Editorial
Organ donation in the paediatric intensive care unit: Time for change?
Organ transplantation remains the definitive treatment option for improving the lives of patients with end-stage organ failure. To our knowledge, the first solid organ transplantation performed in Singapore in July 1970 involved a kidney from a deceased donor.1 Since then, rapid advancements in both transplant surgery and immunosuppressive medical...
Letter to the Editor
Exploring the perspectives of child health strategy stakeholders on resilience and well-being in children and youths in Singapore: A qualitative study
Dear Editor,
Resilience has been defined as the capacity of a dynamic system to adapt well to potential threats,1 while mitigating the negative impact of behavioural and physiological changes due to chronic stress,2 and the resumption of positive functioning thereafter.3 Resilience enables one to adapt positively to adversities in life...
Letter to the Editor
Improving school teachers’ self-efficacy and knowledge on food allergy and management of anaphylaxis using a virtual multidisciplinary workshop
Dear Editor,
Children with food allergies are at risk of inadvertent allergic reactions that range from mild to potentially life-threatening anaphylaxis, even with appropriate dietary avoidance.1 This risk is often increased in community settings such as schools via accidental exposure to allergens during learning activities or meal times. A quarter...
Original Article
Epidemiology of paediatric intensive care unit admissions, deaths and organ donation candidacy: A single-centre audit
With advancements in medical care, mortality rates in critically ill patients have decreased substantially.1,2 Contemporary studies from developed countries report paediatric intensive care mortality rates of 2–3%3,4 in 2014 to 2019, whereas mortality in developing countries can be as high as 50%5 as of 2024, indicating large disparities in...
Original Article
Perioperative emergency laparotomy pathway for patients undergoing emergency laparotomy: A propensity score matched study
Patients requiring emergency laparotomy (EL) are a vulnerable subset within general surgery, with reported 30-day mortality rates ranging from 9% to 18%, which is 3 times higher than similar elective operations.1-3 Unlike elective surgeries, the care for EL patients is time-sensitive as they move from the emergency department, radiology...
Letter to the Editor
Enhancing care in nursing homes: Qualitative insights from the ENHANCE programme
Dear Editor,
Empower Nursing Homes And improve staNdards of CarE (ENHANCE) was a pilot programme introduced by Sengkang General Hospital to address the challenges faced by Singapore’s ageing population. With nearly 1 in 4 Singaporeans projected to be aged 65 years and above by 2030, the demand for effective long-term...
Editorial
Optimising paediatric urinary tract infection diagnosis
Urinary tract infection (UTI) is the most common cause of serious bacterial illness among children and infants.1 Up to 2% of boys and 8% of girls will develop at least 1 episode of UTI by the age of 7 years.1,2 Of these, it is estimated that 12% to 30%...
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
Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study
Urinary tract infection (UTI) is a common diagnosis in the paediatric emergency department (ED). It accounts for an estimated 5–14% of paediatric ED visits yearly in the US.1-3 It is a common cause of serious bacterial infections in children, and the most common microorganism is Escherichia coli (65–75%), followed...
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...
Review Article
Quality of life of family caregivers of children and young adults with Down syndrome: A systematic review and meta-analysis
The family caregiver is “any relative, partner, friend or neighbor who has a significant personal relationship with, and provides a broad range of assistance for a person with a chronic or disabling condition.”1 Family caregivers for children with chronic illnesses are commonly parents, who fulfil their children’s physical and...
Editorial
Living longer and stronger: Are children and young adults with Down syndrome experiencing healthier and better lives?
Down syndrome (DS) is the most common genetic cause of intellectual disability and is associated with multiple medical conditions affecting various organ systems, impacting the individual’s health, development and function.1 In Singapore, the life-birth prevalence of DS was 0.89 per 1000 births in the 1990s, a figure expected to...
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,...
Letter to the Editor
Factors affecting outcomes among older trauma patients in Singapore: A retrospective observational study
Dear Editor,
Singapore faces a rapidly ageing population with its median age projected to be above 45 years by 2030. Our greying demographics is accompanied by a rise in chronic diseases and medication use, including polypharmacy.1 Longer life expectancy and increased activity levels have contributed to higher incidence of geriatric...
Original Article
Diagnostic performance of classification criteria for systemic lupus erythematosus: A validation study from Singapore
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a broad spectrum of clinical presentation.1 Clinical diagnosis by rheumatologists remains the gold standard, but the diagnosis is often challenging due to variability in disease expression mimicking other conditions.
As such, classification criteria have been developed to establish homogeneous groups...
Editorial
Promoting evidence-based care for children and adolescents on the autism spectrum
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has been increasing in worldwide prevalence,1 including Singapore. In this latest issue of the Annals, we share the latest Singapore Clinical Practice Guidelines (CPG) for Autism in Children and Adolescents, discussed by Wong et al.2 This is the culmination of...
Original Article
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 include disabilities that require assistance with activities of daily living, intellectual disability and behavioural problems.5 In the US, it is estimated that more than 50...
Original Article
An augmented reality mobile application for weight estimation in paediatric patients: A prospective single-blinded cross-sectional study
Drug and defibrillation energy doses for children rely on accurate weight measurement, making it essential during emergencies.1,2 However, quickly weighing children in distress is often a challenging task.3,4 Conventionally, age-dependent formulas and length-based tapes like the Broselow tape (BT) and Paediatric Advanced Weight Prediction in the Emergency Room extra-long...
Letter to the Editor
How do current paediatrics residency selection criteria correlate with residency performance?
Dear Editor,
The selection process for potential residents needs to be reviewed regularly and assessed if effective in selecting the best-fit residents who can achieve academic and professional excellence. Objective measures must take precedence over subjective criteria to reduce selection bias while ensuring transparency and accountability. However, the predictors of...
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....
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...
Original Article
Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests
Congenital heart diseases (CHDs) are the most common major congenital anomaly at up to 28%1 and are responsible for 5.7% of all infant mortality.2 While earlier studies in developed countries reported an overall CHD birth prevalence of 3.7–5.54 per 1000 live births,3,4 more recent studies report a global and...
Letter to the Editor
Improving neonatal counselling service for premature births
Dear Editor,
Despite the substantial advancement of neonatal care leading to increased survival of infants of periviable gestation, as young as 22 weeks,1 the anticipated birth of an extremely low gestational age infant remains challenging for both the parents and physician, with regard to decision-making in initiating resuscitation post-delivery. Ideally,...
Original Article
Clinical outcomes of hospitalised individuals with spin-induced exertional rhabdomyolysis
Rhabdomyolysis is a clinical and biochemical syndrome caused by the breakdown of myocytes and release of intracellular components into the bloodstream.1 A subset of rhabdomyolysis is exertional rhabdomyolysis (ER), which is caused by strenuous physical activity. Risk factors for ER include lack of physical endurance, increased duration and intensity...
Letter to the Editor
Emergency department falls interventions improve osteoporosis management in frail older adults
Dear Editor,
Singapore’s population is ageing rapidly and by 2030, around 1 in 4 citizens will be aged 65 and above.1 Older adults represent 21–40% of emergency department (ED) users and proportionally are the highest users of ED services.2
One-third of community dwellers over 65 years of age fall each year,...
Review Article
Consensus statement on Singapore integrated 24-hour activity guide for early childhood
Early childhood is a critical period for growth and development, setting the foundation for future and lifelong well-being.1 Adopting healthy lifestyle behaviours in early childhood can potentially influence and shape behaviours later in life.2 Frameworks have been developed, such as from the Center on the Developing Child at Harvard...
Editorial
Proactive steps to population health: Starting early, starting right
The global burden of non-communicable diseases is rising, with continued projected increases in the prevalence of metabolic syndrome (MetS) in the future. This epidemic, albeit of a metabolic nature, poses broad socioeconomic and healthcare burdens worldwide. Population health improvement and optimisation of healthcare are important to addressing these burdens....
Letter to the Editor
Sublingual ondansetron for treatment of acute gastroenteritis in children in the children’s emergency
Dear Editor,
Acute gastroenteritis (GE) is a leading cause of death globally in children aged below 5 years and the third most common indication for hospital admission in some countries.1,2 Currently, norovirus is the most common cause of GE in children in developed countries.3 Rehydration, either orally or intravenously, is...
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....
Letter to the Editor
Rapid exome sequencing to aid diagnostics in genetic disorders: Implementation and challenges in the Singapore context
Dear Editor,
There is a high burden of genetic disorders in patients admitted to the intensive care unit (ICU), ranging from 45–56%,1,2 and delayed definitive diagnoses with a long diagnostic odyssey often contribute to increased healthcare costs.3 The application of clinical exome sequencing in ICU has been gaining traction, where...
Letter to the Editor
Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders
Dear Editor,
Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based patient-centric care.1
We have developed and implemented a deep-learning model using bidirectional long short-term memory (Bi-LSTM) neural network to enable automated triage of unstructured free-text...
Letter to the Editor
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. The Template for Intervention Description and Replication (TIDieR) checklist was used to allow sufficient details for replication of the study (see Appendix in online Supplementary...
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...
Letter to the Editor
Child passenger safety training for healthcare professionals in Singapore
Dear Editor,
Road traffic injuries are a preventable cause of childhood morbidity and mortality.1,2 Use of age-appropriate child car seats (CCS) lowers the risk of injury and death by about 82% and 28%, respectively.3-5 In Singapore, although the Road Traffic Act states that CCS use is mandatory,6 many children...
Letter to the Editor
Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae infections among hospitalised children in Singapore
Dear Editor,
Mycoplasma pneumoniae has become the leading cause of paediatric community-acquired pneumonia in countries where pneumococcal vaccination is included in the national immunisation programme, including Singapore.1 M. pneumoniae is intrinsically resistant to beta-lactams due to the absence of cell walls. Macrolides, tetracyclines, and fluoroquinolones are used to treat M....
Letter to the Editor
Childhood interstitial lung disease: The end of a diagnostic odyssey
Dear Editor,
Childhood interstitial lung disease is a heterogeneous group of rare disorders featuring pulmonary interstitial remodelling and diffuse parenchymal infiltrates on imaging.1 Incidence is estimated at 0.13–16.2 cases/100,000 children per year.1 ABCA3 (ATP-Binding Cassette, Subfamily A, Member 3) (OMIM #601615) is expressed in alveolar type II cells involved...
Original Article
Validation and comparison of the PECARN rule, Step-by-Step approach and Lab-score for predicting serious and invasive bacterial infections in young febrile infants
The diagnostic approach and management of febrile infants <90 days of age remain a challenge, given that the majority of these infants have no localising signs and symptoms, and may appear clinically well at presentation.1 In addition, the majority of these infants have benign viral illnesses, for which hospitalisation...
Letter to the Editor
High burden of respiratory viral infection-associated mortality among critically ill children
Dear Editor,
Acute lower respiratory infections (ALRIs) are a leading cause of under-5 mortality globally—two-thirds could be attributable to respiratory viral infections (RVIs).1,2 The burden of paediatric RVIs in settings of tropical climate with year-long virus circulation is relatively underreported.3,4 Previous studies in these areas have estimated that around 8–11%...
Original Article
Non-motorised active mobility device use by children in Singapore: Injury patterns and risk factors for severe injury
The Active Mobility Act was introduced in Singapore in 2017 to promote the safe use of personal mobility devices. Non-motorised active mobility devices (AMDs) are popular among children and include tricycles, bicycles, scooters, inline skates, skateboards, longboards and waveboards. While the use of AMDs contributes towards an active lifestyle...
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...
Commentary
Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore
Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED) with blunt or penetrating major trauma. “Trauma team activation” is initiated by the ED specialist through the hospital call-centre, and is a process that mobilises...
Original Article
Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns
Emergency department (ED) overcrowding is a growing issue that threatens public health in various parts of the world,1 including the US,2 UK,3 Australia,4 Japan5 and Taiwan.6
Individuals who visit the ED repeatedly, known as frequent attenders (FAs), have been identified as a possible driver of ED overcrowding. While the...
Editorial
Frequent attenders to multiple emergency departments in Singapore
The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its negative effects include adverse impact on patient safety, medical errors and staff burnout. In addition, high volume of patients waiting to be seen (ED input)...
Commentary
Congenital cytomegalovirus infection: Advocating for screening and education
Cytomegalovirus (CMV) infection is the leading non-genetic cause of congenital neurosensory hearing loss in children, accounting for 21% of cases of hearing loss at birth and 25% of deafness at age 4 years.1 It can also give rise to other serious sequelae such as cerebral palsy, cognitive impairment, seizures...
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...
Review Article
Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents
The World Health Organization’s Global action plan for the prevention and control of noncommunicable diseases 2013–2020 provided guiding principles for national efforts in controlling and reducing non-communicable diseases (NCDs).1 The major NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes—they form a major public health challenge, and are...
Original Article
Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore
Functional gastrointestinal (GI) disorders, such as colic, gastroesophageal reflux (GER) and constipation, are common in infants under 1 year. They are a frequent cause of concern for parents and result in a significant healthcare burden1,2 due to their negative impact on feeding behaviours, caregivers’ mental wellbeing and quality of...
Editorial
Gastroesophageal reflux disease in Asian infants: Similar condition, different perceptions
Gastroesophageal reflux disease (GERD), a common problem in infancy, may lead to troublesome symptoms or complications such as oesophagitis or oesophageal stricturing in a small minority of infants.1 In the majority of cases, however, frequent regurgitations, the commonest symptoms of GERD, resolves with age spontaneously without any medical intervention.2,3...
Review Article
Determinants of emergency department utilisation by older adults in Singapore: A systematic review
Older adults in Singapore contribute to a disproportionately higher number of visits to the emergency department (ED), mirroring trends around the world.1,2 For instance, hospital admissions among those aged ≥65 years have been on the rise from 2018 to 2020, contributing a growing burden to ED services over the...
Original Article
Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial
Critically ill patients in the emergency department (ED) have shorter safe apnoea times due to physiological distress from decreased cardiac output, increased shunting and reduced pulmonary reserves.1 Hypoxia is a commonly encountered adverse event during rapid sequence intubation (RSI)2 and is associated with cardiac arrest, neurological injury and death.3...
Original Article
A Review of Pedestrian Fatalities in Singapore from 1990 to 1994
Fatal road accidents are by no means uncommon in Singapore, a modern tropical metropolis with a population of approximately 3 million. Statistics provided by the Traffic Police Department show that, although the accident fatality rate had fallen sharply from 13.4 per 100,000 population in 1984, to 8.0 per 100,000...
Original Article
Patients Admitted to an Intensive Care Unit for Poisoning
The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed only seven papers on the epidemiology of poisoning since 1975 (the earliest year covered by the database) and none targeting those severe enough to require...
Original Article
Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team
Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute myocardial infarction, to save those with “hearts too good to die”.
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Original Article
Bidirectional Cavopulmonary Anastomosis
Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to Fontan’s operation has been undertaken in an effort to reduce the volume load of a single ventricle as early as possible and to minimise the...
Original Article
Extent and Appropriateness of Emergency Department Services Usage by Foreign Workers in Singapore
Singapore employs more than 350,000 foreign workers currently. With this influx of foreign workers into our city-state which has limited land and resources, it is not surprising that public services like the health service feel the impact of their presence.
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Original Article
Drowning and Near-drowning—Some Lessons Learnt
Drowning is defined as suffocation from submersion in a liquid with death within the first twenty-four hours. Near-drowning implies that recovery has occurred, at least temporarily, or that the victim has survived over twenty-four hours.
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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...
Letter to the Editor
Systemic antibiotic prophylaxis for recurrent infective flares in children and adolescents with atopic dermatitis
Dear Editor,
Atopic dermatitis (AD) is a chronic inflammatory skin disease, affecting approximately 20% of children in Singapore.1 It is associated with skin barrier defects2 and increased skin colonisation with Staphylococcus aureus, which can trigger infective flares, especially in more severe disease. Strategies to reduce S. aureus colonisation and infection...
Commentary
Preparing for the silver boom: A falls prevention tool for older adults in the emergency department
Each year, 28–35% of community dwelling adults over 65 years fall.1 This figure increases to about 50% for those above 80 years old.2 Falls also account for 85% of all geriatric trauma presenting to the emergency department (ED) in Singapore,3 with the crude incidence rate of unintentional falls at...
Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it as there are so few books of medicine written and published in Singapore.
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Original Article
Intravenous Adrenaline or Vasopressin in Sudden Cardiac Arrest: A Literature Review
Of the approximately 15,000 deaths that occur in Singapore every year, about 25% are from cardiac causes; of which, some 30% to 40% occur suddenly, outside of a hospital. The mechanism of death is usually a fatal arrhythmia, most often ventricular tachycardia or fibrillation.
This article is available only as...
Original Article
Audit of Total Parenteral Nutrition in an Adult Surgical Intensive Care
Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to simple starvation.
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Original Article
Acute Coronary Syndrome—Factors Causing Delayed Presentation at the Emergency Department
Acute coronary syndrome (ACS) refers to a continuum of clinical entities ranging from unstable angina pectoris (UAP) to Q-wave myocardial infarction. Mortality rates from acute myocardial infarction (AMI) have seen a worldwide decline in recent years.
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Original Article
The Acute Presentation of Pulmonary Thromboembolism: A Retrospective Viewpoint
Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition has been sporadic.
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Others
Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations
It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in nursing homes.
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Others
Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital
Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly population above the age of 65 will rise from 7.5% in 2002 to 18.9% by the year 2030.
This article is available only as a PDF....
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...
Original Article
Work-related Injury Sustained by Foreign Workers in Singapore
Singapore has a resident population of 3.26 million and 0.53 million foreign workers. Of these half a million foreigners, 450,000 are work permit holders, typically working in lower skill industries and blue-collar sectors, e.g. construction industry.
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Others
Potentially Fatal Paracetamol Overdose and Successful Treatment with 3 Days of Intravenous N-acetylcysteine Regime – A Case Report
Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in a patient can be life threatening.
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Commentary
Clinical Cases Seen in Tsunami Hit Banda Aceh – From a Primary Health Care Perspective
Earthquakes and tsunamis can cause massive destruction over large areas, affecting the lives of many in areas hit by such disasters. The local health care system often gets disrupted and the health and well-being of the survivors may depend on disaster relief organisations from within the country as well...
Others
Financing Newborn Screening Systems: US Experience
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Others
Considerations in Choosing Screening Conditions: One (US) Approach
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Original Article
Observational Study to Determine Factors Associated with Blood Sample Haemolysis in the Emergency Department
Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in many Emergency departments (EDs), where many conditions have time-dependent outcomes, and accurate and quick blood results are thus important.
This article is available only as a...
Original Article
Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative
Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms of its ability to achieve higher patency rates, minimise infarct size, improve left ventricular function and improve long-term survival, as well as lower rates of...
Letter to the Editor
Renal Artery Embolism in a Patient with Vague Abdominal Pain
Thromboembolism is a well-known complication of mitral stenosis especially when it is associated with cardiac dysrhythmias. However, renal artery embolism is a disease that is easily missed due to its infrequent and non-specific presentations.
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Others
Clinical Characteristics of Renal Infarction in an Asian Population
Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months.
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Original Article
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 rise and accounts for nearly 30% of total population mortality.4,5 Singapore data suggests that cancer patients accounted for 13% of total healthcare costs in 2016,...
Editorial
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 a significant strain on public healthcare systems to balance the demands of the pandemic and usual medical care.
There is little literature detailing emergency department (ED)...
Letter to the Editor
Reply from Author: Putting the Wedge under Pressure
We thank the authors for their interest in our study and their insightful comments. We agree that filling pressures such as the central venous pressure and pulmonary artery wedge pressures are inaccurate in predicting cardiac output or fluid responsiveness.
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Letter to the Editor
Putting the Wedge under Pressure
We would like to thank Dr Huck Chin Chew et al for sharing their findings and we are appreciative of their work, “Oesophageal Doppler Ultrasound in the Assessment of Haemodynamic Status of Patients Admitted to the Medical Intensive Care Unit with Septic Shock”. In their paper, Dr Chew and...
Original Article
Epidemiology of Snakebites from A General Hospital in Singapore: A 5-year Retrospective Review (2004-2008)
Snakes are present even in an industrialised country like Singapore. A bite from a venomous snake can inflict much morbidity and occasionally, it can be fatal. In many countries with a large agricultural base, it poses a significant economic burden.
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Original Article
Are New Resuscitation Guidelines Better? Experience of an Asian Metropolitan Hospital
Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have better outcomes.
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Original Article
An Eight Year Review of Exercise-related Cardiac Arrests
Exercise-related cardiac arrest is uncommon, however it is devastating when it occurs in otherwise healthy adults. In young adults, vigorous physical exercise trigger cardiac arrest in those affected by silent congenital cardiovascular conditions. In older adults, sudden vigorous physical exercise increases the incidence of acute coronary events in those...
Original Article
A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore
Our tertiary hospital has a 9-bed Surgical Intensive Care Unit (SICU) that caters to all surgical disciplines except Cardio-Thoracic and Vascular Surgery (which has its own dedicated Cardio-Thoracic Intensive Care Unit).
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Original Article
Normative Data for Quantitative Calcaneal Ultrasound in Asian Children
Dual energy X-ray absorptiometry (DEXA) is currently the gold standard for the assessment of bone mineral density (BMD). It is the commonest tool used to predict fracture risk in patients at risk of osteoporosis. The limitation of DEXA is that it only measures bone density in two dimensions, and...
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...
Review Article
Cognitive Aspect of Diagnostic Errors
It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were constant distractions from the other
things he needed to attend to quickly. The patient, Madam Sumar was referred by her family doctor for chest pain with...
Original Article
Neonatal Outcome of the Late Preterm Infant (34 to 36 Weeks): The Singapore Story
Neonatologists were caught looking the other way in the early part of the millennium. While they were keenly following the progress of extreme preterms and their travails, preterms born at the other end of the spectrum were being quietly ignored as “well babies”. In July 2005, the National Institute...
Letter to the Editor
Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive pathology lies anterior to the spinal cord – prolapsed intervertebral discs (PID), ossified posterior longitudinal ligament (OPLL), spondylodiscitis and retropulsion of fractured bony fragments. More...
Letter to the Editor
Severe Vitamin B12 Deficiency in a 7-Month-Old Boy
Infantile vitamin B12 deficiency often affects children born to mothers whose nutritional intake is inadequate. We describe a 7-month-old boy with a 2-month history of recurrent vomiting, neurodevelopmental regression, failure to thrive (FTT) and macrocytic anaemia, who was diagnosed to have vitamin B12 deficiency.
This article is available only as...
Editorial
Emergency Medicine Residency Programme in Singapore—Where Are We at Since Inception?
It has been 4.5 years since the Accreditation Council for Graduate Medical Education (ACGME-I) accredited competency-based emergency medicine residency programmes were started in July 2010 in Singapore. The transit from a time-based curriculum to a competency-based curriculum, which centres on the 6 ACGME-I core competencies of ‘medical knowledge’, ‘patient...
Original Article
Risk Factors for Severe Adenovirus Infection in Children during an Outbreak in Singapore
Human adenoviruses (HAdVs) are well known pathogens that cause a variety of human illnesses. They are non-enveloped, linear double-stranded deoxyribonucleic acid (DNA) viruses. More than 50 distinct serotypes have been identified since the early 1950s. The wide spectrum of symptoms includes upper respiratory tract illness, pneumonia, conjunctivitis, cystitis and...
Letter to the Editor
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 are unique molecular signatures.1,2 Compared with the West where the annual incidence is 1–3 per million, incidence has been reported to be lower among Asians1...
Original Article
Immunomodulator use in paediatric severe sepsis and septic shock
Paediatric sepsis is one of the main causes of childhood mortality.1 Globally, paediatric severe sepsis and septic shock accounts for 6.2% to 23.1% of paediatric intensive care unit (PICU) admissions, and mortality rates can be as high as 21.3% in North America and Europe to 50.0% in Asia.2-4 Of...
Images in Medicine
A rare case of thigh asymmetry in an infant
A 6-month-old baby boy presented with asymmetry of thighs since birth. On clinical examination, anteromedial aspect of the left thigh was bulky with pale yellow discolouration of the skin and no tenderness. The child was referred for high-resolution ultrasonography. On ultrasonography, there was evidence of a well-defined isoechoic soft...
Letter to the Editor
Prevalence of vitamin D deficiency and insufficiency in Malaysian infants
Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either vitamin D deficient or insufficient. In a study on the state of Kelantan in Malaysia (2010–2012), 60% of pregnant women were vitamin D deficient. Maternal...
Letter to the Editor
Impact of true fetal mosaicism on prenatal screening and diagnosis
Over the past decade, the non-invasive prenatal test (NIPT) has increasingly been used as a method for prenatal screening for trisomy 21 (T21) and other aneuploidies, complementing the traditional approach of first trimester screening (FTS). FTS comprises ultrasound of the nuchal thickness and blood test to measure the levels...
Original Article
A review of child sexual abuse cases presenting to a paediatric emergency department
Child sexual abuse (CSA) is a global public health issue with adverse short- and long-term repercussions. Formal definitions of CSA and the age for defining children differ around the world. In Singapore, CSA refers to any act where a child or young person below 16 years old is used...
Original Article
Prevalence of thyroid malignancy and hormonal dysfunction following radiation exposure in childhood
The incidence of thyroid cancer has been steadily increasing worldwide. Childhood radiation exposure is a known risk factor for thyroid malignancy. However, data on the incidence of thyroid cancer in this high-risk cohort in Singapore are limited. Thus, we assessed data from patients treated in our institution with a...
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...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work pass issued to semiskilled workers, comprise 26.0% of Singapore’s entire labour force. Two other work passes held by FWs, “S pass” and “employment pass”, are...
Original Article
Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there are variations in the reported survival-to-hospital discharge rates among different regions in the world. In Singapore, OHCA incidence rate was 27.2 per 100,000 person-years, with...
Editorial
Community-level interventions for out-of-hospital cardiac arrests in Singapore: Yay or nay?
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and a significant public health problem globally. In Singapore, OHCA affected 11,061 adults between 2011 and 2016. Despite multiple pre-hospital and hospital-based interventions, survival rates remain low. Initiation of time-sensitive cardiopulmonary resuscitation (CPR) while waiting for emergency services arrival...
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....
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...
Letter to the Editor
Importance of antenatal blood group typing and antibody screening in non-ABO/Rh haemolytic disease of the newborn
Haemolytic disease of the fetus and newborn (HDFN) is a severe, potentially fatal alloimmune condition where maternal antibodies are produced, transported across the placenta and react against fetal red blood cell (RBC) antigens, resulting in varying degrees of haemolytic anaemia. Although ABO and Rhesus D (RhD) incompatibility is responsible...
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...
Letter to the Editor
Alternating hemiplegia of childhood presenting as recurrent apnoea in a term newborn infant
Recurrent apnoea in a term infant is usually pathologic, warranting a thorough aetiologic evaluation. An accurate diagnosis is essential in guiding subsequent management and understanding long-term prognosis.
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Original Article
Virtual reality mobile application to improve videoscopic airway training: A randomised trial
Emergency airway management is a keystone of emergency medicine practice and critical skill in residency training. An accredited emergency attending is expected to handle difficult airways that may present unexpectedly with expertise. Flexible bronchoscopic intubation (FBI) technique is considered an important option in the management of predicted difficult airways....
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...
Original Article
Epidemiology and risk stratification of minor head injuries in school-going children
Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports and road traffic injuries are common causes in school-going children. Majority of paediatric head injury cases are mild traumatic brain injuries, defined as a Glasgow...
Editorial
The Singapore Cerebral Palsy Registry: An important new resource for cerebral palsy research
Cerebral palsy (CP) is a common, lifelong disorder of movement and posture resulting from an insult or maldevelopment of the developing brain. The movement disorders of CP are often accompanied by other associated sensory and cognitive impairments. For the majority of children (about 95% in high income countries), the...
Original Article
Causes, functional outcomes and healthcare utilisation of people with cerebral palsy in Singapore
Cerebral palsy (CP) describes a group of permanent, but often changing, disorders that affect movement and posture, causing activity limitation, attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The birth prevalence of CP is estimated to be 1.4–2.2 per 1,000 in high-income countries. It...
Original Article
Emergency airway management in a Singapore centre: A registry study
Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to most intubations performed in the operating room (OR). Additionally, difficult airways are more prevalent in emergency department (ED) populations due to acute conditions such as...
Original Article
Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury
The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range from USD5.9 billion–76.5 billion. Studies performed in the adult population reported that the direct cost of acute rehabilitation had been relatively similar over a 10-year...
Letter to the Editor
Circulatory collapse from rupture of splenic artery aneurysm: A case study
Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted the management challenges faced in the emergency department (ED).
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Original Article
Epidemiology and Control of Hand, Foot and Mouth Disease in Singapore, 2001-2007
Hand, foot and mouth disease (HFMD) is a common childhood viral infection, which is typically mild and self-limiting. It is characterised by a brief prodromal fever, followed by pharyngitis, mouth ulcers and rash on the hands and feet. The disease is caused by numerous members of the Enterovirus genus...