Original Article
Prevalence of complexity in primary care and its associated factors: A Singapore experience
As Singapore’s population ages, the incidence of non-communicable chronic diseases will rise in tandem.1 There exists a subset of individuals, oftentimes elderly with multiple chronic conditions, whose care needs are particularly complex.2 While there is no universal definition of a person with complex needs, these individuals have been found...
Review Article
Mechanisms and roles of hydroxychloroquine in pregnancy in rheumatic diseases
With the prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) around the world, hydroxychloroquine (HCQ) has once again come into public attention due to its potential therapeutic role in COVID-19. HCQ is a classic antimalarial drug that belongs to the 4-aminoquinoline phospholipase A2 inhibitors. It was first introduced...
Letter to the Editor
Knowledge and attitudes towards sarcopenia among healthcare professionals
Dear Editor,
Sarcopenia is the age-related loss of skeletal muscle mass as well as muscle strength and/or performance.1 Sarcopenia is an important public health issue as it has a significant impact on patient health outcomes, and personal and social economic outcomes. It leads to increased adverse outcomes such as increased...
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
Knowledge, attitudes and readiness of final-year medical students towards clinical goals-of-care discussion
Dear Editor,
In a rapidly ageing global population,1 there is increasing recognition of the importance of clinical goals-of-care (GOC) discussions aimed at understanding patients’ goals, wishes and care preferences in the event of serious illness or end-of-life situations,2 in order to affirm patient-centred decision-making, improve quality of life and facilitate...
Letter to the Editor
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...
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...
Review Article
Pharmacogenomics in psychiatry: Practice recommendations from an Asian perspective (2024)
Pharmacogenomic testing in psychiatry is an emerging area with the potential clinical application of guiding medication choice and dosing. Interest in this area has been fanned by commercial pharmacogenomic providers, who have commonly marketed multiple-gene or combinatorial panels that are direct-to-consumer tests. However, this has not been adopted widely...
Editorial
The promise and challenges of pharmacogenomics in psychiatry
Pharmacogenomics (PGx) is an expanding field within precision medicine that is poised to play a crucial role in optimising patient outcomes, particularly in the realm of psychiatry. The remission rate for the initial antidepressant prescribed in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial was only approximately 30%,...
Editorial
Intrapleural fibrinolytic therapy: How low can we get?
Pleural infection is a common medical problem with significant mortality and morbidity.1 Despite advances in antibiotic therapy, the incidence of pleural infection is increasing in the Western world. The management of complicated pleural infections usually involves drainage of pleural effusion from the infected pleural cavity, typically with a pleural...
Original Article
Intrapleural fibrinolytic therapy for pleural infections: Outcomes from a cohort study
Pleural infection, defined as bacterial infection and replication in the pleural space,1 remains a significant cause of mortality.2 Over 80,000 cases of pleural infection are diagnosed each year in the US and the UK.3,4 Data from East Asia suggest that the annual incidence of pleural infections is 8.4 to...
Letter to the Editor
Prevalence and causes of rifampicin-resistance genotypic/phenotypic discrepancy detected on Xpert MTB/RIF in Singapore
Dear Editor,
The Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) (Cepheid, Sunnyvale, CA, US) has been pivotal in tuberculosis (TB) diagnostics, enabling the rapid detection of both TB and RIF resistance. Xpert, a nucleic acid amplification test (NAAT), is recommended by both the World Health Organization (WHO)1 and Singapore's clinical management guidelines2 as...
Commentary
Transforming medical education in the AI era: Balancing technological expertise with humanistic care in tomorrow’s doctors
Standing at the precipice of a new era in healthcare, the integration of artificial intelligence (AI) into clinical practice is progressing at an unprecedented pace. From AI algorithms detecting tumours with remarkable accuracy to predictive models forecasting patient outcomes, these technological marvels are not only changing how we practice...
Letter to the Editor
Natural Language Processing for serious illness communications in palliative surgical oncology
Dear Editor,
Approximately one-fifth of surgeries performed at major cancer centres worldwide are palliative in nature, and one-third of advanced cancer patients receive surgery during their last year of life.1,2 Serious illness communication (SIC) is an essential component of palliative care. In the context of palliative surgical oncology, the surgical...
Review Article
Corticosteroids in critically ill patients with community-acquired pneumonia: A systematic review and Bayesian meta-analysis
Community-acquired pneumonia (CAP) is a common cause of hospital mortality. Each year, in the US alone, more than 1.5 million pneumonia patients are hospitalised, and 1 in 3 of them die within 1 year.1 Mortality is the highest among patients requiring organ support in the intensive care unit (ICU)....
Original Article
Gender dysphoria in children and adolescents: A retrospective analysis of cases in Singapore
The understanding of gender dysphoria (GD) has evolved significantly, from early conflations of sexual orientation and gender identity to its recognition as a distinct condition characterised by gender incongruence. GD is now classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).1 GD is currently defined...
Letter to the Editor
Traction alopecia in women: An under-recognised cause of hair loss
Dear Editor,
Alopecia ranks among the most common clinical complaints encountered by dermatologists.1 In particular, affected women often experience great psycho-emotional stress leading to a reduction in quality of life.2
We conducted a prospective epidemiological study conducted over 77 weeks from 1 August 2022 to 23 January 2024 at an outpatient...
Original Article
Factors influencing smoking cessation: Insights from Singapore’s nationwide health and lifestyle survey
The global prevalence of smoking has declined over the years. According to authors utilising data from the Global Burden of Disease, Injuries, and Risk Factors Study, from 1990 to 2020, the number of male smokers fell by 27.2%, whereas female smokers fell by 37.9%.1 Moreover, the decline in smoking...
Original Article
Five-year outcomes of a holistic programme for managing early chronic kidney disease in primary care
Singapore has the third highest incidence and sixth highest prevalence of end-stage kidney disease (ESKD) in the world.1 Globally, chronic kidney disease (CKD) is estimated to affect over 850 million people, with a prevalence of 13.4% among adults worldwide.2 Diabetes is the main cause of ESKD in new patients...
Original Article
Enhancing guidelines for managing cognitively impaired drivers: Insights from Western evidence for Asian adaptation
Licensing authorities rely on medical certifications of fitness-to-drive when renewing licence for drivers who are at higher risk of crashes. Drivers with cognitive impairment are 2 to 8 times more likely to be involved in a crash compared to those without such impairments,1 and studies show they have a...
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
Long-term outcomes of subthalamic nucleus deep brain stimulation for Parkinson’s disease in Singapore
Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disorder characterised by motor symptoms such as limb bradykinesia, rigidity and resting tremor.1 Non-motor symptoms, including mood disturbances, cognitive impairment, autonomic dysfunction, and sleep disorders, are also common. Disease progression often leads to motor fluctuations and dyskinesias, along with worsening...
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...
Letter to the Editor
Using artificial intelligence as an ethics advisor
Dear Editor,
Ethical dilemmas are common in the practice of medicine and can lead to an array of seemingly reasonable decisions unless policies or regulations mandate certain actions. Choosing the appropriate solution requires not only biomedical evidence, but also requires the balancing of possibly divergent preferences, values, contextual factors and...
Letter to the Editor
The emergence of otter attacks in Singapore: A case series and strategies for management
Dear Editor,
Singapore is experiencing an unprecedented increase in the number of smooth-coated otters (Lutrogale perspicillata). Since 2017, the local otter population has more than doubled to at least 170. This has led to an increase in the number of otter-human attacks since 2021.1,2 While common animal attacks like dog...
Letter to the Editor
Gaps in primary care management of urinary tract infections in Singapore
Dear Editor,
Urinary tract infection (UTI) is a common presentation in primary care, but gaps of care have not been well established in Singapore. UTIs are one of the most common bacterial infections worldwide,1 constituting around 1% of all ambulatory clinic visits.2 The healthcare burden of UTIs remains highly significant,...
Original Article
Screen time and social-emotional skills in preschoolers with developmental, behavioural or emotional issues in Singapore
Preschool children, particularly those with developmental, behavioural or emotional (DBE) issues, are highly vulnerable to the negative effects of excessive screen viewing time (SVT) on their social and emotional development.1,2 Singapore, an island nation with a declining birth rate,3 places significant emphasis on human potential, particularly the social and...
Editorial
Balancing screen time: Insights and impact on preschool children
Over the past decade, the exposure of young children to screen devices at home and preschool has become increasingly common. Screen viewing time (SVT) has risen alongside the surge in ownership of screen devices such as television, smartphones, tablets and laptops worldwide.1 In many countries, screen time and digital...
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
Healthcare burden of cognitive impairment: Evidence from a Singapore Chinese health study
Individuals with cognitive impairment (CI) are predisposed to injuries, infections and treatment complications,1 have poorer treatment compliance, and face greater difficulties with post-discharge care.2 These challenges, exacerbated by comorbidities,3-6 lead to poorer ambulatory care management, reduced contacts with primary and outpatient care providers, and greater use of emergency department...
Original Article
Prevalence of consumption of illicit drugs and associated factors from a nationwide epidemiological survey: The Singapore Health and Lifestyle Survey
Substance use disorders (SUDs) are characterised by the uncontrolled use of a substance by an individual despite its harmful consequences.1,2 The prevalence of consumption of substances and SUDs varies widely across countries. This difference in prevalence can be attributed to factors such as study methodology (the substance included in...
Letter to the Editor
VOWELS: A communication framework for disclosing medical errors in medical oncology and palliative care
Dear Editor,
Recognising the impact of medical errors on patients and the doctor-patient relationship has underscored the need for better communication.1,2 For the most part, these efforts are informed by Chafe et al.’s 6 steps that entail: (1) the identification of the error in a timely fashion; (2) determination of...
Letter to the Editor
Validating two international warfarin pharmacogenetic dosing algorithms for estimating the maintenance dose for patients in Singapore
Dear Editor,
Predicting optimal warfarin dosing is difficult due to complex pharmacodynamics and pharmacokinetics, narrow therapeutic index and susceptibility to many factors.1 Genetic variations of the CYP2C9 and VKORC1 enzymes, occurring in different frequencies in different populations, play a significant role in determining warfarin dosing.1-4 Using pharmacogenetic dosing algorithms to...
Letter to the Editor
Hantavirus haemorrhagic fever and renal syndrome, caused by the Hantaan virus in Singapore: A case report
Dear Editor,
We outline a case of a 59-year-old Malaysian man of Indian origin with no known past medical history apart from diabetes mellitus and hypertension, who presented with a 7-day history of unrelenting fever, myalgia, confusion and unsteady gait. He worked as a shipyard engineer and travelled between Singapore...
Original Article
Frailty-aware surgical care: Validation of Hospital Frailty Risk Score (HFRS) in older surgical patients
Frailty is a clinically recognisable state of vulnerability in older people, resulting from age-associated decline in physiological reserves and function across multiple organ systems, such that the ability to cope with acute stressors is compromised.1 Frailty is prevalent among older people2 and is associated with higher rates of utilisation...
Original Article
Risk of dementia in the elderly with non-alcoholic fatty liver disease: A nested case-control study in the Republic of Korea
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease affecting about 25% of the general population.1,2 NAFLD has a broad disease spectrum ranging from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH)/liver cirrhosis, resulting in increased risk of developing not only liver-related complications but also extrahepatic morbidities.3...
Letter to the Editor
Outcomes of patients admitted for drowning
Dear Editor,
According to the latest Utstein-style consensus, drowning is defined as the primary respiratory impairment resulting from submersion or immersion in a liquid medium.1 Patients may experience hypothermia, acute respiratory distress syndrome and shock.1 The pathophysiology is poorly understood, but could relate to physiological responses to temperature, water swallowing...
Review Article
Through the eyes into the brain, using artificial intelligence
Neurological dysfunction is a leading cause of disability, affecting more than 276 million people worldwide.1 Over the last decades, the prevalence of neurological dysfunction has increased, particularly in the ageing population which is commonly affected by dementia, stroke and brain tumours.1,2 The increasing number of patients suffering from neurological...
Original Article
Low skeletal muscle mass predicts poor prognosis of elderly patients after emergency laparotomy: A single Asian institution experience
Emergency laparotomy (ELAP) for elderly patients is associated with higher mortality and increased postoperative complications compared with those undergoing elective surgery.1-3 Elderly patients, who are more likely to have comorbidities, have lower functional reserves to cope with the increased physiological demand due to their acute illness and eventual surgical...
Editorial
ICU nutrition: Bracing for the silver tsunami
The global population’s life expectancy is growing with a steady increase in the proportion of older patients admitted to the intensive care unit (ICU).1 Up to 13% of the ICU patients are above the age of 80.2 Older critically ill patients have lower physiological reserves of the various organ...
Original Article
Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore
The Patient-Centred Medical Home (PCMH) is a model of chronic care that replaces episodic primary care, with the delivery of primary care to patients, families and communities. It is guided by the principles of first-contact accessibility, comprehensiveness and whole-person orientation, integration and care coordination, sustained clinician-patient relationships, and quality...
Letter to the Editor
Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
Dear Editor,
The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an accompanying editorial were published in the January 2022 issue of the Annals.1,2 An evidence-based approach was used with reference made to relevant published literature. The...
Letter to the Editor
Sedation in gastrointestinal endoscopy in Singapore
Dear Editor,
I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during endoscopy in the hospital setting”2 in your journal in January 2022.
The American Society of Gastrointestinal Endoscopy (ASGE) and the European...
Letter to the Editor
Non-anaesthesiologists administering propofol in the Singapore context
Dear Editor,
Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid onset of action and fast post-procedural recovery.1 Nonetheless, propofol depresses cardiorespiratory function and could result in life-threatening adverse effects.
A workgroup, mainly consisting of gastroenterologists and...
Letter to the Editor
Sedation by non-anaesthesiologists in gastrointestinal endoscopy
Dear Editor,
We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. We are especially intrigued by Statement 6, stating that propofol sedation for endoscopy can be safely and effectively administered by trained...
Original Article
Epidemiological trends and outcomes of children with aural foreign bodies in Singapore
Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to their inquisitive minds and experimental nature.1 Aetiologies for aural FBs include accidental or intentional insertion of FBs into body orifices, ear irritation caused by rhinitis...
Original Article
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...
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...
Others
Creutzfeldt-Jakob Disease Presenting with Visual Blurring, Diplopia and Visual Loss: Heidenhain’s Variant
The electroencephalographic pattern is distinctive in many but not in all patients with Creutzfeldt-Jakob disease (CJD). Often, it is one of diffuse and non-specific slowing in the background with stereotypical generalised periodic high-voltage slow and sharp wave complexes.
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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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Others
Disseminated Penicillium marneffei Infection: A Report of Five Cases in Singapore
Penicillium marneffei is a dimorphic fungus that can cause infection in immunocompromised hosts. Reports on infection with this organism were initially uncommon, but after the first report of disseminated P. marneffei infection in a HIV-infected individual from Bangkok in 1989, the incidence has increased markedly, almost exclusively in patients...
Original Article
Swallowing Impairment and Feeding Dependency in the Hospitalised Elderly
Loss of ability to feed independently and swallowing impairment are common problems in the elderly and will be an increasing cause of disability as the population ages. A study in Europe suggested that up to 10% of people older than 50 experience troublesome dysphagia.
This article is available only as...
Others
Clinical Drug Trials: Practical Problems of Phase III
There has been a rapid increase in clinical trial activity in Singapore and other parts of Asia. Randomised clinical trials are the “gold standard” in study design, which enable the question of efficacy of different treatments or managements to be effectively compared.
This article is available only as a PDF....
Original Article
Deep Vein Thrombosis after Total Knee Replacement
Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis, its incidence is quoted between 46% and 84% in various studies.
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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...
Original Article
Incidence and risk factors of delirium in post-anaesthesia care unit
Post-anaesthesia care unit (PACU) delirium is defined as a disorder in thought processes that affect cognition in terms of memory, comprehension and attention.1 It has a strong association with postoperative delirium, which is present in up to 45% of patients after surgery.2-5 PACU is a wide-reaching problem, and especially...
Editorial
Delirium in patients following general anaesthesia
Delirium is a disturbance of consciousness characterised by an acute onset and fluctuating course of inattention, accompanied by either a change in cognition or a disorganised thinking, resulting in an impaired ability of the patient to receive, process, store and recall information. Delirium develops over a short period of...
Others
Introduction of Problem-based Learning in a Traditional Medical Curriculum in Singapore—Students’ and Tutors’ Perspectives
The National University of Singapore was started in 1905. Since then, it has trained many generations of medical practitioners.
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Original Article
A Retrospective Study of Melanocytic Naevi at the National Skin Centre
Melanocytic naevi are benign proliferation of melanocytes of congenital and acquired types which usually appear during adolescence or early adult life. Naevi are of three common subtypes i.e. junctional, compound and intradermal melanocytic naevi, with characteristic clinical appearance that aids in clinical diagnosis.
This article is available only as a...
Original Article
Measuring Health-related Quality of Life in Singapore: Normal Values for the English and Chinese SF-36 Health Survey
Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many chronic illnesses. With improvements in survival, patients’ perceptions of health are increasingly being recognised as an important outcome in clinical medicine, especially in illnesses where...
Original Article
Nursing Home Falls: A Local Perspective
Falls in the elderly has been a well-studied subject and now occupies an important place in geriatric medicine. While many studies have been done on falls in community-dwelling elderly, relatively few studies have focused on the problem in institutionalised elderly.
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Review Article
Aged Care Issues and Services in Australia
In Australia, the number of elderly people is increasing rapidly. In 2001, the population of Australia was approximately 19 million people and about 12.6% of this population were >65 years old.
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Review Article
Aged Care Services in Singapore – An Overview
The last century has witnessed the establishment of geriatric medicine as a well-recognised medical specialty supported by a respectable body of evidence, which shows that it is able to improve the health outcomes of frail older persons. Since the pioneering work of Marjory Warren in the 1930s, different models...
Others
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 secondary endpoint in clinical research and is essential in economic evaluation of new and often expensive therapies.
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Editorial
Severe Acute Respiratory Syndrome (SARS) — 150 Days On
The Severe Acute Respiratory Syndrome (SARS) has been identified as a new clinical entity in the year 2003. It was on 12 March 2003 that the World Health Organization (WHO) issued a global health alert on the disease then known as atypical pneumonia.
This article is available only as a...
Review Article
Eating Disorders in Singapore: A Review
Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms of shape/weight dissatisfaction and eating abnormalities. Anorexia nervosa is characterised by significant self-induced weight loss secondary to fear of fatness, amenorrhoea (cessation of menstruation for...
Review Article
Youth Suicide and Parasuicide in Singapore
The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or herself in the knowledge, or expectation, of its fatal outcome. Parasuicide or attempted suicide is distinguished from suicide by the non-fatal outcome.
This article is available...
Others
Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore
Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to 1.0 per million population. However, the incidence of CJD in the Singaporean population is not known. With a population of 4 million, an estimated 2...
Original Article
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 15% had arthritis and 6% had eye complications with no other systemic manifestations. These findings are different from epidemiological studies from other countries published in...
Original Article
Characteristics and Acute Rehabilitation of Guillain-Barré Syndrome in Singapore
The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is the most common cause of acute neuromuscular paralysis.
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Original Article
Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore
Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase in prevalence has also been attributed to the changes in lifestyle and urbanisation in developed countries.
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Original Article
Early Dengue Infection and Outcome Study (EDEN) – Study Design and Preliminary Findings
Dengue fever/dengue haemorrhagic fever (DF/DHF) is a re-emerging disease that is endemic in the tropical world. It is caused by 4 closely-related dengue viruses which are transmitted by the Aedes mosquitoes, principally the Aedes aegypti mosquito.
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Original Article
SARS in Singapore – Predictors of Disease Severity
Severe acute respiratory syndrome (SARS) is a recently defined illness caused by a novel coronavirus. The outbreak in Singapore originated from Hong Kong via mainland China.
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Original Article
The Clinical Predictors of Hypertension and Sleepiness in an Asian Population with Sleep-disordered Breathing
Sleep physicians have only recently began to learn much about the epidemiology of sleep-disordered breathing (SDB) from large, well conducted prospective community-based studies. These studies have helped identify the risk factors for identifying sleep apnoea, particularly in the Western population.
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Others
The Future of Medical Education: The Second 100 Years
This is a proud year for the medical profession in Singapore, as we celebrate 100 years of medical education. As the oldest faculty in Singapore’s first university, we are reminded that it was the Medical School which laid the foundation for tertiary education in Singapore. It is appropriate that...
Others
The Medical Students’ Societies and Medical Students’ Publications
For a very long time, King Edward VII (endearingly abbreviated “KE”) was synonymous with the medical school and its associated hall of residence. The name was first used for the School (later called College) in 1912 in recognition of a substantial gift from the King Edward VII Memorial Fund....
Others
The Teaching of Radiology
A record of Diagnostic Radiology would be incomplete without reference to Wilheim Roentgen, who discovered the rays that he could not comprehend; hence, X-rays. The day was Friday, 8 November 1895, as he worked on cathode ray tubes at the University of Wurzburg, Germany. These rays penetrated opaque substances,...
Original Article
In vitro Activities of Antifungal Drugs Against Yeasts Isolated from Blood Cultures and Moulds Isolated from Various Clinically Significant Sites in Singapore
Fungaemia carries with it high mortality rates and appropriate as well as timely antifungal therapy has been shown to be life saving. Amphotericin B has the broadest coverage amongst the antifungal drugs against fungal infection, and was regarded the gold standard treatment for severe fungal infection.
This article is available...
Editorial
Antimicrobial Resistance: A New Beginning and the Need for Action
In this issue, the articles (historical, original and review papers) highlight the extent and problem of antimicrobial resistance in Singapore. The authors should be congratulated on their efforts.
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Commentary
The Media and Suicide
Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020. This is equal to the burden due to wars and homicide, roughly twice the burden of diabetes and equal to the...
Original Article
Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme
Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM) worldwide, with 8.2% of Singapore adults between the ages of 18 and 69 having diabetes and there is little data on the prevalence of diabetic...
Others
A Doctor’s Duty is to Heal the Unhealthy: The Story of Tun Dr Mahathir Mohamad
Mahathir Mohamad was born in 1925 in Alor Setar, Kedah. In 1947, after living through the turbulent times of the Second World War, he entered the King Edward VII College of Medicine in Singapore. He graduated in 1953, and was in government service for the next 4 years before...
Original Article
Concurrent Chemoradiotherapy followed by Surgery in Locally Advanced Squamous Cell Carcinoma of the Oesophagus: A Single Centre Experience
Carcinoma of the oesophagus is a relatively uncommon malignancy in Singapore and incidence rates have been declining since 1968. A total of 506 cases were diagnosed from 1993 to 1997. The age-standardised rate for the same period was 5.8 per 100,000.1 The predominant histologic type is squamous cell carcinoma,...
Review Article
The Prevalence of Psychological and Psychiatric Sequelae of Cancer in the Elderly – How Much Do We Know?
Across the globe, there has been a rapid increase in the absolute and relative numbers of older persons. According to the 1993 World Bank report, the number of people aged 65 and above will form 1 in 4 of the population in 2025.1 The projected percentage increase in the...
Original Article
Acceptance of Prophylactic Surgery and Chemoprevention of Cancer in Singapore – A Survey
The Singapore healthcare philosophy aims to establish a healthy population through preventive healthcare programmes and public health education. Public education usually emphasises the adverse consequences of harmful habits like smoking, alcohol consumption, poor dietary habits and sedentary lifestyles that may contribute to chronic and fatal diseases such as ischaemic...
Original Article
Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care
The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the threat of an avian influenza (AI) pandemic is imminent. Healthcare institutions are expected to be key players during a pandemic, with healthcare workers (HCWs) at...
Original Article
Concomitant Use of Midazolam and Buprenorphine and its Implications Among Drug Users in Singapore
Benzodiazepines (BDZs) (commonly known as “sleeping pills”) are routinely and successfully used in the treatment of sleep and anxiety disorders. However, studies have indicated that BZD use among injecting drug users (IDUs) constitutes a major clinical and public health problem. Misuse has been linked to higher rates of risk-taking...
Others
A Brief History of Pathology and the Chapter of Pathologists
A history of the Chapter of Pathologists would be incomplete without a history of the specialty of Pathology in Singapore. Pathology is in fact the first specialty practiced in Singapore. This was due to the seriousness of the public health situation and infections like water borne diseases in Singapore...
Others
From the Chapter of Physicians, Academy of Medicine, Singapore to the College of Physicians, Singapore
The transformation of the previous Chapter of Physicians, Academy of Medicine, Singapore to the current College of Physicians, Singapore in 2004 was the outcome of a steady progress in and a natural evolution of medical specialty development in Singapore. Just like the Academy which was established in 1957 as...
Others
From the Chapter of Anaesthetists to the College of Anaesthesiologists, Singapore
The arrival of Sir Stamford Raffles in 1819 herald the birth of western medicine in Singapore. Doctors were then sent here from Britain. These early doctors were ‘jack of all trades’ practising everything from public health to pathology. They had difficulties communicating with the locals and had little knowledge...
Others
Academy of Medicine, Singapore – The Next Twenty-Five Years (1982-2007)
The Academy of Medicine was founded in 1957 as the professional corporate body of medical and dental specialists in Singapore. From a modest beginning with only 34 members, it has since grown in membership, activities, stature and international reputation. Of special mention among the major activities in the first...
Original Article
Epidemiology, Management and Treatment Outcome of Medulloblastoma in Singapore
Medulloblastoma (MBL) is the most common type of malignant brain tumour in childhood. It belongs to the group of tumours known as primitive neuroectodermal tumour (PNET), which is a highly malignant, small round blue cell tumour of the central nervous system. The term “medulloblastoma” is classically reserved for PNETs...
Original Article
Timing of Hospital Presentation After Acute Cerebral Infarction and Patients’ Acceptance of Intravenous Thrombolysi
Intravenous thrombolysis in acute cerebral infarction has been proven to be efficacious in improving functional outcome if given within 3 hours from stroke onset.1 Singapore recently received national licensing for the use of intravenous thrombolysis for this indication. Delay in hospital presentation is an important hindrance to the administration...
Original Article
Demographic and Clinical Features of 150 Pathological Gamblers Referred to a Community Addictions Programme
Pathological gambling has been defined as a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and work life. The diagnosis is not made if the gambling behaviour is better accounted for by a Manic Episode .1 Diagnostic criteria are similar to those for substance dependence and include...
Original Article
Multimodal prehabilitation before major abdominal surgery: A retrospective study
Ageing is one of the biggest public health concerns of the 21st century, presenting a challenge to the practice of medicine globally. As the Singapore population ages, research is needed to refine our knowledge in the care of older persons and the frail, so that better methods of care...
Others
Successful Rehabilitation With Cochlear Implant in Post-irradiation Induced Hearing Loss in Nasopharyngeal Carcinoma Patient
Nasopharyngeal carcinoma (NPC) is a common disease in Asia.1 Radiotherapy is the mainstay of treatment. Following radiotherapy, complications like profound sensorineural hearing loss may occur. If functionally active auditory fibres survive and there are no signs of recurrent tumour, we believe that successful rehabilitation is possible with a cochlear...
Original Article
A Prospective Cohort Study on the Impact of a Modified Basic Military Training (mBMT) Programme Based on Pre-enlistment Fitness Stratification Amongst Asian Military Enlistees
Basic military training (BMT) is seen as a vital initiation phase into military service when new recruits are conditioned to the rigours of military training in terms of physical and combat fitness. This training period assumes a great significance in Singapore where all able-bodied males between the ages of...
Original Article
Where the Elderly Die: The Influence of Socio-Demographic Factors and Cause of Death on People Dying at Home
The subject of place of death was brought to the forefront of the medical community in July 2004 when 2 important publications were released; one by the World Health Organization1 and another from the House of Commons Select Committee on Health.2 Both reports highlighted that the proportion of deaths...
Original Article
Trends in Importation of Communicable Diseases into Singapore
Singapore is a city-state in Southeast Asia, with a total population in 2007 of 4,839,400, of which 3,642,700 (75.3%) are Singaporean residents. The remaining 25% constitute of immigrant workers on work permit, foreigners on employment pass, and student pass holders.
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Original Article
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 13.7 million people in 2005 to 64.6 million people in 2050.
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Original Article
Acceptance of Information and Communication Technologies for Healthcare Delivery: A SingHealth Polyclinics Study
Information and communication technologies, such as internet portal and short message system (SMS), are increasingly used in healthcare delivery worldwide.1,2 Typically, these technologies are used to facilitate or enhance communication and exchange of information between patients and doctors or other health professionals. Both healthcare consumers and providers can benefit...
Original Article
Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later
Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom onset, utilisation is limited by delayed arrival of most patients to hospital.
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Original Article
Junior Doctors’ Attitudes Towards Older Adults and its Correlates in a Tertiary-care Public Hospital
Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.8% of the population in 1995 and is projected to increase to 20% by the year 2030. The medical community is also faced with a similar problem in caring for an ageing...
Original Article
Diagnostic Accuracy of Anthropometric Indices for Obesity Screening Among Asian Adolescents
Obesity or excess body fat is strongly associated with enhanced risks of morbidity and mortality, and its prevalence is rapidly escalating worldwide. Despite these concerns, no standard definition of obesity for screening, diagnosis and subsequent intervention has been agreed upon internationally. The current definitions are mostly defined statistically, and...
Original Article
Health-related Quality of Life is Associated with Diabetic Complications, but not with Short-term Diabetic Control in Primary Care
Type 2 diabetes mellitus is a major chronic disease globally. With increasing life expectancy, long-term complications of diabetes mellitus leading to significant morbidity and mortality have great impact on each patient’s health. Health-related quality of life refers to a person’s self-perceived functioning and well-being, and is increasingly used to...
Original Article
Quality of Life in Pathological Gamblers in a Multiethnic Asian Setting
Pathological gambling is categorized under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) as an impulse control disorder not elsewhere classified. The disorder is characterised by an excess preoccupation with gambling, need to gamble with increasing amounts of money in order to achieve the desired excitement,...
Original Article
Causes of Death in Hospitalised Human Immunodeficiency Virus (HIV)-infected Patients at a National Referral Centre in Singapore: A Retrospective Review from 2008 to 2010
The advent of the highly active antiretroviral therapy (HAART) era has greatly reduced the mortality and incidence of new diagnoses of acquired immune deficiency syndrome (AIDS)-defining illnesses (ADIs) in individuals infected with human immunodeficiency virus (HIV) in many countries. This has led to a paradigm shift in the management...
Original Article
Causes of Death and Factors Associated with Early Death Among Human Immunodeficiency Virus (HIV)-Infected Persons in Singapore: Pre-Highly Active Antiretroviral Therapy (HAART) and Peri-HAART
Since the first case of human immunodeficiency virus (HIV) was diagnosed in Singapore in May 1985, a total of 4845 cases and 1389 HIV/acquired immune deficiency syndrome (AIDS) deaths have been reported as of December 2010. With the introduction of highly active antiretroviral therapy (HAART), AIDS diagnoses declined by...
Original Article
A Subacute Model of Geriatric Care for Frail Older Persons: The Tan Tock Seng Hospital Experience
The number of persons aged over 65 will increase from 8.4% in 2005 to 18.7% in 2030, which translates to absolute numbers of 296,900 in 2005 to 873,300 of older persons in Singapore by 2030. The life expectancy at birth has also increased from 79.1 years (2003) to 80.6...
Original Article
Melanoma: Differences between Asian and Caucasian Patients
Cutaneous melanoma is the most common cause of mortality amongst skin cancer in Caucasian populations and incidence rates per 100,000 patient years vary between 21.9 in the United States to 55.9 in Australian males. In contrast, the incidence of melanoma in Asia is significantly lower with incidence rates of...
Original Article
Overcoming Barriers to Mammography Screening: A Quasi-randomised Pragmatic Trial in a Community-based Primary Care Setting
Breast cancer is the leading cancer among women in Singapore, accounting for 29% of all cancers occurring in women between 2006 and 2010. Evidence shows that breast cancer screening with mammography is effective at reducing breast cancer mortality, particularly where the uptake of screening is high, at a recommended...
Original Article
Association of Socioeconomic Status (SES) and Social Support with Depressive Symptoms among the Elderly in Singapore
Depression in the elderly is a major public health issue. Associated morbidities such as higher risk of impairment in physical, mental and social functioning can be substantial, with the most serious complication being suicide. In the elderly, depression can often be undiagnosed and untreated because it may be related...
Original Article
Hoarding in an Asian Population: Prevalence, Correlates, Disability and Quality of Life
Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value, leading to clutter, distress, and disability. The clutter in severe hoarding precludes the use of space to accomplish the activities for which they were designed, such as...
Original Article
Clinical Outcome and Cost Comparison Between Laparoscopic and Open Appendicectomy
Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. The traditional operation of choice was the open appendicectomy (OA) pioneered by McBurney in 1894. In 1981, the laparoscopic technique was introduced by Kurt Semm and since then, laparoscopic appendicectomy (LA) is increasingly...
Original Article
Osteogenic Sarcoma in Children and Young Adults
Osteogenic sarcoma (OS) is a primary malignant tumour of the bone, derived from primitive bone-forming mesenchyme and characterised by the production of osteoid tissue or immature bone by the malignant proliferating spindle cell stroma. Although primary bone tumours are rare in childhood, they are the sixth most common malignant...
Original Article
Single Centre Experience of Transjugular Liver Biopsy in 152 Patients
The first reported case of liver biopsy was recorded in 1883 by Ehrlich. Since then, the technique of liver biopsy has been modified tremendously with major advances over the last 50 years, allowing safer and more reliable methods of performing liver biopsy.
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Commentary
Projecting the Number of Older Singaporeans with Activity of Daily Living Limitations Requiring Human Assistance Through 2030
Similar to other developed countries in Asia, including Japan, South Korea and Taiwan, the population of Singapore is ageing rapidly. In 2011, 9.3% of the population was 65 years of age or older. Due in part to decades of sub-replacement level fertility rates and increases in longevity, by 2030...
Original Article
Determinants of Health-Related Quality of Life Among Community Dwelling Elderly
Singapore is experiencing an unprecedented age shift as the post-war baby boomers turn 65 years in 2012. Currently there are 378,700 people aged 65 and above, and these numbers are estimated to go up to 600,000 by 2020. These growing elderly population have multiple coexisting medical conditions which are...
Original Article
A Review of Back Injury Cases Notified to the Ministry of Manpower from 2011 to 2012
Work-related low back disorders consist of both low back pain (LBP) and low back injuries. They are a significant and increasing problem all over the world. Studies estimate that between 60% and 90% of people will suffer from low back disorders at some point in their life. Among the...
Original Article
Academic Medicine Education Institute (AM∙EI): Transforming the Educational Culture of Health Professionals
In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their individual strengths to become an integrated academic healthcare cluster. This new academic healthcare cluster has a mission to provide outstanding clinical service, discover and promote...
Original Article
Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases
Over the past few decades, the introduction of laparoscopic surgery has been the biggest game changer in abdominal surgery.1 However, although the first laparoscopic liver resections (LLR) were reported in the early 1990s,2,3 widespread adoption of LLR was met with initial skepticism due to technical concerns and the fear...
Commentary
Prehabilitation and Its Role in Geriatric Surgery
The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As the life expectancy of the population has improved significantly in the past few decades, a substantial portion of this rapidly ageing population will place a...
Editorial
Estimating the impact of COVID-19-induced coagulopathy
The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...
Editorial
Tackling osteoporosis and fragility fractures in Singapore
A shift in worldwide population ageing demographics has occurred in the 21st century. The longevity miracle is most keenly felt in Singapore, a young nation which gained its independence only in 1965, but has one of the fastest growing ageing populations in the world. It is estimated that by...
Original Article
Assessing the Content Validity of the EQ-5D Questionnaire Among Asians in Singapore: A Qualitative Study
EQ-5D is a tool to measure and value health status. It is a standardised questionnaire that comprises 2 components: a Descriptive System (DS) on the first page and a hash-marked visual analogue scale (EQ-VAS) on the second page. Importantly, responses to the DS can be converted into a utility...
Original Article
Nation-Wide Observational Study of Cardiac Arrests Occurring in Nursing Homes and Nursing Facilities in Singapore
Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in Singapore and from around the world. Between 2010–12, local OHCA patients with a witnessed arrest and shockable rhythm had a survival-to-hospital discharge rate of 11.0%. Treatment of OHCA patients is resource-intensive since it requires invasive interventions and potentially...
Editorial
Transcatheter Aortic Valve Implantation in Singapore: Reflecting on the First Decade
Transcatheter aortic valve implantation (TAVI) has markedly changed the way aortic valve stenosis is treated. It is 18 years since the first patient was treated with TAVI for severe aortic stenosis. The original concept of TAVI was simple: insert a stent-like device by creating an opening in the obstructed...
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...