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Delayed presentation is associated with serious bacterial infections among febrile infants: A prospective cohort study

Young infants ≤90 days old are at risk of serious bacterial infections (SBIs) due to their immature immune systems and may develop severe complications...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

Idiopathic inflammatory myopathies: Not nearly the end of the road

The clinical spectrum of idiopathic inflammatory myopathies (IIM) has broadened over the past half century from a simple disease characterised primarily by muscle and...

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...

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....

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...

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...

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...

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,...

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...

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...

Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series

Dear Editor, Thrombosis is an unexpected complication of COVID-19 initially reported in 3 patients from China.1 These patients tested positive for immunoglobulin (Ig) A anticardiolipin...

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...

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)...

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...

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...

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...

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...

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...

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...

One Hundred and Seventy Cases of Childhood Onset Rheumatological Disease in Singapore

Children with rheumatological disease form a small but important proportion of the ill paediatric population. Most of the published data available are based on...

APACHE II and SAPS II are Poorly Calibrated in a Hong Kong Intensive Care Unit

The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) scoring systems are widely used...

Systemic Sclerosis in DRw52-positive Silica-exposed Males: A Case Report

Familial scleroderma was first documented in 1953 by Rees and Bennett who described the occurrence of a localised disease in a father and daughter....

Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) Syndrome: A Brief Review of a Rare Condition

The acronym SAPHO refers to a syndrome characterised by synovitis, acne, pustulosis, hyperostosis and osteitis. In 1961, a link between acne conglobata and arthritis...

The Role of Occupational Therapy in Rheumatoid Arthritis Management

Rheumatoid arthritis is a systemic disease characterised by remissions and exacerbations that vary in severity and timing among people. Its chronic and degenerative course...

A Case of Sulindac-induced Enteropathy Resulting in Jejunal Perforation

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of various rheumatic conditions including rheumatoid arthritis (RA). The adverse effects of NSAIDs on...

Musculoskeletal Pain Clinic in Singapore—Sacroiliac Joint Somatic Dysfunction as Cause of Buttock Pain

Patient A, a 33-year-old male administrative coordinator presented with left buttock pain of 4 to 5 years duration which radiated down to the leg...

Intra-Synovial Corticosteroid Injections in Juvenile Chronic Arthritis—A Review

Locally injected intra-synovial corticosteroids are useful to target selected joint, tendon sheath or bursal inflammation in children with pauciarticular or polyarticular juvenile chronic arthritis...

Osteoporosis—The Need for a Paradigm Shift

Osteoporosis is becoming an increasing public health problem in most countries. Osteoporosis literally means “porous bones” and involves skeletal fragility leading to an increased...

Managing Problem Gout

Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval...

Lipid Disorders and Rheumatic Diseases

The relationship between lipid disorders and arthritis is manifold. Hyperlipidaemia may manifest clinically in the musculoskeletal system. In 1968, Khachadurian studied 14 families of...

Rheumatoid Arthritis—A Review

Rheumatoid arthritis (RA) is a chronic inflammatory arthritis which is occasionally associated with extraarticular manifestations. Although the first good clinical description was by Landre-Beauvais...

Imaging of Thoracic Manifestations of Scleroderma

Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys,...

Overview of Imaging in Rheumatologic Diseases

Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations...

Advances in Antiphospholipid (Hughes’) Syndrome

Phospholipids (PLs) are components of cell membranes. Their function is not only to maintain the structure of the membranes but also to modify the...

The Appropriate Use of Antineutrophil Cytoplasmic Antibody (ANCA) Testing in Rheumatic Diseases

In 1982, Davies and co-workers in Melbourne described the presence of a serum factor that stained the cytoplasm of neutrophil leukocytes by indirect immunofluorescence...

Oral Tolerance: Mechanisms and Therapy of Autoimmune Diseases

Immunologic tolerance is a hallmark of the immune system whereby immune cells are tolerant of self antigen. Historically, this tolerance was thought to be...

The Genetics of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic rheumatic disease characterised by protean clinical manifestations as well as the presence of multiple autoantibodies. Tissue deposition...

Systemic Lupus Erythematosus in Singapore

Systemic lupus erythematosus (SLE) or lupus (“wolf” in Latin) in short, is an autoimmune disorder of unknown aetiology(ies) and characterised by diverse clinical manifestations...

Murine Lupus: Pathogenic Mechanisms and Genetic Origins

The complex and non organ-specific nature of systemic lupus erythematosus (SLE) has made it difficult for researchers to unravel the genetic defects and pathogenic...

Education in Rheumatology

The fact that there is an increasing and growing need in societies for care of sufferers of rheumatic conditions can be shown from national...

The Sensitivity and Specificity of Autoantibodies to the Sm Antigen in the Diagnosis of Systemic Lupus Erythematosus

The presence of multiple autoantibodies is the hallmark of systemic lupus erythematosus (SLE). Many of these autoantibodies target nuclear antigens e.g. histones, Sm, RNP,...

Clinical Predictors of Nephritis in Systemic Lupus Erythematosus

Lupus nephritis is a common manifestation of lupus associated with significant morbidity and mortality. The use of cytotoxic agents has resulted in improved renal...

Adult-onset Still’s Disease in an Oriental Population: Manifestations, Course and Outcome in 16 Patients

Although George Still first described systemic onset juvenile rheumatoid arthritis (JRA) comprising fever, arthritis, lymphadenopathy and splenomegaly in 1897, it was not until 1971...

Clinical Presentation and Disease Associations of Gout: A Hospital-based Study of 100 Patients in Singapore

Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate...

Ankylosing Spondylitis in Singapore: A Study of 150 Patients and a Local Update

Back pain is a common but often self-limiting problem. However, it is important to recognise causes of chronic backache such as ankylosing spondylitis which...

Development of Rheumatology in Singapore

Patients with rheumatic diseases frequently consult primary care physicians, internists and orthopaedic surgeons. In the past, few doctors took interest in these diseases. This 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...

A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block

The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is...

The Genetics of Spondyloarthropathies

The spondyloarthropathies (SpA) comprise a heterogenous group of conditions that include ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis/Reiter’s syndrome, arthritis associated with inflammatory bowel...

Traditional Chinese Medicines as Immunosuppressive Agents

Traditional Chinese Medicines (TCM) are derivatives of natural products that have been used for centuries in China to treat a variety of human disorders,...

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...

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...

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...

An Audit of Patients with Rheumatic Disease Requiring Medical Intensive Care

Patients with rheumatic disease are often immunocompromised as a result of either their disease or treatment. They may become ill either from a flare...

New Disease Modifying Agents in Adult Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by symmetrical inflammatory arthritis. Most patients exhibit a chronic course. This article is available only as...

New Cyclooxygenase Inhibitors

Cyclooxygenase inhibitors are non-steroidal anti-inflammatory drugs (NSAIDs). They have been used in the treatment of rheumatic diseases for several decades. This article is available only...

10th Seah Cheng Siang Memorial Lecture: Going Places—A Rheumatological Odyssey

I am greatly honoured to deliver the 10th Seah Cheng Siang memorial lecture. I came into direct contact with Professor Seah in January 1965...

Immunotherapy in Autoimmune Diseases

In the early 1700s, Lady Mary Wortley Montagu, wife of the British ambassador to Turkey, introduced the practice of variolation against smallpox into Western...

Outcome of Pregnancy in Asian Women with Systemic Lupus Erythematosus: Experience of a Single Perinatal Centre in Singapore

Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more...

The Bone and Joint Decade 2000-2010: For Prevention and Treatment of Musculoskeletal Disease

The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its...

Steroid-induced Osteoporosis

Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed....

Primary Meningococcal Arthritis and Endogenous Endophthalmitis: A Case Report

Primary meningococcal arthritis (PMA) and endogenous meningococcal endophthalmitis are both uncommon presentations of meningococcal infection that should be considered in the differential diagnosis of...

Validity and Reliability of the EQ-5D Self-report Questionnaire in Chinese-speaking Patients with Rheumatic Diseases in Singapore

Health-related quality of life (HRQoL) refers to patients’ perceptions of their own functioning and well-being. HRQoL is increasingly being used as a primary or...

Intermittent Epoprostenol Infusions in Systemic Lupus Erythematosus Associated Pulmonary Hypertension—A Series of Three Cases

Pulmonary hypertension (PHT) is seen in 0.5% to 14% of systemic lupus erythematosus (SLE) patients and is associated with a grave prognosis. The overall...

Behcet’s Disease: Experience in a Tertiary Rheumatology Centre in Singapore and a Review of the Literature

The only published study on Behcet’s disease in Singapore by Tan E et al (34 patients at the National Skin Centre) found that only...

Septic Monoarthritis and Osteomyelitis in an Elderly Man Following Klebsiella pneumoniae Genitourinary Infection: Case Report

Despite improved antimicrobial therapy over the past 30 years, there has been little change in the incidence, outcome, or, causative organisms in septic arthritis....

Financing Newborn Screening Systems: US Experience

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Considerations in Choosing Screening Conditions: One (US) Approach

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Value of Joint Aspirations in the Diagnosis and Management of Arthritis in a Hospital-based Rheumatology Service

Joint aspiration with synovial fluid analysis can provide information which complements that which is available from the history and physical examination of the patient,...

Forestier’s Disease Presenting as a Retropharyngeal Mass in an Elderly with Dysphagia

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a non-inflammatory enthesopathy of unknown etiology. Affecting predominantly men, it results in flowing,...

Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden

Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from...

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...

Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?

A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron emission tomography/computed...

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...

Is the Apprehension Test Sufficient for the Diagnosis of Anterior Shoulder Instability in Young Patients without Magnetic Resonance Imaging (MRI)?

A good history and a detailed physical examination is often sufficient to make a diagnosis of a recurrent anterior dislocation of the shoulder, even...

Acute Onset Polyarthritis with Pitting Edema: Is it RS3PE?

A 48-year-old female presented with pain and swelling in the bilateral proximal interphalangeal (PIP), metacarpophalangeal (MCP) and wrist joints for the past 20 days....

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Herpes zoster-associated aseptic arthritis in adult patients: A case report

Aseptic arthritis can often be associated with viruses— in the Singapore context—dengue or chikungunya viruses. The association of varicella-zoster virus (VZV) with arthritis however,...

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...

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...

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...

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...

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...

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...

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...

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...

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...