Editorial
Beyond survival: Addressing gaps in psychosocial support for survivors of childhood cancer
I read with great interest the study conducted by Fong et al. published in this issue of Annals, which evaluated psychological symptoms and health-related quality of life (HRQOL) among a cohort of 143 young adult survivors of childhood cancer in Singapore.1 Almost 1 in 4 survivors demonstrated significant psychological...
Original Article
Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore
Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...
Editorial
Transcranial magnetic stimulation in psychiatry: A Singapore perspective
The use of repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) has not been described in Singapore. Reports on the effectiveness of rTMS in populations outside of Western countries are also limited. Thus, Ye et al.’s study on the naturalistic outcomes of rTMS...
Review Article
Quality of life of children and young adults with Down syndrome from caregivers’ perspective: A systematic review and meta-analysis
Down syndrome (DS), with an incidence of about 1/1000 to 1/1100 live births1 is the most common autosomal trisomy and genetic cause of intellectual disability. Individuals with DS may have multiple comorbidities including congenital cardiac and gastrointestinal anomalies, obesity, sleep disorders, and visual and hearing impairments.2,3 Despite the comorbidities,...
Original Article
Prevalence and risk factors of depression and anxiety in primary care
The global prevalence of individuals living with a mental disorder in 2019 was 970 million, with anxiety and depressive disorders being the most common.1 The Singapore Mental Health Study 2016 showed that the lifetime prevalence of at least one mood, anxiety or alcohol use disorder was 13.9% in the...
Editorial
Illicit drug consumption in Singapore: Where are we in the fight against drugs?
Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be a growing problem worldwide. In 2021, 1 in 17 people aged 15–64 in the world had used a drug in the past 12 months. Notwithstanding...
Editorial
Asian media reporting on suicide: Concerning trends
Asharani et al. present an enlightening study of media influences on suicidality and suicides from multinational data, all within Asia.1 This is important, as knowledge based on media and suicide has been dominated by Western cultures and English and other European languages. Pulling together various independent studies, as Asharani...
Letter to the Editor
Oral antiviral utilisation among older adults with COVID-19 in primary care: A population-wide study during successive Omicron waves in Singapore
Dear Editor,
Studies have repeatedly demonstrated the real-world effectiveness of oral antivirals (OAVs) in preventing hospitalisation and death in patients with mild-to-moderate COVID-19 at high risk for progression to severe COVID-19 when initiated within 5 days of symptom onset, even during waves of Omicron transmission.1 However, there is a need...
Letter to the Editor
Development of immediate and chronic spontaneous urticaria following mRNA COVID-19 vaccination: Tolerability of revaccination and immunological study
Dear Editor,
Coronavirus 2019 (COVID-19) vaccination remains one of the key public health measures against the SARS-CoV-2 infection, significantly reducing illness severity and mortality rates. Urticaria and/or angioedema are cutaneous reactions that have been reported in response to messenger RNA (mRNA) COVID-19 vaccination and potentially affect fitness for revaccination.1...
Letter to the Editor
Perinatal outcomes of pregnancies affected by COVID-19 in Singapore: A cohort study
Pregnant women and infants were not spared from the coronavirus disease 2019 (COVID-19) after it was first identified in December 2019.1,2 In the beginning of the pandemic, a lack of data on transmission risks and outcomes of pregnancies affected by SARS-CoV-2, impacted perinatal clinical decision-making.1,3 We report the perinatal...
Letter to the Editor
Outcomes of COVID-19 infection in patients on dialysis and kidney transplant recipients: A single-centre audit
Dear Editor,
Patients with end-stage kidney disease (ESKD) are at increased risk of adverse outcomes following COVID-19 infection. Their vulnerability stems from multiple factors including kidney failure, comorbid illnesses, close contact in the haemodialysis centre, and transplant immunosuppression. European registry data in the pre-vaccination era report a COVID-19 mortality rate...
Commentary
Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground
In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....
Review Article
Cardiovascular effects of COVID-19 in children
The global coronavirus disease 2019 (COVID-19) pandemic was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While the respiratory system is the primary infectious target of SARS-CoV-2, systemic symptoms are fairly common and organ systems throughout the body can be affected with multisystem organ failure in the...
Original Article
Long COVID prevalence, risk factors and impact of vaccination in the paediatric population: A survey study in Singapore
On 5 May 2023, more than 3 years since the start of the COVID-19 pandemic, the World Health Organization (WHO) declared that COVID-19 no longer constituted a public health emergency. Despite high numbers of children and younger persons (CYPs) having acute COVID-19,1 information on the quality of health and...
Editorial
COVID-19: The virus, vaccine and paediatric heart
The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality around the world. The development of vaccines has cushioned the effect of the virus and thus, provided hope in the fight against the disease.1 Yet, there are still small battles with COVID-19, at the bench and...
Review Article
Consensus statement on Singapore perinatal mental health guidelines on depression and anxiety
Perinatal mental health conditions have been recognised as a key area of focus by the World Health Organization, with the new guide published in September 20221 highlighting the importance of screening, diagnosis and management of perinatal mental health conditions that are integrated into maternal and child health (MCH) services....
Editorial
Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening
In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a...
Editorial
Impact of pre-existing depression on severe COVID-19 outcomes
The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the lives of billions of individuals around the world.1 Public healthcare around the work have mainly focused on the clinical manifestations and treatment of the deadly...
Letter to the Editor
Investigating the stressors and coping mechanisms of students in medical school: A qualitative study
Dear Editor,
Medical school can be a stressful experience for students, with burnout being increasingly common.1 Stressors in medical education include a heavy academic workload, pressure of good academic performance, and comparison with peers of high aptitude.2 Stress can be either beneficial or detrimental to development, depending on personal regulation...
Letter to the Editor
Healthcare worker job burnout, anxiety and depression: A one-year comparison during COVID-19 in Singapore
Dear Editor,
The mental health of our healthcare workforce has never been as scrutinised as it has the last three years since the COVID-19 pandemic. Worldwide, appreciation of healthcare workers (HCWs) as the first line of defence during the pandemic soared, even as studies of HCW mental wellness increased exponentially.1,2...
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...
Original Article
Impact of COVID-19 on mental health and social service provision in Singapore: Learnings from a descriptive mixed-methods study for future resource planning
Coronavirus disease 2019 (COVID-19) was declared a global health emergency by the World Health Organization in January 2020.1 Singapore reported its first case of COVID-19 on 23 January 2020 and the subsequent emergence of clusters led to a string of restrictions to contain the outbreak and protect the health...
Editorial
Self-esteem and positive body image to overcome female sexual dysfunction
Human sexuality is arguably one of the main pillars of health, like nutrition and sleep. Improvements in diagnostic and therapeutic biotechnologies have enabled focus on not only deadly diseases, but also on the quality of life and sexual functions of men and women. Digital media also play a considerable...
Letter to the Editor
Delayed treatment with nirmatrelvir/ritonavir could remain effective in patients with Omicron BA2.2 variant of COVID-19
Dear Editor,
In late February 2022, the Omicron BA.2.2 subvariant drove the outbreak of COVID-19 and rapidly spread through many parts of the world. Omicron-infected individuals aged ≥80 years who are unvaccinated are particularly at high risk of poor outcomes.
COVID-19 vaccines and antiviral therapeutics have protected individuals most at risk...
Letter to the Editor
Rash characteristics of paediatric patients with COVID-19 in Singapore
Dear Editor,
Children with COVID-19 infection can present with a variable spectrum of clinical manifestations, and sometimes mucocutaneous manifestations can be the only manifestation of COVID-19 infection in children.1,2,3 We report 4 cases of paediatric patients who had COVID-19 with mucocutaneous involvement, admitted to a tertiary children’s hospital in Singapore....
Original Article
Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome
A spectrum of immune dysregulation has been described following SARS-CoV-2 infections—from the cytokine storm in the acute phase, to hyperinflammatory syndromes that occur after the resolution of the initial infection.1 Multisystem inflammatory syndrome (MIS) was first reported in children in April 2020 as a hyperinflammatory syndrome with features similar...
Original Article
Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients
The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with solid and haematological malignancies to SARS-CoV-2 infections.1,2 Global efforts to combat SARS-CoV-2 led to the unprecedented rapid development of multiple vaccines, with reported efficacies of...
Editorial
Early COVID-19 booster is beneficial in cancer patients
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in Wuhan, China, on 31 December 20191 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare systems around the world, and rendered...
Letter to the Editor
A strategy to make COVID-19 vaccination more accessible to the elderly
Dear Editor,
Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services.
While the...
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....
Original Article
Multisystem inflammatory syndrome in children in Singapore
While children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulting in coronavirus disease 2019 (COVID-19) have milder manifestations compared to adults,1,2 a rare multisystem inflammatory syndrome leading to multiorgan failure and shock (multisystem inflammatory syndrome in children ) has been recognised to affect children with exposure to...
Editorial
Multisystem inflammatory syndrome in children: A unique manifestation of COVID-19
During the coronavirus disease 2019 (COVID-19) pandemic, children have been relatively spared from the severe symptomatic infection affecting adults, particularly the elderly and those with comorbidities. One of the most challenging aspects of paediatric SARS-CoV-2 infection has been the discovery of a unique late manifestation of infection characterised by...
Review Article
Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations
Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into an ongoing global pandemic.2 In May...
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,...
Editorial
The impact of COVID-19 pandemic on loss and grief
As of 17 October 2022, the COVID-19 pandemic has claimed more than 6.5 million lives globally, with 1,639 deaths reported in Singapore.1 With numerous countries imposing measures such as lockdowns and social distancing measures that isolate individuals, there has been a steady increase in a variety of mental disorders...
Letter to the Editor
Prevalence of perceived weight-based stigmatisation in a multiethnic Asian population
Dear Editor,
People with obesity contend with obesity-related stigmas, in addition to health complications.1 In contrast to the West, literature documenting the prevalence of such stigmas in Asia is sparse. We report the prevalence of perceived weight-based stigmatisation in Singapore.
An anonymised questionnaire was administered to 101 consecutive patients presenting to...
Letter to the Editor
Employers’ attitudes towards employing people with mental health conditions
Dear Editor,
The advantages of employment for young people with mental health conditions (PMHC) are well known and documented,1 but many remain unemployed. Besides offering monetary benefits, employment provides a better self and social identity, helps the person gain a sense of personal achievement, and enhances mental well-being. Being unemployed...
Letter to the Editor
Teaching and learning during the COVID-19 pandemic: Perspectives of medical students in Singapore
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has resulted in many changes to medical education, including the site and mode of teaching, conducting of examinations and a shift towards prioritising the mastery of clinical skills relevant to infection control. Hence, Ng et al.’s suggestions on how to maximise learning...
Letter to the Editor
Screening for somatisation in an Asian children’s hospital emergency setting
Dear Editor,
In recent years, self-harm is the leading cause of morbidity and mortality among adolescents in Singapore.1,2 This is just the tip of the iceberg as youths with undiagnosed mental health disorders often present to the healthcare system with non-psychiatric symptoms.3 These psychosomatic symptoms do not have an organic...
Original Article
Prevalence of burnout among healthcare professionals in Singapore
Burnout was first described in 1974 by Herbert Freudenberger, where he discussed the concept based on physical signs, behavioural indicators, judgment, emotional factors, and the preventive measures to avoid burnout.1 In 2019, the World Health Organization defined burnout as an occupational phenomenon in the International Classification of Diseases 11th...
Editorial
Bridging electroconvulsive therapy in schizophrenia with cognition and quality of life
Schizophrenia is one of the most debilitating severe mental illnesses with significant impact,1 irrespective of culture or socioeconomic class.2 Over the decades, antipsychotic medication has been the mainstay of treatment for patients with schizophrenia. Nevertheless, about 25% of patients do not respond to first-line antipsychotic medication, with more than...
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...
Original Article
Epidemiological trends and outcomes of children with aural foreign bodies in Singapore
Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to their inquisitive minds and experimental nature.1 Aetiologies for aural FBs include accidental or intentional insertion of FBs into body orifices, ear irritation caused by rhinitis...
Original Article
Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore
Within 3 weeks of the World Health Organization declaring the COVID-19 pandemic on 11 March 2020, the Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) developed a set of nutrition guidelines that addresses issues on nutrition assessment; timing and feeding route; caloric...
Editorial
Challenges and considerations in delivering nutritional therapy in the ICU during COVID-19 pandemic
Coronavirus disease 2019 (COVID-19) has created unprecedented challenges for healthcare workers in Singapore and across the world. Providing clinical nutrition and metabolic care to patients with COVID-19 has been highly challenging. In this issue of the Annals, Lew et al.1 reported the results of a multicentre retrospective observational study...
Letter to the Editor
BNT162B2 COVID-19 mRNA vaccination did not promote substantial anti-syncytin-1 antibody production nor mRNA transfer to breast milk in an exploratory pilot study
Dear Editor,
Vaccine hesitancy still threatens global efforts to end the COVID-19 pandemic caused by SARS-CoV-2 and its emerging variants. Social media-driven “conspiracy theories” cast doubts on vaccine safety for reproductive health,1 including concerns that vaccine-induced SARS-CoV-2-neutralising antibodies (NAb) cross-react with human syncytin-1—a protein involved in gamete fertilisation and...
Commentary
COVID-19 vaccination acceptance of healthcare workers in Singapore
The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end April 2022.1 With the introduction of vaccines that are effective in reducing severe COVID-19 illnesses and deaths, Singapore had since pivoted from a COVID-19 elimination...
Original Article
Prevalence and correlates of psychological distress and coronavirus anxiety among hospital essential services workers in Singapore
The Coronavirus Disease 2019 (COVID-19) has affected almost all geographies in the world since 2020. Many countries have imposed strict isolation measures to contain the spread of this disease. While the majority of the population has been working from home, essential workers continue manning the frontlines, facing risks such...
Letter to the Editor
Evaluation of a health screening protocol for recovered COVID-19 patients before “return-to-play” and strenuous physical activity
Dear Editor,
We conducted a prospective, single-centre cohort study to develop guidance for military personnel returning to strenuous activities following SARS-CoV-2 infection. The patients underwent a clinical review followed by a protocol to screen for cardiac, respiratory, haematological, endocrine/renal and neurological complications after recovery from infection.
Both the study and screening...
Review Article
Use of Atypical Neuroleptics in a State Mental Institute
Schizophrenia is the most severe of all mental disorders and affects about 1% of the population. The main disturbances of schizophrenia comprise positive symptoms, negative symptoms and disorganisation.
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Review Article
Somatisation among Asian Refugees and Immigrants as a Culturally-shaped Illness Behaviour
During the past two decades, close to one million Southeast Asian refugees of war have resettled in North America. Together with the already significant Asian immigrant population, they represent one of the fastest growing minority groups in the United States.
This article is available only as a PDF. Please click...
Others
How the Mental Hospital was Renamed Woodbridge Hospital in 1951
In the 1920s the government embarked on an ambitious programme to build hospitals, staffed largely by graduates of the King Edward College of Medicine. The “Mental Hospital”, commissioned and built by the British in 1928, was sited at Yio Chu Kang and spread out over 80 hectares of sprawling...
Others
Selective Serotonin Reuptake Inhibitor Discontinuation Symptoms
Selective serotonin reuptake inhibitors (SSRIs) are a new class of antidepressants which are effective, better tolerated with less side effects and more specific in receptor activity than the older tricyclic antidepressants. However, like tricyclic antidepressants and other groups of antidepressants such as the monoamine oxidase inhibitors (MAOIs) and the...
Review Article
Under-diagnosed Psychiatric Syndrome II: Pathologic Skin Picking
Pathologic skin picking may be defined as the habitual picking of skin lesions, which when chronic and extensive, can lead to significant distress, dysfunction and disfigurement. The underlying skin lesions may range from benign ones, e.g. barely noticeable irregularities of the skin, to more severe ones, e.g. acne, eczema,...
Original Article
A Clinical Study of Seven Cases of Trichotillomania in Singapore
Trichotillomania was first described by a French dermatologist Hallopeau (1889) of a young man who pulled out his hair in tufts. The word trichotillomania is derived from the Greek thrix which means hair; tillein, to pull; and mania, madness or frenzy.
This article is available only as a PDF. Please...
Review Article
Under-diagnosed Psychiatric Syndrome I: Trichotillomania
Trichotillomania (TTM) is a chronic psychiatric condition characterised by uncontrollable, self-inflicted, hair pulling, resulting in noticeable hair loss. First described by Hallopeau a century ago, it was previously regarded as an obscure condition.
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Others
Psychological Trauma, Physical Health and Somatisation
Trauma does not respect persons or culture. While Singapore is fortunate to have been spared large-scale disaster and war for decades, it has nevertheless had its share of traumatic incidents.
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Others
Medical Leave Granted to Psychiatric Inpatients—A One-year Retrospective Review
The Department of Psychological Medicine, National University Hospital (NUH) has a 26-bedded inpatient unit. This study retrospectively examines the medical leave granted to all admitted patients over a one-year period in 1998.
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Original Article
Mental Health Literacy in Singapore: A Comparative Survey of Psychiatrists and Primary Health Professionals
The management of mental health disorders within a nation requires a system of care extending from the primary health care setting to tertiary and specialist care settings. To that end, professional knowledge of the recognition, management and prevention of mental disorders is critical.
This article is available only as a...
Others
Identification of Genes for Schizophrenia Susceptibility
Schizophrenia, described as “the most human of all diseases,” affects about 0.5 % to 1% of the population and typically develops in the early 20s in men and the late 20s to early 30s in women. It is one of the most severe, if not the most severe, of...
Others
Muscle Dysmorphia in a Young Chinese Male
In 1891, Morselli described “dysmorphophobia” in 78 patients who were severely miserable, preoccupied and distressed by perceived deformities. The word “dysmorphia” in Greek means ugly. Body dysmorphic disorder appeared in DSM-III in 1987.
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Original Article
Contrasting Clozapine Prescribing Patterns in the East and West?
Schizophrenia is a severe mental illness which causes enormous suffering, impaired social and occupational functioning, as well as higher mortality among the sufferers. The mainstay of treatment is neuroleptics which are largely effective for certain symptoms of this illness.
This article is available only as a PDF. Please click on...
Letter to the Editor
Graves’ disease after COVID-19 vaccination
Dear Editor,
Case 1 was a 41-year-old man with a history of primary hyperthyroidism. At the time of diagnosis, thyroglobulin antibodies were elevated although no thyrotropin receptor antibodies (TRAB) were available. The patient was treated with carbimazole for 20 months. At the time of cessation of carbimazole in May 2020,...
Letter to the Editor
Impact of COVID-19 infections among kidney transplant recipients
Dear Editor,
More than 2 years since the start of the COVID-19 pandemic, cases continue to climb despite global efforts at viral control. This is largely driven by the emergence of viral variants. In the later part of 2021, the Delta variant was the predominant variant circulating globally, and was...
Letter to the Editor
Paediatric living-donor liver and kidney transplantation during COVID-19
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has impacted global healthcare including paediatric solid organ transplantation (SOT). We report our experience of resuming paediatric living-donor SOT during COVID-19, which took into account safety considerations for living donors, paediatric recipients and the transplant healthcare team. The US Centers for Disease...
Letter to the Editor
The evolution of severity of paediatric COVID-19 in Singapore: Vertical transmission and multisystem inflammatory syndrome in children
Dear Editor,
Coronavirus disease 2019 (COVID-19) arrived in Singapore in January 2020 as imported cases, followed by local transmission predominantly involving dormitories, with later spread within the wider community. Children still represent the minority of cases in Singapore, with around 8,000 paediatric cases as of 6 November 2021 out of...
Original Article
Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting
The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality worldwide. The development of mRNA vaccines has heralded much hope in the fight against the disease. The safety and efficacy of these vaccines have been well demonstrated in clinical trials,1,2 and also against severe disease from...
Original Article
The moderating effect of employment status on the relationship between lifetime major depressive disorder and positive mental health
Studies across the world have reported a high prevalence of mental disorders,1-3 highlighting that mental disorders remain one of the major causes of “non-fatal burden”.4 In particular, major depressive disorder (MDD) has been identified as a highly prevailing mental disorder and the leading cause of disability worldwide. More than...
Editorial
The relationship between major depressive disorder and employment status
Major depressive disorder is associated with executive dysfunction that includes impairment in problem-solving and decision-making,1 as well as with occupational impairment.2 One of the challenges during the COVID-19 pandemic has been to maintain employment status. It has been reported that employment status is associated with measures of quality of...
Review Article
Cardiac Effects of Psychotropic Drugs
The incidence of mortality is higher among psychiatric patients than among the general population and the cause of which may be the psychiatric disorder itself or other related factors like life-style and medications. Reports of sudden deaths among patients taking psychotropic drugs have raised concerns that some of the...
Original Article
Men Who Commit Rape in Singapore
Of all the sexual crimes committed, rape stands out as one of the most serious forms of sexual assault, yet there is a general lack of clinical information on convicted rapists in Singapore and elsewhere. We believe this to be the first such study in Singapore.
This article is available...
Original Article
Psychiatric Illness, Personality Traits and the Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder seen by gastroenterologists and has been found to account for 50% of referrals to a Gastroenterology clinic. It has an estimated prevalence of between 15% and 25% in the non-patient population.
This article is available only as a PDF....
Review Article
Behavioural Disorders in Childhood: A Singapore Perspective
A review of five Western epidemiological studies of children aged 6 to 11 years revealed an average prevalence of 25% for psychiatric disorder (ranging from 12.4% to 48%). Asian studies show a similar prevalence range, with a 6.1% prevalence in a Malaysian study of 1- to 15-year-old children, a...
Original Article
The Views of Mental Health Professionals Towards Psychotherapy—A Singapore Survey
There is a trend in Asia towards a greater application of psychotherapeutic approaches in multidisciplinary settings to emotional and behavioural disturbances. The inaugural issue of Asian Psychologist announced landmarks in the education and training of clinical psychology in two major Asian communities.
This article is available only as a PDF....
Original Article
Pilot Study to Assess the Viability of a Rape Trauma Syndrome Questionnaire
In their 1974 study, Burgess and Holmstrom1 interviewed a heterogeneous sample of 92 adult females admitted between 1972 and 1973 to the emergency ward of the Boston City Hospital with the presenting complaint of being raped. From the analysis of the responses of these women, the authors identified “an...
Original Article
Thyroid Dysfunction in Chronic Schizophrenia Within a State Psychiatric Hospital
Thyroid dysfunction can give rise to various psychiatric symptoms. While there is a persistent interest in the role of thyroid axis in affective disorders, there is limited data on the interaction of thyroid dysfunction with psychotic disorders such as schizophrenia.
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Commentary
Mental Disorders and Public Safety of the Community at Large—Does the Tarasoff Principle Apply in Singapore?
In the course of their work, psychiatrists treat patients who, because of their mental disorders, may pose a danger to themselves and/or to others. What is the duty of the psychiatrist treating this patient?
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Letter to the Editor
Preventing Youth Suicide
This letter is in reference to Dr Ung’s article published in the Annals which investigated youth suicide and parasuicide in Singapore. The study of suicide has a very respectful tradition as many studies have led to the recognition of cultural and environmental risk factors.
This article is available only as...
Review Article
Eating Disorders in Singapore: A Review
Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms of shape/weight dissatisfaction and eating abnormalities. Anorexia nervosa is characterised by significant self-induced weight loss secondary to fear of fatness, amenorrhoea (cessation of menstruation for...
Review Article
Youth Suicide and Parasuicide in Singapore
The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or herself in the knowledge, or expectation, of its fatal outcome. Parasuicide or attempted suicide is distinguished from suicide by the non-fatal outcome.
This article is available...
Original Article
Five-Year Review of Adolescent Mental Health Usage in Singapore
The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in almost every area, including epidemiology, classification and treatment.
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Letter to the Editor
Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study
Dear Editor,
The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response.
We present our qualitative study, guided by...
Letter to the Editor
Pressure injuries related to N95 respirator masks among healthcare workers during the COVID-19 pandemic
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic outbreak, which started in 2019, has affected millions of patients globally.1 Singapore is not spared, being one of the first countries to import COVID-19 cases from China.2 Nosocomial transmission of SARS-CoV-2 had been reported in various cohort studies of healthcare workers (HCWs),...
Original Article
Post-SARS Psychological Morbidity and Stigma Among General Practitioners and Traditional Chinese Medicine Practitioners in Singapore
Severe acute respiratory syndrome (SARS) is the first severe and readily transmissible new disease to emerge in the 21st century (WHO). The countries most severely affected by this epidemic were Hong Kong, China, Taiwan, Canada and Singapore.
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Review Article
A Risk Reduction Approach for Schizophrenia: The Early Psychosis Intervention Programme
Schizophrenia is a serious mental disorder with a profound impact on patients, their caregivers and society. The Global Burden of Disease lists schizophrenia among the top 10 contributors to health burden and disability around the world.
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Original Article
Interleukin-2 Levels in Chronic Schizophrenia Patients
Autoimmune processes have been implicated in the pathogenesis of schizophrenia. Several pieces of indirect evidence point towards a role of autoimmune processes in at least some cases of schizophrenia.
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Others
Abuse of Prescription Buprenorphine, Regulatory Controls and the Role of the Primary Physician
Buprenorphine is an opiate partial agonist that has been used for pain management, and in the past few years has been approved for the treatment of opioid dependence in Singapore and other countries. Buprenorphine is available in primary care clinics and can be prescribed by all licensed physicians who...
Original Article
Reducing Polypharmacy Through the Introduction of a Treatment Algorithm: Use of a Treatment Algorithm on the Impact on Polypharmacy
The use of 2 or more antipsychotic medications (polypharmacy) for an episode of psychosis is pervasive despite the lack of evidence-based data. It is also associated with higher daily dosing, more frequent use of adjunctive medications such as anticholinergic agents, higher rate of adverse effects and under-utilisation of atypical...
Original Article
Socio-demographic Profile and Help-seeking Behaviour of Buprenorphine Abusers in Singapore
Opiate dependence is a major health and social concern in many countries across the world. The burden of disease is considerable, with surveys indicating that up to 2% of the population had used opiates for non-medicinal reasons.
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Editorial
Medicalising the Treatment of Opioid Dependence
Traditionally the treatment of opioid dependence in Singapore has not been viewed as a public health problem, but rather as a social problem that necessitated custodial and other punitive approaches. The turning point came in 1996, when, after a pilot programme in the Prisons Department, naltrexone was introduced as...
Others
“The one” Annoying Patient
Schizophrenia – a mind torn asunder – is a difficult illness to live with, both for the patient as well as for the caregiver; thus, it is not an uncommon sight to see the authorities bring such patients to our psychiatric practice, whether abandoned or simply lost. What was...
Review Article
The Risk of Suicidality with Selective Serotonin Reuptake Inhibitors
The first antidepressants were discovered 50 years ago by chance. Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) dominated the treatment of depression from the late 1950s until the late 1980s, when selective serotonin reuptake inhibitors (SSRIs) were introduced.
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Original Article
Clinical and Social Correlates of Duration of Untreated Psychosis in First-episode Psychosis Patients
First-episode studies of schizophrenia have reported that the longer the duration of untreated psychosis (DUP), the poorer the response to antipsychotic medication and treatment outcome. The findings of these studies have led to the assertion that by reducing DUP, treatment outcome for schizophrenia and other related psychosis might be...
Commentary
The Media and Suicide
Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020. This is equal to the burden due to wars and homicide, roughly twice the burden of diabetes and equal to the...
Commentary
Performance Measures for Mental Healthcare in Singapore
Mental disorders are prevalent worldwide and while they are disabling and costly, they have not received that amount of attention and resources needed. A recent survey of low-income and middle-income countries (as per World Bank classification) revealed that government spending on mental health is much lower than what is...
Original Article
Mental Health Professionals’ Perceived Barriers and Benefits, and Personal Concerns in Relation to Psychiatric Research
Epidemiological research has shown that mental disorders can result in considerable healthcare and other opportunity costs. There are some reports that have highlighted the negligence of mental health and the lack of recognition of the importance of mental disorders.
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Original Article
Pathways to Specialist Care in an Insomnia Clinic at a Psychiatric Hospital: A Comparative Analysis of Two Periods
The complaint of insomnia is common and patients generally either self-medicate and/or consult primary healthcare providers. Referrals to a specialist for further management largely depends on the initial assessments and findings, the presence of comorbidity and/or difficulties in treating the underlying problems.
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Editorial
Suicide
The word suicide is derived from the Latin word suicidium, itself derived from sui (of oneself) and cidium (a killing; caedere = to kill. The word appears to have been first used around 1651, although the self-killing act itself is recorded in antiquity.
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Review Article
Behavioural Sleep Disorders in Children and Adolescents
Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are often overlooked by healthcare practitioners.
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Review Article
Hypnotherapy for Sleep Disorders
Derived from ‘Hypnos’, the Greek God of sleep, the word hypnosis literally means sleep. Ironically, hypnosis is not a form of sleep but a state of increased concentration and awareness.
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Original Article
Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most current version of the Diagnostic and Statistical Manual of Diseases (DSM), fourth edition, has 2 lists of behavioural symptoms grouped under “inattentive” and “hyperactive-impulsive” symptoms,...
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...
Commentary
Providing Integrated Mental Health Services in the Singapore Primary Care Setting – the General Practitioner Psychiatric Programme Experience
Mental disorders are recognised as a major public health problem worldwide, and the management of mental health problems places an enormous burden on health services.
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Original Article
Prevalence and Correlates of Excessive Internet Use among Youth in Singapore
There has been an explosive growth of Internet usage worldwide and this is expected to continue with its use becoming an integral part of everyday life. The Internet has become more accessible in homes, schools, colleges, libraries and Internet cafes; access is further aided with the increasing affordability of...
Commentary
The personal recovery movement in Singapore – past, present and future
Early psychiatric conceptions of successful mental health recovery traditionally focused on reducing or eradicating symptoms.1 The personal recovery movement of the early 1990s in the US prioritised a more holistic and consumer-driven understanding of recovery.2 This paradigm shift emphasises that recovery is best defined by people with lived experiences,...
Editorial
The Annals: Welcoming the future of Medicine
What started as a cluster of cases of pneumonia in Wuhan, the capital city of China’s Hubei Province, in December 2019, has since evolved into a pandemic with devastating consequences to health and livelihoods.1 Hardly a day passes without the term COVID-19, the disease caused by the severe acute...
Original Article
Impact of Depression on Health Related Quality of Life in Patients with Diabetes
Diabetes Mellitus (DM) is a serious chronic illness that imposes significant morbidity and mortality and has a major impact on the quality of life of the individuals suffering from this illness. Singapore, a multi-ethnic country in Southeast Asia, with Chinese, Malay and Indian as the three main ethnic groups,...
Letter to the Editor
Management of a Patient with Schizophrenia and Underlying Pituitary Macroadenoma
Hyperprolactinemia was found to be prevalent in a multi-centred study of 402 patients with schizophrenia, schizoaffective disorder and schizophreniform disorder treated with conventional antipsychotics and Risperidone. Antipsychotics inhibit the dopamine receptors and induce hyperprolactinemia via the tubulo-infundibular pathway, with subsequent downstream effects on multiple systems.
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Original Article
Psychological Symptoms in People Presenting for Weight Management
Multiple factors contribute to the genesis and maintenance of obesity which is a difficult condition to treat and weight loss is often not maintained. The psychological problems found in obese patients have recently received increasing attention.
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Editorial
Preventive Psychiatry
In medicine, measures that save the most lives and improved the quality of life of millions have largely been public health measures that in most instances, had been preventive measures. The most obvious examples are the infectious diseases which were – to use the cliché – the scourge of...
Original Article
Monthly Take-Home Methadone Maintenance Regime for Elderly Opium-Dependent Users in Singapore
The misuse of illicit opiates remains a global problem, placing a heavy burden on society. Literature on the effectiveness of opiate substitution pharmacotherapies in reducing consumption of illegal drug use, criminal activities, injecting and sharing behaviours, the spread of blood-borne diseases and mortality, now spans several decades and countries.
This...
Review Article
Panic Attack and its Correlation with Acute Coronary Syndrome – More Than Just a Diagnosis of Exclusion
Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for a physician not to consider it as a possible diagnosis in any patient presenting with acute symptoms of chest tightness or discomfort, palpitations, dyspnoea, diaphoresis,...
Letter to the Editor
Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the light of some of the points raised such as frequent comorbidities that occur with ADHD as is the case of Autistic disorder and other conditions...
Letter to the Editor
Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?
I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than curing for attention deficit hyperactivity disorder (ADHD) is taking place. There are some evidence-based points that should be noted.
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Original Article
Socio-demographic Profile and Psychiatric Comorbidity of Subjects with Pathological Gambling
Gambling has been defined as a wager of any type of item or possession of value upon a game or event of uncertain outcome in which chance, of a variable degree, determines the outcome. The failure to resist the impulse to gamble despite disruption to personal, family and vocational...
Original Article
Weight Gain in Asian Patients on Second-generation Antipsychotics
Weight gain is a serious side-effect with antipsychotic medication use. There is increasing evidence that with certain second-generation antipsychotics (SGA) weight gain liability is greater than with the high potency first-generation antipsychotics (FGA).
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Original Article
The Health-Related Quality of Life of Junior Doctors
It is widely reported that junior doctors experience a large amount of work-related stress and fatigue. This has detrimental effects both on the well-being of the junior physicians and the health and well-being of the patients that they are treating. Junior doctors, especially those undergoing traineeship, have shown high...
Original Article
Where do People with Mental Disorders in Singapore go to for Help?
Not only are mental disorders prevalent in any country, it is also common that many of those with mental disorders are neither seeking nor receiving help. This is the case even in developed countries: of the 31% of the US population affected by at least one mental illness, 67%...
Letter to the Editor
Plasma IP-10 could identify early lung disease in severe COVID-19 patients
Dear Editor,
The global pandemic of SARS-Coronavirus-2 (SARS-CoV-2) infection has imposed tremendous strain on healthcare resources worldwide, as a significant proportion of patients require intensive care. Although the majority have mild infections, up to 20% are estimated to become critically ill from severe disease.1 Age, concurrent comorbidities, more severe...
Original Article
Effectiveness of Assertive Community Management in Singapore
In Asia, various community programmes have been adopted and studied in several countries in an effort to promote de-institutionalisation, community psychiatric services and reduce relapses or readmission rates. In Manila, Philippines, the National Mental Hospital has successfully reduced hospitalisation by 70% after introducing the Acute Crisis Intervention Services (ACIS),...
Original Article
Adverse reactions and safety profile of the mRNA COVID-19 vaccines among Asian military personnel
The COVID-19 pandemic has led to significant changes in the way of life for many around the world.1,2 After more than a year, many countries continue to struggle with rising infection rates, and economic and social impact of the pandemic.3-5 COVID-19 vaccines have become available since the end of...
Original Article
Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study
Since the first case of coronavirus disease 2019 (COVID-19) was reported in China in late December 2019, the pandemic has spread throughout the world, with the World Health Organization (WHO) reporting over 206 million cases and over 4 million deaths globally as of 15 August 2021.1 To contain the...
Original Article
Height and Mental Health and Health Utility Among Ethnic Chinese in a Polyclinic Sample in Singapore
Several studies have found adult height predictive of mental health and emotional well-being. A study of Swedish conscripts demonstrated an inverse association between
height at age 18 to 19 and suicide mortality over 15 years of follow-up. Similarly, a study of Filipinos demonstrated an inverse association between height at age...
Editorial
You Are Worth More Than What You Weigh: Preventing Eating Disorders
Times have changed. Maternal mortality rates at the start of the 1900s were around 1 in 100 live births in the best maternity institutions. This has declined by around 3 orders
of magnitude in the last 100 years to about 3 in 100,000 live births in places like Singapore. Perinatal...
Original Article
An Analysis of Blinding Success in a Randomised Controlled Trial of Fish Oil Omega-3 Fatty Acids
There has been growing interest in the use of dietary supplementation to treat psychiatric disorders. In particular, supplementation of omega-3 fatty acids has been researched as a potential means of preventing and managing psychopathology. These fatty acids are ingested through dietary sources (e.g. fish), with inadequate concentrations implicated in...
Commentary
Schizophrenia as a Lifelong Illness: Implications for Care
The management of schizophrenia has advanced considerably since the term was first coined in 1911, with Kraepelin’s early pessimism tempered by more recent evidence examining outcome. The discovery of antipsychotics represented a major breakthrough in the treatment of schizophrenia, while more recently we have witnessed promising initiatives such as...
Commentary
Integrating mental healthcare in primary care in Singapore
Management of mental health conditions can be both resource-intensive and costly. The rigour of obtaining appointments and the long waiting time at tertiary hospitals, coupled with the need to obtain leave from work form a significant financial and logistical burden on patients for the treatment of mental health conditions....
Original Article
Safety and side effect profile of Pfizer-BioNTech COVID-19 vaccination among healthcare workers: A tertiary hospital experience in Singapore
The newly emerged coronavirus virus 2019 (COVID-19) disease was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on 30 January 2020, and subsequently designated a pandemic on 11 March 2020.1 Globally, over 209 million cases have been reported, with more than 4.4 million...
Commentary
Prehabilitation and Its Role in Geriatric Surgery
The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As the life expectancy of the population has improved significantly in the past few decades, a substantial portion of this rapidly ageing population will place a...
Letter to the Editor
The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown
Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties in the care of patients with communicable diseases like COVID-19. PPE is also worn by ancillary staff such as security personnel, porters, medical transport crew...
Editorial
Seasonal haze: Knowledge gaps and risk perception behaviours
The seasonal haze in Southeast Asia has been a recurrent concern whenever we enter the southwest monsoon season (June–September). This phenomenon, caused by agricultural fires, has vast effects on multiple countries in the region.
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Commentary
ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series
Coronavirus disease 2019 (COVID-19) has been associated with thromboembolic phenomenon in the early phase of disease. Growing evidence suggests a hypercoagulable state as well as abnormal platelet activation, impaired fibrinolysis, and endothelial dysfunction in COVID-19 patients, resulting in thrombosis. The lungs are thought to be the epicentre of thrombosis,...
Original Article
Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study
Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health...
Original Article
Dietary intake of persons with depressive and psychotic disorders in Singapore
Unhealthy diet is a modifiable risk factor in many health conditions, including mental disorders. Nutritional psychiatry is an emerging field that examines the role of diet and nutrition in mental health. Since its beginnings in the 2000s, a notable change in the field was a switch in focus from...
Editorial
Nutritional psychiatry: The next frontier in mental health treatment
The World Health Organization has envisioned for every human being’s fundamental right to be able to enjoy the highest attainable standard of health, even in the presence of disease or infirmary. Singaporeans’ average life expectancy is projected to reach 85.4 years by the year 2040 and the burden of...
Letter to the Editor
Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 Panel for early diagnosis of COVID-19
An effective response to the SARS-CoV-2 that has caused the coronavirus disease 2019 (COVID-19) pandemic1 requires rapid and accurate diagnostic testing. We evaluate the QIAstat-Dx® Respiratory SARS-CoV-2 Panel—a multiplex real-time polymerase chain reaction (RT-PCR) assay—against an E-gene RT-PCR assay2 that successfully identified cases at the start of the COVID-19...
Letter to the Editor
Antibiotic stewardship algorithm to rationalise antibiotic use among hospitalised COVID-19 patients
As presentation of COVID-19 may mimic that of bacterial pneumonia, antibiotics are often prescribed. Concerns regarding overuse of antibiotics are now being raised particularly as we learn of the low rates of bacterial and fungal co-infection. To limit unnecessary antimicrobial exposure, we posit an algorithm for antibiotic guidance.
This article...
Letter to the Editor
Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore
The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during COVID-19-related lockdowns. Notably, there have been reports that patients with acute emergencies such as strokes and heart attacks are either not seeking treatment, or are...
Letter to the Editor
Radiological changes on chest CT following COVID-19 infection
COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution computed tomography (HRCT) features of the lungs during the onset of COVID-19; however, few studies have described the radiological changes and outcome of residual lesions...
Letter to the Editor
Stress and resilience of paediatric healthcare workers during COVID-19
The coronavirus disease 2019 (COVID-19) pandemic has caused multiple changes in healthcare systems as governments implement measures to boost acute services. Healthcare workers (HCWs) across different specialties are reported to have decreased quality of life and increased stress, further aggravated during the pandemic.
This article is available only as a...
Review Article
Severe COVID-19 and coagulopathy: A systematic review and meta-analysis
Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications. Our understanding of the pathophysiology of the disease process is still evolving. As part of the host response to viraemia, it has been postulated that...
Editorial
Estimating the impact of COVID-19-induced coagulopathy
The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...
Letter to the Editor
Impact of COVID-19 on mental health and occupational burnout in a surgical unit in Singapore
In this study, we assessed the impact of COVID-19 on the psychological well-being and burnout among staff who manage critically ill general surgery and trauma patients as part of the Acute Care Surgery (ACS) service at the Singapore General Hospital, Singapore. The ACS team may be exposed to COVID-19...
Letter to the Editor
A resuscitation course designed for a psychiatric hospital
It is challenging to maintain the resuscitation skills of doctors in a psychiatric hospital. Our study describes a resuscitation course designed specifically for the Institute of Mental Health in Singapore to address competency gaps, which proved to be relevant and helpful to the trainees.
This article is available only as...
Commentary
Optimum early orthopaedic surgery in COVID-19 patients
Multiple guidelines have been established regarding the management of COVID-19 patients. However, there remains a paucity regarding specific guidelines on the optimal timing for surgeries in COVID-19 patients requiring early orthopaedic surgery. This paper aims to provide evidence-based recommendations regarding the timing to proceed with early orthopaedic surgeries in...
Original Article
Vulnerability to rumours during the COVID-19 pandemic in Singapore
The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found to be elevated among healthcare workers and the general population. Others have reported a higher incidence of stress-related symptoms or post-traumatic stress disorder. These findings...
Original Article
Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore
In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community transmission began early in the outbreak, the government started emphasising the role that individuals had to play by adopting health-preventive behaviours.
This article is available only...
Original Article
Psychosocial impact of the COVID-19 pandemic on paediatric healthcare workers
Early studies done in China during this COVID-19 pandemic have shown considerable mental health impact on healthcare workers (HCWs), especially those working on the frontline. HCWs exposed directly to COVID-19 may be affected not only by fears of contracting the virus and spreading it to their loved ones, but...
Editorial
The impact of COVID-19 pandemic on global mental health: From the general public to healthcare workers
The COVID-19 pandemic began in late 2019 and was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. To decrease the spread of the virus and demand on the healthcare system, governments globally executed multiple public health measures including lockdown, social distancing, significant closure of...
Review Article
Living with COVID-19: The road ahead
The COVID-19 pandemic has made an unprecedented impact on global morbidity, mortality and healthcare measures to contain the infection.1 Multiple waves of infections in 2020 and 2021 have resulted in significant disruptions to healthcare, economies and societies globally, with few countries able to avoid major epidemics. In the initial...
Editorial
The Novel Coronavirus (SARS-CoV-2) Pandemic
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and was reported to the World Health Organization (WHO) on 31 December 2019. An outbreak of unknown aetiology was suspected because many early cases were linked...
Review Article
Precautions When Providing Dental Care During Coronavirus Disease 2019 (COVID-19) Pandemic
Coronavirus disease 2019 (COVID-19) is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported to the World Health Organization (WHO) as pneumonia of unknown aetiology in the Chinese city of Wuhan on 31 December 2019. Since then, COVID-19 has spread across the globe and...
Commentary
Autism Spectrum Disorder and COVID-19: Helping Caregivers Navigate the Pandemic
The coronavirus disease 2019 (COVID-19) pandemic has disrupted societies globally. As of 11 May 2020, 53 children have been infected with COVID-19 in Singapore (Ministry of Health, Singapore, unpublished data). Children generally have mild disease, although there is emerging literature on paediatric multisystem inflammatory syndrome temporally associated with COVID-19....
Letter to the Editor
Cross-reaction of Sera from COVID-19 Patients with SARS-CoV Assays
SARS-CoV-2 is a new zoonotic coronavirus (CoV) that emerged in Wuhan, China, which was first reported to the World Health Organization (WHO) on 31 December 2019. This coronavirus disease (COVID-19) causes mild to moderate respiratory illness in the majority of patients, but can cause serious complications in the elderly...
Review Article
COVID-19 and Singapore: From Early Response to Circuit Breaker
The COVID-19 pandemic first broke out in Wuhan, China, in December 2019, where a cluster of pneumonia cases was reported and the novel coronavirus later identified. Since then, the virus has spread rapidly across the world, registering a total of 85000 reported cases across 53 countries/territories by 29 February...
Original Article
Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children
Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...
Review Article
Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre
As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...
Review Article
Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months
Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...
Original Article
Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore
Since the first cases of coronavirus disease 2019 (COVID-19) in pregnancy were described, significant concerns have been raised about the potentially increased susceptibility of pregnant women to severe disease, and the unquantified risk of mother-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the fetus and neonate....
Letter to the Editor
Resuming otolaryngology services following a COVID-19 lockdown in Singapore
When the COVID-19 outbreak first occurred, we tweaked our department workflows to cope with the various demands of our practice and the pandemic. When Singapore’s Multi-ministry Taskforce on COVID-19 deemed that it was safe to begin reopening the economy in 3 phases,3,4 our department adopted a gradual resumption of...
Letter to the Editor
COVID-19: Lessons from Thailand
The COVID-19 pandemic has massively disrupted the social and economy of many countries. Thailand has been successful in controlling the spread of the disease and treating COVID-19 patients. We discuss Thailand’s strategy in containing the disease, management of severe COVID-19 patients, as well as future perspectives of COVID-19.
This article...
Commentary
Videoconsultation to overcome barriers during COVID-19
Since February 2020, Government Restructured Hospitals in Singapore began deferring non-urgent outpatient appointments. This aimed to facilitate physical distancing and reallocate healthcare resources to combat the pandemic. As the pandemic becomes increasingly prolonged, this strategy is unsustainable. There is increasing interest in using videoconsultations to ensure that patients receive...
Letter to the Editor
Positive RT-PCR detected in patients recovered from COVID-19
Positive real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acid following 2 consecutive negative RT-PCR tests have been reported in China and Korea. This has led to speculation regarding “persistent carrier states”, “re-infections” or “re-activations” and raises questions about using negative RT-PCR as part of de-isolation criteria. We...
Letter to the Editor
Cerebral venous thrombosis in a patient with mild COVID-19 infection
Emerging reports suggest venous and arterial thromboembolic diseases can complicate recovery from COVID-19. Postulated mechanisms include hypercoagulability, hypoxia, immobilisation, excessive inflammation and diffuse intravascular coagulation, especially in patients with severe COVID-19 infection. Nauka et al. provided vital insight that thrombotic complications can happen in a patient with non-critically ill...
Letter to the Editor
Decrease in emergency department attendances during COVID-19 especially in school-going children
Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with minor ailments, but these observations have yet to be evaluated in Singapore. We investigated ED attendances during the coronavirus disease 2019 (COVID-19) pandemic in Singapore.
This...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...
Review Article
Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review
Coronavirus disease 2019 (COVID-19) has spread rapidly from China to other countries around the world, with the World Health Organization characterising it as a global pandemic on 12 March 2020. The number of fatalities owing to COVID-19 is escalating rapidly. COVID-19 is caused by the Severe Acute Respiratory Syndrome...
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,...
Review Article
Obesity in COVID-19: A Systematic Review and Meta-analysis
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is established that increasing age and comorbidities such as cardiovascular diseases are associated with risk of infection, more severe disease and adverse outcomes. Obesity is an epidemic globally, causing...
Commentary
Mental Health Strategies to Combat the Psychological Impact of Coronavirus Disease 2019 (COVID-19) Beyond Paranoia and Panic
On 30 January 2020, the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) an international public health emergency after the number of cases soared across 34 regions in Mainland China and surpassed that of severe acute respiratory syndrome (SARS) in 2003. The virus was believed...
Original Article
Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection
In this report, we describe a patient who developed acute respiratory distress syndrome (ARDS) with rapid clinical deterioration. Unfortunately, not much is known about the clinical features and risk factors for ARDS and critical illness even as the number of COVID-19 cases continues to climb at an alarming rate...