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Health district at Queenstown: Catalyst for translational research

Ageing societies dominating global demographics is not new. However, the pace of global population ageing is causing disquietude. In 2017, the global population over...

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...

Health practices, behaviours and quality of life of low-income preschoolers: A community-based cross-sectional comparison study in Singapore

Poverty is a serious concern that has been found to bring about various adverse psychological, social and developmental outcomes.1 Living in poverty as a...

Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation programme

Strong evidence consistently links low income to Adverse Childhood Experiences (ACEs) and children’s long-term health, developmental, educational and social outcomes.1,2 Poverty increases parenting stress, and...

The potential of RNA therapeutics in dermatology

Graphic design by Liu Yujia Ribonucleic acid (RNA) therapeutics involving, among others, microRNAs (miRNAs), small interfering RNAs (siRNAs) and/or antisense oligonucleotides (ASOs) hold great potential...

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

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

Defining breast cancer-related lymphedema (BCRL) prevalence and risk factors: A pragmatic approach to lymphedema surveillance

Breast cancer-related lymphedema (BCRL) is a chronic progressive pathological condition of the lymphatic system that can lead to significant impact on the quality of...

Breast cancer-related lymphedema (BCRL): Should we be doing more or less for the axilla?

Breast cancer mortality has declined steadily over the years with breast cancer screening, and improvement in diagnostic and therapeutic regimens. Despite cancer survivors living...

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...

Normative data for baseline and longitudinal neuropsychological assessments in Singapore

Dear Editor, Neuropsychological assessments play a vital role in the early detection of cognitive disorders. However, the lack of Singapore-specific norms has resulted in a...

Oocytes on ice: Exploring the advancements in elective egg freezing for women

Elective egg freezing (EEF), otherwise known as oocyte cryopreservation for age-related fertility loss, has become a viable option for single women to preserve their...

Caregiver reported long-term outcomes in children with major trauma and traumatic brain injuries: A single-centre retrospective study

Traumatic injuries in children are a significant cause of mortality and morbidity worldwide.1 Children with major trauma are at risk of poor outcomes.2-4 These...

Anti-osteoporosis drugs reduce mortality in cancer patients: A national cohort study of elderly with vertebral fractures

Osteoporotic vertebral fractures (OVFs) are the most prevalent type of fragility fractures, affecting 25% of adults in their early 70s and 43% of those...

Anti-osteoporosis drugs and reduction of mortality in cancer patients

Osteoporosis and cancer share a complex relationship, with each condition influencing the progression and outcomes of the other.1 Multiple factors, such as chemo- and...

Four cases of HIV infection in men taking pre-exposure prophylaxis in Singapore

Dear Editor, Pre-exposure prophylaxis (PrEP) with co-formulated tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) is an effective prevention strategy against sexual transmission of human immunodeficiency...

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

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

AL amyloidosis: Singapore Myeloma Study Group consensus guidelines on diagnosis, treatment and management

Amyloidosis refers to disorders characterised by the deposition of insoluble amyloid fibrils, which are pathogenic,1 resulting in organ dysfunction. Amyloidoses differ in the protein...

Clinical utility of PET/MRI in multiple myeloma

Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and...

Improving management of AL amyloidosis

In this issue of the Annals, Tan et al. on behalf of Singapore Myeloma Study Group presented the consensus guidelines on light chain (AL)...

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...

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...

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...

Association of quality-of-care indicators with asthma outcomes: A retrospective observational study for asthma care in Singapore

Asthma, a chronic inflammatory disorder of the airways,1 is a common respiratory condition, with an estimated 262 million people affected worldwide.2 In Singapore, 5%...

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...

Robotic surgery in morbidly obese women with endometrial cancer in Singapore

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

An approach to genetic testing in patients with metastatic castration-resistant prostate cancer in Singapore

Prostate cancer is the fifth most common cancer in Asian men, and with its rising incidence, is emerging as a health priority in Asia.1...

Challenges with mainstreaming genetic testing for metastatic prostate cancer treatment in Singapore

Compared with other solid tumours, patients with metastatic prostate cancer typically have better survival in the range of years.1 The long survival translates to...

The role of PIVKA-II in hepatocellular carcinoma surveillance in an Asian population

Dear Editor, Alpha-fetoprotein (AFP) is the most established biomarker for surveillance of hepatocellular carcinoma (HCC) in at-risk individuals. However, its sensitivity and specificity are...

Association between self-care and chronic kidney disease in patients with type 2 diabetes mellitus

Dear Editor, Chronic kidney disease (CKD) is one of the key complications occurring in 25–40% of patients with type 2 diabetes mellitus (T2DM).1 Our...

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

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

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...

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...

Multidisciplinary lung cancer clinic: An emerging model of care

Dear Editor, Lung cancer management is progressively complex and multidisciplinary input is often needed. The recent publication of CheckMate 816 heralds a paradigm shift...

Characteristics of anti-transcriptional intermediary factor 1 gamma autoantibody-positive dermatomyositis patients in Singapore

Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of acquired, systemic autoimmune conditions characterised by muscular and extramuscular manifestations. As a subset within the...

A recurring nasal mass

A 56-year-old Chinese man presented to the Ear, Nose and Throat clinic with months of unilateral right-sided nasal obstruction. He reported occasional mucopurulent discharge...

Early rehabilitation to improve functional outcomes in childhood cancer in Singapore

Dear Editor, We conducted a prospective, single-centre cohort study to review the impact of a multidisciplinary rehabilitation programme in children with cancer in Singapore....

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...

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...

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

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

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) hysterectomy in Singapore

Dear Editor, Hysterectomy is one of the most common gynaecological procedures, and various approaches are available such as abdominal, laparoscopic and vaginal.1 Several studies...

Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore

Polycystic ovary syndrome (PCOS) is a common endocrine disorder estimated to affect 4–21% of women, depending on the diagnostic criteria used.1 Clinical manifestations of the...

Current Management of Early Vulvar Cancer

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

Serum Selenium in the General Population of Singapore, 1993 to 1995

The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3%...

Traumatic Dislocation of the Testes

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

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

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

Plasma Vitamins A, C and E in the General Population of Singapore, 1993 to 1995

The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3%...

The Role of Multiple Segment Osteotomies in Orthognathic Surgery

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

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

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

Impact of COVID-19 infections among kidney transplant recipients

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

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

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

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

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

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

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

Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)

Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point....

Current Concepts of Tumour Metastasis

Tumour metastasis, or the spread of cancer cells from a primary tumour to distant sites, remains the principal cause of treatment failure and poor...

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

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

Trends in Cancer Incidence Among Singapore Malays: A Low-risk Population

Cancer is now one of the most common causes of death in the world. Inspection of changes in cancer incidence in ethnically or geographically...

Cutaneous and Subcutaneous Metastases of Adenocarcinoma of the Colon and Rectum

Cutaneous metastasis from colorectal adenocarcinoma is an interesting condition not only because of its rarity, it occurs in less than 4% of patients with...

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

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

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...

Parathyroid Carcinoma: A Case Series

Parathyroid carcinomas account for 1% to 3% of patients with primary hyperparathyroidism (PHPT).1 Patients usually present with a severe form of hyperparathyroidism at diagnosis,...

Contemporary Results of Endopyelotomy for Ureteropelvic Junction Obstruction

Ureteropelvic junction obstruction (UPJO) results in the gradual dilatation of the renal collecting system, and may lead to deterioration of renal function and pain....

The Relationship between Postoperative Complications and Outcomes after Hip Fracture Surgery

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

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

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

Thoracic Complications of Radiofrequency Ablation of Recurrent Hepatoma

Radiofrequency ablation (RFA) intended to produce complete thermal necrosis of unresectable primary or secondary hepatic malignancies have gained widespread availability and acceptance over the...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore

As only 5–10% of thyroid nodules harbour malignancy, fine-needle aspiration (FNA) is important in triaging nodules requiring surgical excision from nodules that may be...

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the...

The case for better hospitalisation selection in cancer patients

Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been...

5th College of Surgeons Lectureship: Surgery beyond Scalpels

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

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

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

Renojejunal Fistula: An Extremely Rare Form of Renoenteric Fistula

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

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

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

Gynaecologic Robot-Assisted Cancer and Endoscopic Surgery (GRACES) in a Tertiary Referral Centre

Hysterectomy is the most common major gynaecologic operation. Over 600,000 hysterectomies are performed annually in the US. In Singapore, almost 9000 hysterectomies are performed...

Early Outcome Following Emergency Gastrectomy

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

Demographic Determinants of Survival in Osteosarcoma

The treatment of osteosarcoma has seen tremendous improvements over the last 3 decades of the twentieth century. Over the last decade it appears that...

The Hidden Impact of Childhood Cancer on the Family: A Multi-Institutional Study from Singapore

Chronic childhood illnesses have varying degrees of impact on the children and their families. Some chronic conditions that have little or no impact on...

Causes and Features of Erythroderma

Erythroderma is a dermatological reaction characterised by extensive erythema and scaling of the skin secondary to a variety of causes. An improved understanding of...

Routine intraoperative frozen section adds little value to the management of thyroid nodules with Bethesda III cytology

Dear Editor, We would like to highlight the need to reduce intraoperative frozen section (FS) during diagnostic hemithyroidectomy performed on thyroid nodules with Bethesda III...

Telemedicine for palliative care: Current and future challenges

Dear Editor, We read with interest the article published in the June 2021 issue of the Annals titled “Use of telemedicine in healthcare during COVID-19...

Managing buccal space tumours

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

Misdiagnosis of a Large Uterine Vein Thrombosis as a Uterine Myoma Prior to Hysterectomy: A Case Report

Dear Editor, Intravascular thrombosis is a serious problem that sometimes causes death due to acute pulmonary thromboembolism (PTE). There are a few reports on the...

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

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

Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?

The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The...

Prenatal Diagnosis of Chromosomal Abnormalities—Shifting Paradigm

It is very likely that in 10 years time, invasive prenatal diagnostic tests like amniocentesis and chorionic villus sampling (CVS) will join the club...

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

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

A maxillary sinus mass

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

Rapidly progressive ulcer in an older woman

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

Bone in the breast: Clinical, radiological and pathological correlation

An 84-year-old woman presented with a left breast mass that had been rapidly growing over a few months. On clinical examination, there was a...

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

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

Treatment of Ewing sarcoma in children: Results from a single centre

Dear Editor, Ewing sarcoma is a malignant mesenchymal tumour that presents as a bone or soft-tissue sarcoma. Translocations involving the EWS gene on chromosome 22q12...

Does pulmonary metastasectomy of colorectal metastases translate to better survival? A systematic review

Colorectal cancer (CRC) is the one of most common cancers worldwide. Metastatic disease occurs in approximately half of all CRC patients, in either synchronous...

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

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

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

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

Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians

In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which...

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

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

An unusual submandibular tumour

A woman in her 60s presented with a non-tender, non-enlarging swelling in the left submandibular triangle of the neck for 3 months. She had...

Penile preserving surgery in penile cancer management

Penile cancer is a condition that accounts for approximately 0.4% of cancers among Singapore males. Overall, this is an uncommon cancer with higher rates...