
The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality worldwide. The development of mRNA vaccines has heralded much hope in the fight against the disease. The safety and efficacy of these vaccines have been well demonstrated in clinical trials,1,2 and also against severe disease from...
Original Article
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 has a strong association with postoperative delirium, which is present in up to 45% of patients after surgery.2-5 PACU is a wide-reaching problem, and especially...
Editorial
Delirium in patients following general anaesthesia
Delirium is a disturbance of consciousness characterised by an acute onset and fluctuating course of inattention, accompanied by either a change in cognition or a disorganised thinking, resulting in an impaired ability of the patient to receive, process, store and recall information. Delirium develops over a short period of...
Others
Listeria Meningoencephalitis: Two Cases and a Review of the Literature
The general experience of local physicians and available data suggest that listerial infections of the central nervous system (CNS) are uncommon among adults in Singapore. This situation may change.
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Others
Panhypopituitarism due to Pituitary Cyst of Rathke’s Cleft Origin—Two Case Reports
Rathke’s cleft cysts are non-neoplastic cystic epithelial lesions of the sellar and suprasellar region which are thought to originate from the remnants of Rathke’s pouch and are characteristically lined by a single layer of ciliated cuboidal or columnar epithelium with goblet cells. However, foci of squamous epithelium in Rathke’s...
Review Article
Causes and Management of Descemet’s Membrane Detachment Associated with Cataract Surgery—Not Always a Benign Problem
It is well known that stripping of Descemet’s membrane (DM) occurs not infrequently during cataract surgery. In 1928, Samuels described frequent DM detachments of small dimensions during cataract extraction of minor consequence.
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Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it as there are so few books of medicine written and published in Singapore.
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Review Article
Advances in Neurointensive Care
Neurointensive care has come into being in the past decade as a recognised subspecialty. Pioneering neurointensivists in the United States, such as Allan Ropper and Dan Hanley, have led in demonstrating the specialised expertise that neurointensivists offer to critically ill patients.
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Review Article
The Eye in Neurology: Evaluation of Sudden Visual Loss and Diplopia—Diagnostic Pointers and Pitfalls
The first step in the evaluation of sudden visual loss is to determine if the visual loss is monocular or binocular. The first diagnostic pitfall to avoid is the assumption that what is one-sided is one-eyed.
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Review Article
Neuroprotection in Acute Stroke
The neuronal cells of the central nervous system are especially susceptible to various forms of insult such as trauma and ischaemia. Once the ischaemic cascade is set into motion by the initiating injury, the resultant damage is traditionally considered to be unavoidable, untreatable and permanent.
This article is available only...
Review Article
Current and Emerging Treatments in Parkinson’s Disease
Parkinson’s disease (PD) affects 1% of adults above the age of 65 years. It is characterised histologically by the loss of neurons in the substantia nigra pars compacta and the presence of Lewy bodies within the degenerating neurons.
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Original Article
Trinucleotide Repeat Analysis of Huntington’s Disease gene in Singapore
Huntington’s disease (HD) is an autosomal dominantly inherited disease, affecting 1 in 10,000 individuals of European origin. The incidence in the Asian population is much lower, and the estimated prevalence in Singapore is 3 to 15 per million.
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Original Article
Aseptic Meningitis in Children—The Singapore Experience
Aseptic meningitis is a common diagnosis among infants admitted for fever without an obvious source. In cases where the aetiologic agent could be identified, more than 90% were due to enteroviruses.
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Others
Update in the Management of Stroke
Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders has been rising dramatically over the last few years, exceeding 10,400 in 2001.
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Others
6th Yahya Cohen Lecture: Visual Experience During Cataract Surgery
What a patient can see during his or her surgery can be a cause of anxiety for the patient. It may cause additional stress to what for most patients is already a traumatic event.
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Others
Stroke Disease Management—A Framework for Comprehensive Stroke Care
Disease management (DM) is an approach to patient care that coordinates medical resources for patients across the entire healthcare delivery system. It requires a shift in focus from viewing patient care as discrete episodes or fragmentary encounters with different parts of the healthcare system, to provision of high-quality care...
Original Article
Variance Analysis Applied to a Stroke Pathway: How This Can Improve Efficiency of Healthcare Delivery
Stroke is the fourth principal cause of death in Singapore, and the leading cause of long-term disability amongst developed countries. Due to the spiralling increase in healthcare expenditure in recent years, many countries have implemented cost-containing measures in healthcare financing.
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Others
Age-related Macular Degeneration: What’s New
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed western world, accounting for approximately 50% of all cases of registered blindness. The prevalence of AMD seems to be increasing at a rate not commensurate with the increasing age of the population, although this observation...
Others
Visual Rehabilitation with New-Age Rigid Gas-Permeable Scleral Contact Lenses—A Case Series
Advanced primary corneal ectasia presents a difficult problem in terms of visual rehabilitation. Soft contact lenses do not address the astigmatic aberrations in these conditions and conventional rigid gas-permeable (RGP) corneal contact lenses though useful in less severe disease, are poorly tolerated by those with progressively worsening keratoconus and...
Original Article
Nursing Home Falls: A Local Perspective
Falls in the elderly has been a well-studied subject and now occupies an important place in geriatric medicine. While many studies have been done on falls in community-dwelling elderly, relatively few studies have focused on the problem in institutionalised elderly.
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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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Review Article
Seeing How We Think About Words Using BOLD Contrast fMR Imaging
Functional brain imaging refers to a set of non-invasive imaging techniques that are used to infer linkages between brain structure and function. In this review, blood flow functional magnetic resonance imaging (fMRI) is specifically discussed.
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Review Article
Imaging of Acquired Immunodeficiency Syndrome (AIDS)
The pandemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global healthcare problem and HIV infection is the most common cause of death worldwide. There are now 60 million deaths recorded from the infection worldwide by the United Nations AIDS (UNAIDS) organisation, most of them in sub-Saharan...
Others
Gyrate Atrophy of the Choroid: Two Cases
Gyrate atrophy of the choroid (GA) is a rare choroidal dystrophy. It is an autosomal recessive disorder that results in progressive deterioration in peripheral and night vision.
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Review Article
Nipah Encephalitis Outbreak in Malaysia
From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started in Ulu Piah, Tambun and Ampang near Ipoh in the state of Perak, later involved Sikamat, Sungai Nipah, Kampong Sawah and Bukit Pelanduk areas in...
Original Article
The impact of deprescribing interventions on oral proton pump inhibitor utilisation in a Singapore tertiary hospital: A quality improvement initiative
The established efficacy of proton pump inhibitors (PPIs) in the treatment of upper gastrointestinal (GI) disorders, coupled with their perceived safety, have led to PPI overutilisation.1,2 Prescription of PPIs in absence of evidence-based indication, also known as low-value prescribing, is prevalent across the spectrum of healthcare settings.1-4 Within Singapore,...
Others
MELAS: A Case Report
A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to multiple dental caries, phenytoin-induced gingival hyperplasia and severely worn-down and eroded dentition. He is under regular follow-up by the Paediatrics Department of the National University...
Others
Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore
Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to 1.0 per million population. However, the incidence of CJD in the Singaporean population is not known. With a population of 4 million, an estimated 2...
Others
Initial Experience of Macular Translocation in Singapore – One-year Results
Choroidal neovascularisation (CNV) is a devastating complication of macular degeneration and a major cause of irreversible vision loss in many developed countries. The most common cause of CNV is age-related macular degeneration but it may also occur secondary to a variety of other aetiologies such as pathological myopia, ocular...
Review Article
Axoglial Interaction via the Notch Receptor in Oligodendrocyte Differentiation
Oligodendrocytes (OLs) derived from the common neural progenitor cells in the central nervous system (CNS) ensheathe the nude axon to form the myelin that not only effects saltatory conduction but also protects and maintains the axonal structure. It is the last type of cells that appear in the CNS....
Review Article
Ocular Surface Stem Cells and Disease: Current Concepts and Clinical Applications
The ocular surface is a complex biological continuum responsible for the maintenance of corneal clarity, elaboration of a stable tear film for clear vision, as well as protection of the eye against microbial and mechanical insults. The ocular surface epithelium comprises corneal, limbal and conjunctival epithelia, of which the...
Letter to the Editor
Re: Evidence for an “epidemic” of myopia
In the Annals January 2004 theme issue on Myopia, Park and Congdon have disputed the reality of the increases in prevalence of myopia in East Asia for several reasons. In particular, they criticise the 2 best documented sets of cohort data, from Taiwan and Singapore, on methodological grounds.
This article...
Original Article
Contact Lens Microbial Keratitis and Prior Topical Steroid Use: A Disaster in the Making?
Topical steroid use in cornea ulcers is still a very contentious issue in ophthalmology. A recent review by Wilhelmus found that the use of topical steroids before the diagnosis of bacterial keratitis significantly predisposed eyes with preexisting corneal disease to ulcerative keratitis.
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Original Article
Integrated Hydroxyapatite Implant and Non-integrated Implants in Enucleated Asian Patients
Much has been published on the complications of integrated and non-integrated implants. Most studies on integrated implants pertain to experience with the hydroxyapatite implant, with the coralline (such as the Bio-Eye) {Integrated Orbital Implants, Inc., San Diego, California, USA} type dominating its cancellous bone counterpart (the Molteno M-sphere) {IOP,...
Others
A Case of Right Loin Pain: Septic Ovarian Vein Thrombosis Due to Campylobacter fetus Bacteraemia
Septic ovarian venous thrombosis is an uncommon entity. Classically, it occurs as a postpartum complication with reported frequency of 1 in 600 to 2000 deliveries.
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Original Article
Hemifacial Spasm in Singapore: Clinical Characteristics and Patients’ Perceptions
Hemifacial spasm (HFS) is a movement disorder characterised by intermittent involuntary contractions of the facial muscles. It begins with contractions of the orbicularis oculi, gradually spreading to involve the rest of the ipsilateral facial muscles.
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Original Article
Characteristics and Acute Rehabilitation of Guillain-Barré Syndrome in Singapore
The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is the most common cause of acute neuromuscular paralysis.
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Others
Clinical Indications for Positron Emission Tomography (PET) Scanning
The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications.
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Review Article
PET Tracers and Radiochemistry
Positron emission tomography (PET) has become a powerful scientific and clinical tool for probing biochemical processes in the human body. This is due, in large part, to advances in instrumentation and synthetic chemistry.
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Review Article
Physical Principles and Technology of Clinical PET Imaging
The past few years have seen the transition of positron emission tomography (PET) from the research domain into mainstream clinical applications for oncology. The emergence of PET as the functional imaging modality of choice for diagnosis, staging, therapy monitoring and assessment of recurrence in cancer has led to an...
Editorial
Positron Emission Tomography – A Vital Component of Molecular Imaging
Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of such modalities as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). As far back as 1951, positron-emitting radiotracers have...
Others
Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association
The spinocerebellar ataxias (SCAs) are a rare group of neurodegenerative disorders that are clinically and genetically heterogeneous. Almost all SCAs are due to trinucleotide repeat expansions and 16 types of SCAs have been described.
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Review Article
The Correction of Myopia Evaluation Trial: Lessons from the Study Design
“A properly planned and executed clinical trial is a powerful technique for assessing the effectiveness of an intervention”. While each new clinical trial involves unique issues relevant to a particular condition or disease, overarching common guidelines for all studies provide the framework for obtaining meaningful results.
This article is available...
Original Article
Myopia Progression Among Preschool Chinese Children in Hong Kong
Myopia occurs when the image of distant objects, focused by the cornea and lens, falls in front of the retina. It is the commonest eye problem worldwide. Its prevalence varies in different parts of the world – myopia occurs in 25% of the adult population in the United States,...
Review Article
The Epidemiology of Myopia in Hong Kong
Myopia is a refractive condition in which the image of a distant object is formed anterior to the retina of the unaccommodated (relaxed) eye. It occurs when the refractive power of the eye is too great compared to the length of the eyeball and this may occur because the...
Original Article
Prevalence of Myopia in Taiwanese Schoolchildren: 1983 to 2000
Today in Taiwan, with increasing level of educational and living standard, the prevalence and severity of myopia appear to be on an upward trend. This is true elsewhere also, especially in Asia. In Asia, there is currently a high prevalence of myopia, especially among the Chinese and Japanese.
This article...
Review Article
Evidence for an “Epidemic” of Myopia
A number of authors have recently proposed that myopia is increasing at an “epidemic” rate, particularly in East Asia, and especially among populations of Chinese descent. It has been reported that the prevalence of myopia among some populations in this area has reached 90%.
This article is available only as...
Review Article
Using Natural STOP Growth Signals to Prevent Excessive Axial Elongation and the Development of Myopia
Myopia in humans results from an imbalance between the refractive power of the cornea and lens and the axial length of the eye, such that the image of an object at infinity falls in front of the retina, with the lens at rest. Accommodation, therefore, cannot focus the blurred...
Review Article
Ocular Shape and Myopia
Myopia develops from a mismatch of the eye’s anatomical axial length and its focal length, as determined by the combined optical powers of the cornea and lens. For higher degrees of myopia and myopic progression, this mismatch develops primarily as a consequence of disproportionate ocular growth, chiefly of the...
Others
Is it Possible to Slow the Progression of Myopia?
The rates of myopia, including high myopia , have been reported to be rising to epidemic proportions in Asia and solutions to this huge public health problem are urgently needed. Many researchers agree that myopia is not determined solely by genes and that environment may play a huge role.
This...
Editorial
Issues and Challenges for Myopia Research
Myopia is an ocular disorder of major public health and socioeconomic significance in many East Asian urban cities. In Singapore, the prevalence of myopia is one of the highest worldwide, affecting 28% of school children at the start of their primary education and 70% of those completing university education.
This...
Original Article
Accommodative Stimulus Response Curve of Emmetropes and Myopes
There is a strong association between myopia and near work, and it has been reported that the rapid rise in the prevalence of myopia in Singaporean children may be related to an increase in near work demands such as reading. Although the mechanism by which near work affects myopia...
Original Article
Electrophysiological Findings in Persons With Nyctalopia
Nyctalopia is a subjective sensation of poor vision under dark conditions. It may be clinically associated with retinal diseases affecting the rod photoreceptors or post-receptoral pathways.
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Commentary
Identification of a Common Genetic Risk Variant (LRRK2 Gly2385Arg) in Parkinson’s Disease
For diseases with complex inheritance, the age-old debate regarding the relative contribution of gene-environment interaction never fails to generate interest, discussion and hypothesis within the scientific community. The unraveling of the human genome project brings hope and great optimism that a verdict on such debates may be in the...
Others
Neisseria meningitidis Keratitis in Adults: A Case Series
Neisseria meningitidis has been reported as a causative organism for conjunctivitis and endogenous endophthalmitis, more commonly in neonates and young children. A search of the literature on Medline revealed very few reports on infective keratitis caused by N. meningitidis.
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Others
Visual Recovery Following Emergent Orbital Decompression in Traumatic Retrobulbar Haemorrhage
Acute retrobulbar haemorrhage is a potentially sight threatening condition that can occur spontaneously or following retrobulbar injections and trauma to the orbit. Visual loss results from central retinal artery occlusion or optic neuropathy from direct compression or from compression of optic nerve venous drainage.
This article is available only as...
Review Article
Macular Carotenoids and Age-related Maculopathy
The macula lutea is an anatomic region of the posterior retina that measures approximately 5.5 mm in diameter, and is exquisitely specialised for sharp central vision. Lutein (L) is a carotenoid, which, along with its stereo isomer zeaxanthin (Z), is concentrated at the macula lutea, to give it its...
Review Article
Neural Progenitor and Stem Cells in the Adult Central Nervous System
Seminal studies in the 1960s, using -thymidine autoradiography, reported that neurogenesis occurs in discrete areas of the adult mammalian brain, in rodents. Studies in the 1970s and 1980s confirmed that neurogenesis occurs in hippocampus and subventricular zone (SVZ) of rodents.
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Others
Book Review
Ophthalmologists today depend heavily on various investigative modalities such as fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) for an accurate diagnosis and optimal management of macular disorders. This book is a quick reference guide for common macular disorders encountered in an ophthalmic practice and...
Others
Recombinant Tissue Plasminogen Activator (r-TPA) in Fibrin Dissolution due to Postoperative Endophthalmitis
Cataract surgery is one of the most successful surgical procedures performed. However, postoperative endophthalmitis, defined as severe inflammation involving both the anterior and posterior segments of the eye secondary to an infectious agent, is an uncommon but devastating complication.
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Original Article
Orbital Metastatic Tumour as Initial Manifestation of Asymptomatic Gastric Adenocarcinoma
Metastatic orbital tumour from gastric cancer is rare. In a Japanese survey of metastatic orbital tumours seen over 95 years, gastric metastases accounted for only 8.6% (11 patients) of cases. A series of orbital tumours from 1976 to 1999 by Rootman et al reported only 2 cases of metastasis...
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
Retrospective Review of Eyes with Neovascular Age-related Macular Degeneration Treated with Photodynamic Therapy with Verteporfin and Intravitreal Triamcinolone
Among the variety of paradigms implicated in the pathogenesis of choroidal neovascularisation (CNV), an inflammatory component has been a recent focus of interest. The findings that complement factor H (CFH) polymorphisms are associated with an increased risk in the development of age-related macular degeneration (AMD) and that the histopathology...
Original Article
Rates of Posterior Capsule Rupture During Cataract Surgery Among Different Races in Singapore
Posterior capsule rupture (PCR) is a potentially serious intraoperative complication of cataract surgery. The anecdotal experience of some surgeons suggests that differences in the anatomy of the eyelids, bony orbit, nasal bridge and other facial features, as well as the globe itself among different races may influence such factors...
Others
Surgically-induced Corneal Changes Following Macular Translocation with Punctate Retinotomies and Chorioscleral Infolding (Limited Macular Translocation)
Changes in corneal curvatures and astigmatism after retinal surgery are well documented. Although some of these changes are mild and transient, some have reported clinically significant irregular and asymmetric corneal changes.
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Review Article
Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation
Paediatric cataract has a low incidence compared with adult cataract. The estimated incidence is about 1 to 6/ 10,000 births.
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Original Article
Efficacy of Measuring Visual Performance of LASIK Patients under Photopic and Mesopic Conditions
LASIK is routinely carried out to correct the refractive errors of myopic patients. A high percentage of patients have good high-contrast visual acuity after undergoing LASIK surgery, with the majority of them having unaided vision that meets the minimum recommended criteria for driving.
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Original Article
Role of Ultrasound Biomicroscopy (UBM) in the Detection and Localisation of Anterior Segment Foreign Bodies
The presence of an intraocular foreign body (IOFB) is a common complication of ocular trauma. For surgical planning, the localisation of IOFBs has to be accurate. Posterior segment foreign bodies are detected by clinical examination and imaging techniques such as computed tomography (CT) and low-frequency (5 MHz to 10...
Original Article
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 would increase by 150% in 2025. As the population with type II diabetes increases, so does the prevalence of diabetic retinopathy and other microvascular complications.
This...
Commentary
Ethical Issues in Ophthalmology and Vision Research
The importance of ethics in research was highlighted in the USA when a healthy volunteer subject, 24-year-old Ellen Roche, died in a Johns Hopkins asthma study in 2002. Investigations showed that there had been serious deficiencies in the ethical review and research work was suspended in Johns Hopkins until...
Others
Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids
Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE atrophy that may represent sequelae of previous episodes. CSCR can arise secondary to chronic treatment with steroids.
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Original Article
A Novel Locus for X-linked Retinitis Pigmentosa
Retinitis pigmentosa (RP) is characterised by initial night blindness followed by progressive loss of visual fields and eventually, loss of central vision. RP is the most prevalent group of inherited retinopathies, affecting approximately 1 in 3500 individuals.
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Original Article
Utility and Validity of the Self-administered SF-36: Findings From an Older Population
The shift towards broader health perspectives and the emphasis on patient preferences have led to the development of many health questionnaires and their inclusion as primary and secondary outcome measures in clinical trials. Measurements of health-related quality of life (HRQOL), a multidimensional concept encompassing physical, emotional and social aspects...
Others
The Role of Optical Coherence Tomography (OCT) in the Diagnosis and Management of Retinal Angiomatous Proliferation (RAP) in Patients with Age-related Macular Degeneration
Retinal angiomatous proliferation (RAP), initially described as deep retinal vascular anomalous complex in 1992 by Hartnett et al, has been recently defined as a new, distinct form of exudative age-related macular degeneration (AMD). In choroidal neovascularisation (CNV), the choroidal new vessels may proliferate through the retinal pigment epithelium (RPE),...
Original Article
Axial Length: A Risk Factor for Cataractogenesis
There are several known risk factors for cataract formation, including older age, lower educational status, smoking, ultraviolet light exposure, trauma, dehydration, diabetes, uveitis and glaucoma. Epidemiological research has been confounded by co-existing risk factors that are difficult to measure.
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Original Article
Clinical Features of Autosomal Dominant Retinitis Pigmentosa Associated with a Rhodopsin Mutation
Retinitis pigmentosa (RP) is the most prevalent group of inherited retinopathies. This spectrum of diseases affects approximately 1 in 4800 individuals.
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Original Article
A Novel Mutation of the VMD2 Gene in a Chinese Family with Best Vitelliform Macular Dystrophy
Best vitelliform macular dystrophy is an autosomal dominant disorder characterised by an egg yolk-like appearance of the macula. The vitelliform “egg yolk” lesions result from abnormal accumulation of lipofuscin in the retinal pigment epithelium (RPE).
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Original Article
Characterisation of Human Tear Proteins Using High-resolution Mass Spectrometry
Over the last few years, with advances in mass spectrometry, there has been increasing interest in exploring the proteome of body fluids such as plasma, urine, cerebrospinal fluid (CSF) and saliva. An important objective is to search for potential biomarkers for the diagnosing and monitoring the progression of disease.
This...
Original Article
Scanning Laser Polarimetry in Pulmonary Tuberculosis Patients on Chemotherapy
Pulmonary tuberculosis is a worldwide disease. In Hong Kong, there are about 7000 new cases of pulmonary tuberculosis each year and the prevalence remains high at about 110/100,000. The male elderly (>60 years) are at the greatest risk.
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Letter to the Editor
Time to Raise Awareness of Blindness as Another Smoking-related Condition
Singapore currently has a comprehensive range of tobacco control policies and programmes. It started implementing legislative measures against cigarette smoking in the early 1970s, and since then has been regularly reviewing and revising its laws and their enforcement.
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Letter to the Editor
“Galaxy in My Eye”: An Artist’s View of Cataract Surgery from Behind the Crystalline Lens
Cataract surgery is the most commonly performed elective surgery in many countries. As a result of advances in surgical and anaesthetic techniques, most cataract surgeries are currently performed under local anaesthesia.
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Commentary
Methodologies for Interventional Myopia Studies
Past studies on intervention in myopia progression have given conflicting results. For example, in the past, studies on (PMMA) hard contact lenses took researchers in the past on a roller-coaster ride.
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Others
Ethambutol-associated Optic Neuropathy
Tuberculosis (TB) has been present since ancient times. Around 460 BC, Hippocrates identified phthisis, which is the Greek term for consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor and long relentless wasting) as the most widespread disease of the times, which...
Others
Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis
Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes and non-caseating epithelioid granulomas in affected organs.
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Others
Retrobulbar Alcohol Injection for Orbital Pain Relief Under Difficult Circumstances: A Case Report
The management of pain in the orbital region, whether ocular or orbital in origin, is complex and lies at the margins of several subspecialty interests. Because of this, and because of its rarity, it has received little attention in the literature.
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Others
Book Review
In Retinal Vascular Disorders, Dr Mohan and co-authors cover common and important retinal vascular disorders in a series of short chapters which are written by one or more of the authors. The text is organised logically, with clear headings and subdivisions, and is generally well-written and quite readable.
This article...
Others
Vision 2020 and Prevention of Blindness: Is it Relevant or Achievable in the Modern Era?
This review article considers the universal definition of blindness, the causes of world/global blindness, and ongoing international efforts in blindness prevention. The prospects for Vision 2020 – 20/20 or 6/6 visual acuity for all by year 2020 – worldwide, and for Singapore in particular, and whether it is relevant...
Original Article
Enhancement of the Mechanical and Biological Properties of a Biomembrane for Tissue Engineering the Ocular Surface
The most recent treatment for severe ocular surface disease is the transplantation of cultivated corneal and conjunctival epithelial stem cells, which makes use of human amniotic membrane (HAM) as a substrate and cell carrier. Although the results are quite promising, this new procedure is still facing some challenges.
This article...
Others
Mycobacterium-related Ocular Inflammatory Disease: Diagnosis and Management
Tuberculosis (TB) is an ancient disease that has been detected in 3000-year-old Egyptian mummies. Robert Koch’s discovery of the tubercle bacillus as the aetiologic agent of this disease in 1882 led to the acceptance of “Koch’s postulates,” which remain the gold standard for linking a pathogen to a disease.
This...
Others
Photodynamic Therapy for Choroidal Neovascularisation Secondary to Inflammatory Chorioretinal Disease
Photodynamic therapy using verteporfin (Visudyne, Novartis Ophthalmics) has been proven safe and effective for the treatment of predominantly classic, age-related macular degeneration (AMD)-related subfoveal choroidal neovascularisation (CNV), pathologic myopia-related CNV, and subgroups of AMD-related occult CNV. Visual results following verteporfin treatment of subfoveal, non-AMD related CNV have been variable....
Original Article
Variables Determining Perceived Global Health Ranks: Findings from a Population-based Study
In 1982, Mossey and Shapiro first demonstrated that global self-rating of health was a better predictor of 7-year survival than medical records or self-reports of medical conditions in participants of the Manitoba Longitudinal Study. Since then, many population-based longitudinal studies have confirmed that global self-rated health remains an independent...
Original Article
Multivariate Analysis of Childhood Microbial Keratitis in South India
Corneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and treat, as they are unwilling and sometimes unable to cooperate during active management.
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Original Article
Can the Sequential Use of Conventional Silicone Oil and Heavy Oil be a Strategy for the Management of Proliferative Vitreoretinopathy?
Advances in vitreoretinal surgery have greatly increased the anatomical re-attachment rate in cases with proliferative vitreoretinopathy (PVR). The availability of perfluoro-carbon liquids, indirect viewing systems for surgery, illumination systems allowing bimanual dissection, the use of dyes and the use of retinotomies have all contributed to achieving a complete re-attachment...
Original Article
Surgical Outcomes of 25-Gauge Transconjunctival Vitrectomy Combined With Cataract Surgery for Vitreoretinal Diseases
The recent development of 25-gauge instrumentation for vitreous surgery has promoted a great interest in the transconjuctival sutureless vitrectomy system. Similar to the trend towards minimally invasive surgical intervention in the case of current cataract surgery, smaller incisions with self-sealing wounds in vitrectomy might decrease surgical trauma and operating...
Review Article
New Concepts in the Management of Optic Nerve Sheath Meningiomas
Optic nerve sheath meningiomas (ONSMs) account for one-third of primary optic nerve tumours, are the second most common optic nerve tumours after gliomas, and are the most common tumours of the optic nerve sheath. Although ONSMs are said to comprise 1% to 2% of all meningiomas, their reported incidence...
Review Article
Ophthalmic Regional Block
Patient comfort, safety and low complication rates are the essentials of local anaesthesia. The anaesthetic requirements for ophthalmic surgery are dictated by the nature of the proposed surgery, the surgeon’s preference and the patient’s wishes.
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Review Article
Hyperbaric Oxygen Therapy for Radiation-induced Optic Neuropathy
Radiation optic neuropathy (RON) is an infrequent but usually devastating consequence of radiation to the optic pathways. It is almost exclusively an iatrogenic phenomenon, occurring in patients who have undergone radiation therapy for tumours and other lesions in sites near the visual apparatus, such as the choroid, orbit, paranasal...
Review Article
The Natural History of Occult Choroidal Neovascularisation Associated With Age-related Macular Degeneration. A Systematic Review
Choroidal neovascularisation (CNV) is a leading cause of blindness in the western world. It causes 90% of the visual loss in age-related macular degeneration (AMD).
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Review Article
Retinal Prostheses for the Blind
Each year, thousands of people are afflicted with photoreceptor degenerative diseases that reduce vision to bare light perception or complete blindness. Retinitis pigmentosa (RP) is the leading cause of inherited blindness with 1.5 million people worldwide affected and an incidence of 1/3500 live births.
This article is available only as...
Editorial
Age-related Macular Degeneration: An Emerging Challenge for Eye Care and Public Health Professionals in the Asia Pacific Region
Age-related macular degeneration (AMD) is a severe ocular disease characterised by progressive deterioration of the macula, the most sensitive central back portion of the retina. Choroidal neovascularisation (wet AMD) leading to haemorrhage and scar formation beneath the central retina accounts for most cases of legal blindness from AMD (80%...
Others
Intravitreal Triamcinolone Acetonide for the Treatment of Diffuse Diabetic Macular Oedema – A Case Report
Focal and grid laser photocoagulation are the primary surgical treatments for diabetic macular oedema. However, laser treatment of eyes with diffuse macular oedema has been disappointing.
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Original Article
Bruch’s Membrane Abnormalities in Dome-shaped and Mushroom-shaped Choroidal Melanomas
Uveal melanoma is the most common primary intraocular malignancy and is diagnosed chiefly in the fifth to seventh decades of life. The choroid is the most common site for its development, and choroidal melanomas grow as dome-shaped or mushroom-shaped tumours.
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Original Article
Human Limbal Progenitor Cell Characteristics are Maintained in Tissue Culture
The surface of the eye is covered by 3 distinct forms of non-keratinising stratified squamous epithelium – transparent corneal epithelium overlying the corneal surface, conjunctival epithelium covering the sclera, and a junctional intervening zone of limbal epithelium overlying the limbal region which lies between the corneal and sclera. To...
Original Article
Angiographic Characteristics of Acute Central Serous Chorioretinopathy in an Asian Population
Acute central serous chorioretinopathy (CSCR) is a condition of unknown origin characterised by a serous detachment of the macula. It afflicts young healthy adults, mostly men, between the ages of 20 and 50 years.
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Original Article
A Nationwide Survey on the Knowledge and Attitudes of Malaysian Optometry Students on Patients’ Visual Experiences During Cataract Surgery
Cataract is one of the most common causes of visual impairment in the elderly and its surgery is the most common major ophthalmic surgery, with over 8 million performed globally every year. The majority of cataract surgeries are performed under regional (retrobulbar, peribulbar or sub-Tenon’s) or topical anaesthesia.
This article...
Editorial
Re-defining Neurological Syndromes: The Genotype Meets the Phenotype
Since time immemorial, generations of medical students and physicians have always been taught that a thorough and detailed history and examination is the foundation of the practice of good clinical medicine. This is particularly so in Neurology, in which the detection of an absent reflex or of focal weakness...
Editorial
Towards 2020 Vision in Singapore
With the increasing demands of contemporary life, higher levels of visual performance are expected. In modern societies such as Singapore, many more adults will join the workforce and perform complex tasks that require perfect visual function.
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Original Article
An Intelligent Tutoring System for Trauma Management (Trauma-Teach): A Preliminary Report
In Singapore, trauma1-7 is the leading cause of hospitalisation and the fifth leading cause of morbidity and mortality.8,9 Common causes of trauma include road traffic accidents, industrial accidents, falls and recreational activities. In treating the trauma patient, it is essential that the processes of resuscitation and the identification of...
Others
Fungal Pan-sinusitis with Severe Visual Loss in Uncontrolled Diabetes
Fungi are known opportunistic organisms, which potentially invade and infect a host with depressed immunity. Fungal pan-sinusitis complicated with orbital apex syndrome or cavernous sinus syndrome has been described in immunosuppressed patients.
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Original Article
Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia
Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected vision equal to or worse than 20/40, and it varies from as low as 2.72% in South Africa to as high as 15.8% in Chile.
This...
Others
The Teaching of Radiology
A record of Diagnostic Radiology would be incomplete without reference to Wilheim Roentgen, who discovered the rays that he could not comprehend; hence, X-rays. The day was Friday, 8 November 1895, as he worked on cathode ray tubes at the University of Wurzburg, Germany. These rays penetrated opaque substances,...
Letter to the Editor
Opening Our Eyes to Guide Dogs for the Blind in Singapore
The concept of the modern guide dog first began in Germany after World War I in an effort to support veterans blinded in combat. In 1927, Dorothy Eustis, having gained inspiration from her visit to a guide dog school in Potsdam, Germany, introduced guide dogs into the United States...
Others
Ultrasound Assisted Thrombolysis in Acute Ischaemic Stroke: Preliminary Experience in Singapore
Most patients with acute ischaemic stroke have arterial thrombi that occlude extra- or intracranial vessels. Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for ischaemic stroke within 3 hours from symptom onset.
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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
Functional Neuroimaging of Sleep Deprived Healthy Volunteers and Persons with Sleep Disorders: A Brief Review
Most adults have experienced sleep deprivation at some stage of their lives, be it in the context of work, illness or play. Sleep deprivation can be both total, taking place over 1 to 2 nights, or chronic partial, as characterised by insufficient restorative sleep over days, months and even...
Review Article
Treatment of Circadian Rhythm Sleep Disorders with Light
In humans, the daily pattern of consolidated sleep and wake is strongly influenced by the timing of exposure to light and darkness. In the absence of environmental time cues, cycles of sleep-wake, physiology, and gene expression continue to exhibit a near-24-hour circadian rhythm (derived from the Latin phrase “circa...
Review Article
Basic Science Review on Circadian Rhythm Biology and Circadian Sleep Disorders
The sleep-wake cycle, with its characteristic intervals of activity alternating with restfulness that recur with a periodicity approximating the 24-hour day-night cycle, is the prototypical example of a behaviour that demonstrates a circadian rhythm. Circadian (from the Latin “circa diem” – “about a day”) rhythms are also discernible in...
Images in Medicine
Delayed and Extra-pontine Myelinolysis after Osmotic Dysregulation
A 58-year-old Chinese man was admitted because of increasing lethargy and confusion over 4 days. He had been taking hydrochlorthiazide for hypertension and regularly consumed ethanol in moderation.
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Letter to the Editor
Limb-Shaking Transient Ischemic Attack with Distal Micro-Embolic Signals and Impaired Cerebrovascular Reactivity Using Transcranial Doppler
We present a patient with limb-shaking transient ischaemic attack (TIA) associated with extracranial carotid occlusion and suggest that the pathophysiological mechanism is hypoperfusion, as evidenced by impaired cerebrovascular reactivity.
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Letter to the Editor
Progressive Hemi-facial Atrophy and Keratoconus
Progressive hemifacial atrophy (Parry-Romberg syndrome, PHA) is characterised by slowly progressive atrophy, usually involving one side of the face, and may be associated with ocular manifestations which include enophthalmos, restrictive strabismus and hypotony. We report a case of keratoconus seen in a patient with PHA after obtaining approval from...
Commentary
Neuropsychiatry – An Emerging Field
Neuropsychiatry can be described as the interface between neurology and psychiatry – the intersecting field of enquiry for both the brain and the mind. In more practical terms, it often, though not necessarily, narrows down to psychiatric comorbidities of neurologic diseases (e.g. depression in a patient with stroke) and...
Others
Effects on the Contralateral Eye After Intravitreal Bevacizumab and Ranibizumab Injections: A Case Report
Vascular endothelial growth factor (VEGF) is recognised as an important mediator in the pathogenesis of age-related macular degeneration (AMD) and retinal neovascularisation. Anti-VEGF therapies such as pegaptanib (Macugen, EyeTech/OSI Pharmaceuticals) and ranibizumab (Lucentis, Genentech) are Food and Drug Administration (FDA)-approved in the US for the treatment of neovascular AMD.
This...
Editorial
Alzheimer’s Disease – Towards More Patient-centred and Meaningful Clinical Outcomes
More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in Tübingen. The patient, Auguste Deter, suffered memory loss, disorientation, hallucinations and died at an early age of 55.
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Commentary
Sir Gordon Arthur Ransome (1910-1978) – His Teaching Style and His Legacy
Sir Gordon Arthur Ransome was born in Salop, England, in 1910.1 He came to Singapore in 1938, where he taught and practised medicine for 33 years before his retirement in 1971.
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Others
Corticospinal Tract Degeneration in Amyotrophic Lateral Sclerosis: A Diffusion Tensor Imaging and Fibre Tractography Study
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterised by spinal and cortical motor neuron degeneration. Although electro myography, muscle biopsy and motor unit number estimation are useful for the evaluation of lower motor neuron (LMN) damage, there is at present no objective and quantitative technique to detect...
Review Article
Biomarkers of Mild Cognitive Impairment and Alzheimer’s Disease
Alzheimer’s disease (AD) is the most prevalent form of age-related dementia in the modern society. Other than symptomatic treatment with acetylcholinesterase inhibitors at its earlier stages, no disease-modifying strategies are currently known.
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Original Article
Validation of Transcranial Doppler with CT Angiography in Cerebral Ischaemia: A Preliminary Pilot Study in Singapore
Transcranial Doppler (TCD) is routinely performed to assess the blood flow in patients with cerebral ischaemia and provides important real-time information about cerebral haemodynamics. TCD can aid in the diagnostic work-up by detecting, localising and grading the severity of intracranial arterial obstruction.
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Original Article
Superior Sagittal Sinus Thrombosis: Subtle Signs on Neuroimaging
Cerebral venous thrombosis (CVT) is an infrequent but potentially deadly disease. The mortality rate of CVT is 10% to 20%, and surviving patients may suffer significant morbidity such as seizures or neurological deficits.
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Review Article
Current Understanding of the Treatment and Outcome of Acute Primary Angle Closure Glaucoma: An Asian Perspective
Primary angle-closure glaucoma (PACG) is a major cause of irreversible blindness in Asia and many parts of the world. It is a particularly serious problem in East Asia, where it represents the major form of glaucoma.
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Original Article
Seeing the Wood for the Trees: Approaches to Teaching and Assessing Clinical Pharmacology and Therapeutics in a Problem-based Learning Course
Over the last 3 decades, the rate of knowledge accumulation in drug development has been enhanced by advances in molecular modelling, the molecular genetics of drug action and the screening from natural sources for novel therapeutic agents. These advances mandate the need for a more adaptive and responsive educational...
Editorial
Embryonic Stem Cells and Parkinson’s Disease: Cell Transplantation to Cell Therapy
Although levodopa is currently a well-endorsed form of treatment for Parkinson’s Disease (PD), the search for a safe, long-term and dyskinesia-free treatment remains an agenda for many clinicians and scientists alike. Amongst others, restorative cell therapies are considered a potential treatment for this debilitating disease.
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Commentary
Bridging the Gap Between Primary and Specialist Care – An Integrative Model for Stroke
Cerebrovascular disease (CVD) is Singapore’s fourth leading cause of death, comprising 9% of all deaths, a crude death rate of 40.4/100,000, an age- and sex-standardised prevalence of 3.65% among adults aged ≥50 years, and an incidence of 1.8/1000 patient-years. It is among our top 10 causes of hospitalisation. With...
Letter to the Editor
Acute Concomitant Esotropia during Heroin Detoxification
Although acute concomitant esotropia following heroin detoxification or withdrawal has been described in a few case reports in Europe and Australia, it has not been reported elsewhere. Given the high prevalence of heroin use, however, this phenomenon may have been overlooked.
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Letter to the Editor
Malignant Syndrome of Two Parkinson Patients due to Withdrawal of Drugs
Neuroleptic malignant syndrome (NMS) is characterised by the impairment of consciousness, high fever, rigidity and autonomic instability. Although originally described in patients taking neuroleptic drugs, this syndrome may also occur in patients with Parkinson’s disease (PD) during withdrawal or reduction of levodopa therapy or other dopaminergic drug therapy and...
Others
Intraocular Avastin (Bevacizumab) for Neovascularisation of the Iris and Neovascular Glaucoma
Neovascularisation of the iris is associated with many ischaemia retinal disorders and elevated levels of the vascular endothelial growth factor is found in patients with neovascular glaucoma. Inhibition of the vascular endothelial growth factor has been shown to prevent retinal ischaemia-associated neovascularisation of the iris.
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Review Article
Evaluating the Optic Nerve and Retinal Nerve Fibre Layer: The Roles of Heidelberg Retina Tomography, Scanning Laser Polarimetry and Optical Coherence Tomography
Glaucoma is an optic neuropathy with characteristic optic nerve damage and visual field loss. With the introduction of the ophthalmoscope by Helmholtz in 1851, ophthalmologists were able to visualise changes of optic nerve head associated with glaucoma. Von Graefe described glaucomatous optic nerve damage as “amaurosis with excavation of...
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...
Others
Radiology: Does It Have a Sell-by Date?
Radiology is riding the crest of a wave. We have superb images, available immediately in all parts of the hospital. Fusion of functional and structural imaging modalities is a reality and molecular imaging is developing fast. Modern radiology increases the effectiveness of treatment, reduces the length of hospital stay...
Original Article
Emergency Department Headache Admissions in an Acute Care Hospital: Why Do They Occur and What Can We Do About It?
Headache is a common presenting complaint in the Emergency Department (ED), accounting for 1% to 4% of all visits.1-3 A significant proportion of these visits would result in hospital admissions and the associated socioeconomic burden. Most of these patients seek pain relief and assurance that their persistent headache is...
Review Article
Hypoxic-ischaemic Brain Injury in Young Infants
In young infants, different types of hypoxic-ischaemic brain injury can occur.1-6 Brain injury can be localised or diffused.2-6 In localised brain injury, arterial or venous periventricular infarctions are encountered. Causes of arterial infarction in the paediatric population are coagulopathies, vasculopathies, polycythaemia, and emboli from cyanotic congenital heart disease.7 In...
Letter to the Editor
Cysticercosis of the Levator Palpebrae Superioris
Cysticercosis cellulosae, the larval form of the pork
tapeworm Taenia solium, causes cysticercosis, in which
humans serve as the intermediate hosts in the parasite
life cycle. Cysticercosis is endemic in developing regions
such as South America, India and China.
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Letter to the Editor
Multimodal Therapeutic Approach in Acute Ischaemic Stroke with Real-time Neurovascular Monitoring
Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for acute ischaemic stroke (IS) within the therapeutic time-window according to the current guidelines. However, significantly low recanalisation rates have been demonstrated with intravenous thrombolysis alone.
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Original Article
Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden
Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from 13.7 million people in 2005 to 64.6 million people in 2050.
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Letter to the Editor
Chewing-induced Facial Dystonia
Dystonia is a movement disorder characterised by sustained muscle contractions, repetitive twisting movements, and abnormal postures of the trunk, neck, face, or arms and legs. Classification of this condition may be based on topography, age at onset, cause, or by the presence of genetic markers.
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Original Article
Intraretinal Segmentation on Fourier Domain Optical Coherence Tomography
Optical coherence tomography (OCT) has become an indispensable tool in the management of retinal and optic nerve diseases as well as in clinical trials. In late 1996, the earliest commercially available OCT had an axial resolution of approximately 17 μm.
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Original Article
Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later
Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom onset, utilisation is limited by delayed arrival of most patients to hospital.
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Editorial
Alzheimer’s disease–The Inexorable Epidemic
Alzheimer's disease (AD) is the most common form of dementia which refers collectively to syndromes of progressive deterioration of memory along with other cognitive domains such as language, praxis and executive function. More than 70 million people worldwide have dementia currently and AD accounts for over 50% of all...
Letter to the Editor
Unusual Cause for Unilateral Headache: A Quadrigeminal Cistern Arachnoid Cyst
Young adults are frequently presented with headaches due to various causes. Atypical facial pain, renamed as persistent idiopathic facial pain (PIFP) is a poorly understood condition with the pain described as a persistent facial pain that does not have the characteristics of cranial neuralgias and which is not attributable...
Letter to the Editor
Intravitreal Bevacizumab for the Treatment of Myopic Choroidal Neovascularisation in an Asian Population
Myopic choroidal neovascularisation (mCNV) is one of the most common causes of permanent central visual loss in patients with high myopia, and its natural history results in the development of chorioretinal atrophy around the regressed mCNV, causing further progressive central visual loss.
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Others
Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report
The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to the development of several intravitreal anti-angiogenic therapeutics. Ranibizumab (Lucentis, Genentech, San Francisco, USA) and pegaptanib (Macugen, OSI/Eyetech Pharmaceuticals, New York, USA) have been FDA-approved for...
Editorial
Genome-wide Association Studies: Promises and Pitfalls
Genetic testing is an important means to confirm the diagnosis of an inheritable disease. For this to be feasible, genes that are associated with the disease need to be identified. Hunting for the genes that cause or are associated with a particular disease is a challenging task.
This article is...
Letter to the Editor
Atypical Presentation of Central Retinal Artery Occlusion
Central retinal artery occlusion (CRAO) typically presents with a retinal “cherry red spot”. In CRAO, infarction of the retinal nerve fibre layer renders the retina opaque. The fovea, where this layer is absent, retains its normal orange red colour due to perfusion from the underlying choroidal vessels, resulting in...
Original Article
Computed Tomography Features in Enteric Fever
Enteric fever is a potentially fatal multi-systemic febrile disease caused by Salmonella. Salmonella are gram-negative, rod-shaped facultative intracellular anaerobic bacteria with more than 2500 serotypes that cause a broad spectrum of clinical manifestations. Clinically, Salmonella can be divided into 2 distinct categories. The first group being the non-typhoidal species...
Editorial
Epilepsy: Looking Beyond Seizures
World Epilepsy Day falls on 26 March 2013. As we observe this important date in Singapore, it is perhaps instructive to take a step back to review epilepsy as a disease, to reflect on progress made, and as yet unresolved challenges.
Epilepsy is a fairly common disease affecting 5 to...
Editorial
Sleep, Public Health and Wellness: The Elephant in the Room
The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of city dwellers can implement
to reduce their risk of accidents, coronary artery disease, diabetes, cancer and all-cause mortality while improving their cognitive performance. Unlike costly supplements...
Letter to the Editor
Bilateral Polychromatic Crystalline Keratopathy as the Initial Manifestation of IgG-Lambda Multiple Myeloma
Dear Editor,
Multiple myeloma is a subgroup of plasma cell dyscrasias with neoplastic proliferation of plasma cells or their precursors. Crystalline keratopathy is a well-recognised but rare ocular manifestation of multiple myeloma. We present a rare case of IgG-lambda multiple myeloma that manifested as polychromatic crystals in the cornea—a presentation...
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.
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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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Letter to the Editor
Single-level Anterior Corpectomy with Fusion versus 2-level Anterior Cervical Decompression with Fusion: A Prospective Controlled Study with 2-year Follow-up Using Cages for Fusion
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive pathology lies anterior to the spinal cord – prolapsed intervertebral discs (PID), ossified posterior longitudinal ligament (OPLL), spondylodiscitis and retropulsion of fractured bony fragments. More...
Letter to the Editor
27-Gauge Vitrectomy for Primary Rhegmatogenous Retinal Detachment: Is it Feasible?
Pars plana vitrectomy (PPV) using the 27-gauge transconjunctival approach is the last frontier of small gauge vitrectomy. Only 1 paper has been published so far describing the use of 27-gauge vitrectomy in a limited number of cases, including epiretinal membranes, idiopathic macular holes, diabetic vitreous haemorrhages, a vitreous biopsy...
Editorial
A Decade of Progress in the Understanding, Prevention and Treatment of Age-related Macular Degeneration in Singapore
The year 2014 had marked the 10th anniversary of the nationwide Age-related Macular Degeneration (AMD) Awareness Week in Singapore.1 This public health campaign, organised annually since 2005, aims to generate awareness and understanding of AMD by promoting the importance of education, early detection, and knowledge of treatment and rehabilitation...
Images in Medicine
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 with no epistaxis. There was no mucopus, nasal obstruction, facial pain or fever. She denies any history of hypertension, trauma, head and neck cancer, anticoagulation...
Letter to the Editor
Chorea precipitated by phototherapy as initial presentation of systemic lupus erythematosus
Dear Editor,
Chorea is a well-recognised albeit rare neuropsychiatric manifestation of systemic lupus erythematosus (SLE). We describe here a case of a 67-year-old woman presenting with chorea, which affected her left lower limb and both upper limbs after phototherapy.
Chorea is an extrapyramidal movement disorder characterised by non-repetitive, abrupt, involuntary jerky...
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
Rare homozygous PRKN exon 8 and 9 deletion in Malay familial early-onset Parkinson’s disease
Little is known about the genetics of Parkinson’s disease (PD) in Southeast Asian populations.1 We extended knowledge of the Southeast Asian monogenic PD landscape by describing a Malaysian Malay family with early-onset PD (EOPD), defined as onset at <50 years of age and a rarely reported homozygous PRKN exon...
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...
Letter to the Editor
Seeing through the eyes of patients with age-related macular degeneration
Age-related macular degeneration (AMD) is a severe ocular disease characterised by progressive deterioration of the macula, the most sensitive central part of the retina. It is the most common cause of irreversible vision loss among individuals aged ≥60 years in developed countries, and accounts for about 6% of all...
Editorial
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 (95% UI 93.2–111 million) and 143 million disability adjusted life years lost (DALYs) (95% UI 133–153 million) in 2019. The impact is even higher in...
Editorial
The Singapore Cerebral Palsy Registry: An important new resource for cerebral palsy research
Cerebral palsy (CP) is a common, lifelong disorder of movement and posture resulting from an insult or maldevelopment of the developing brain. The movement disorders of CP are often accompanied by other associated sensory and cognitive impairments. For the majority of children (about 95% in high income countries), the...
Original Article
Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury
The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range from USD5.9 billion–76.5 billion. Studies performed in the adult population reported that the direct cost of acute rehabilitation had been relatively similar over a 10-year...
Original Article
Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore
Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million by 2025, driven in part by marked economic and epidemiologic transition in recent decades.1 In China, the prevalence of diabetes rose from 1% in 1980...
Letter to the Editor
Neuro-Behçet’s disease presenting as isolated intracranial hypertension
Behçet’s disease (BD) is a chronic multisystem inflammatory disease with a classic triad of painful oral ulcers, genital ulcers and uveitis. Neurological manifestations, though uncommon, can affect both central and peripheral nervous system; producing parenchymal, non-parenchymal and mixed forms of the disease. Ophthalmic findings include ocular inflammation and other...
Review Article
Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review
The World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern on 30 January 2020. To control the outbreak, many countries have implemented nationwide lockdowns and social distancing measures, which have brought challenges to accessibility of healthcare services and continuation of long-term medical care,...
Original Article
Excimer Laser Phototherapeutic Keratectomy for Recurrent Corneal Erosions
Recurrent cornea1 erosion (RCE) syndrome is a commonly encountered clinical condition which may be difficult to treat. Hansen first described it in 1872.
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Original Article
Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks
Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good operating conditions, with the facial nerve block preventing blepharospasm and providing lid akinesia.
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