Related Articles

Long-term survival and clinical implications of allogeneic stem cell transplantation in relapse/refractory lymphoma: A 20-year Singapore experience

Over the past few decades, a wide array of novel therapies has become available for the treatment of relapsed/refractory (R/R) lymphoma. Despite these advancements, outcomes and the durability of disease control remain poor for many patients. While autologous hematopoietic stem cell transplantation (auto-HSCT) may be appropriate for some lymphoma...

COVID-19 residual symptoms and adverse drug reactions after oral antiviral therapy in the Singapore primary care setting

Dear Editor, The COVID-19 pandemic remains a significant public health threat with over 7 million deaths worldwide (as of 14 January 2024).1 In Singapore, oral antivirals (OAVs) nirmatrelvir/ritonavir and molnupiravir were approved in 2022 for treating mild-to-moderate COVID-19 in adults at risk of progression to severe disease.2,3 Clinical trials in...

Evaluating the role of technology in disseminating education to patients with chronic kidney disease

Dear Editor, The optimal management of chronic kidney disease (CKD) requires lifestyle changes and adherence to long-term medications. Knowledge is a component of health literacy and is needed for self-management. Limited health literacy can lead to negative outcomes, such as adverse clinical events and mortality.1 Using technology to improve patients’ knowledge...

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

Achieving optimal fluid balance for a patient undergoing major surgery, especially transplant surgery, has always been the lofty goal of peri-operative care,1 which often proves to be an elusive target. While keeping the patient well hydrated improves organ perfusion, being too generous with fluids can result in morbidity, such...

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...

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...

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...

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

There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....

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....

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...

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...

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...

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

Acute kidney injury (AKI) affects 21.6% of critically ill adult patients,1 with 5–7% requiring kidney replacement therapy (KRT).2 AKI carries significant prognostic and socioeconomic implications—chronic kidney disease (CKD) progression over 1 year has been described in 21%, 30%, and 79% of initial survivors with septic AKI reversal, recovery and...

Micronutrients and kidney health

Chronic kidney disease (CKD) is a structural and functional disorder of the kidney caused by many diseases, such as diabetes, hypertension and glomerular disease.1 There are many factors that contribute to the development and progression of CKD, and often, we do not look at the exposure of heavy metals...

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...

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...

Impact of COVID-19 on mental health and healthcare service delivery

The COVID-19 pandemic has claimed more than 6.8 million lives globally.2 While there is yet a cure for the disease, vaccines are now available to minimise transmission risk and protect against severe infection. However, COVID-19 vaccines have had a mixed reception, with concerns of their side effects and of...

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...

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....

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...

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 earlier study also showed that CKD was present in 53% of patients with T2DM recruited from a secondary care diabetes centre and primary care polyclinic...

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...

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...

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...

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....

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...

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...

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...

White precipitate in a dialysis circuit

An 81-year-old man who had been fully vaccinated against COVID-19 was admitted to the medical intensive care unit on day 5 of his COVID-19-induced pneumonia for high flow nasal oxygen treatment. He had hypoxaemic respiratory failure secondary to acute respiratory distress syndrome (ARDS) from the COVID-19-induced pneumonia. He had...

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...

Palliative dialysis in hospice: A paradox or promising answer?

Dear Editor, End-stage renal disease (ESRD) patients have higher mortality, hospital admissions and invasive procedures towards the end of life.1 However, many of them (82%) prioritise minimising suffering over life prolongation. Although twice as many patients prefer dying at home and inpatient hospice (65%) compared to hospital (27%), hospice utilisation...

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...

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...

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...

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...

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...

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...

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...

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

Peritoneal dialysis (PD) is a well-established long-term dialysis modality for patients with end-stage kidney disease (ESKD).1 It is recommended that a PD catheter should be placed at least 2 weeks prior to the anticipated need of long-term PD treatment for a planned-start PD.2 Despite wide-spread promotion of planned-start dialysis for...

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...

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

In-hospital cardiopulmonary resuscitation (CPR) for chronic kidney disease (CKD) patients is shown to have lower survival1 and a higher proportion of survivors on maintenance haemodialysis were discharged to skilled nursing facilities.2 Despite that, haemodialysis patients still preferred CPR during cardiac arrest3 and there are lower do-not-resuscitate orders for the...

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

End-stage renal failure (ESRF) is a major cause of morbidity and mortality worldwide, including Asia.1 In Singapore, incidence of chronic kidney disease (CKD) stage 5 has increased from 383.9 per million population (PMP) in 2010 to 414.8 PMP in 2015. Incidence of patients requiring dialysis has increased in tandem....

Survival outcome of haemodialysis and peritoneal dialysis

End-stage renal disease (ESRD) is a challenging and growing health issue, with number of patients increasing globally. The use of dialysis has greatly improved the survival and life expectancy of ESRD patients. Haemodialysis (HD) and peritoneal dialysis (PD) are 2 broad dialysis modalities used for ESRD. Despite the advancement...

Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children

Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease. This article is available only as...

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,...

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...

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...

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...

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...

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...

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),...

Molecular Adsorbent Recirculating System (MARS)

Liver failure is clinically heterogeneous in aetiology, pathophysiology, clinical severity and prognoses. It can be divided into the following categories: acute liver failure (ALF), of which the most severe form is fulminant hepatic failure (FHF); acute-on-chronic liver failure (AoCLF), such as acute viral hepatitis flare in those with chronic...

Retardation of Kidney Failure – Applying Principles to Practice

By 2010 there will be more than 2 million patients worldwide on maintenance dialysis, a 400% increase in 20 years.1 This increase, occurring predominantly in developing nations, is being driven especially by a worldwide increase in the incidence of diabetes, and is too great to be offset by increased...

Nephrologists-led intervention increases utilisation of peritoneal dialysis in Singapore

Dear Editor, Over the past decade, the utilisation of peritoneal dialysis (PD) among end-stage kidney disease (ESKD) patients in Singapore has been persistently low (<20%).1 Difficulty in accessing PD catheter insertion services is considered one of the main obstacles to the growth of the PD population.2 Traditionally, PD catheter insertion...

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...

Profile of Hospitalisation and Death in the First Year after Diagnosis of End-stage Renal Disease in a Multi-ethnic Asian Population

End-stage renal disease (ESRD) is reaching epidemic proportions and is increasingly a public health issue due to the cost of providing care to these patients. There are many kidney disease databases and registries tracking and studying trends in the epidemiology and care of ESRD patients. This article is available only...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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

Diabetic kidney disease remains a significant disease burden globally and is associated with increased medical costs once chronic kidney disease (CKD) ensues. Therefore, optimisation of CKD management through glycaemic control and albuminuria reduction are key strategies for retarding renal deterioration. Sodium glucose cotransporter-2 (SGLT-2) inhibitors are a new class...

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...

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...

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...

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...

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...

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...

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...

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

Approximately one in ten patients admitted to an intensive care unit (ICU) develops acute kidney injury (AKI), an important complication of ICU patients, and requiring renal replacement therapy (RRT). It is well known that AKI contributes to mortality and chronic kidney diseases which result in health and economic burdens....

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 treatment of choice in severe symptomatic aortic stenosis (AS) patients who have prohibitive and high surgical risks. TAVI has also gained increasing uptake in patients...

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....

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...

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...

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...

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...

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...

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....

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...

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...

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...

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...

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...

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...

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

Diabetes is a chronic disease characterised by elevated levels of blood glucose. The most common type of diabetes is type 2 diabetes mellitus (T2DM). This usually occurs in adults and arises through insulin resistance or an insufficiency of insulin production. Diabetes is one of the priority non-communicable diseases targeted...

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...

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...

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

Membranous nephropathy is an organ-specific autoimmune disease and is the most common cause of adult-onset nephrotic syndrome. The diagnosis of membranous nephropathy mainly depends on pathological characteristics observed through various techniques such as diffuse thickening of the glomerular basement membrane and spike formation by light microscopy, granular deposition of...

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,...

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...

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...

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...