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%,...
Review Article
Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore
Persons living with dementia experience chronic and progressive cognitive decline in 1 or more cognitive domains, affecting their everyday activities.1 Globally, the number of persons living with dementia is expected to rise from 55 million in 2019 to 139 million in 2050, with an estimated two-thirds in lower- and...
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...
Commentary
Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...
Review Article
National surgical antibiotic prophylaxis guideline in Singapore
Surgical antibiotic prophylaxis (SAP) refers to the administration of antibiotics prior to clean and clean-contaminated surgeries to prevent postoperative surgical site infections (SSIs). An optimal SAP should be highly effective in preventing SSI. An ideal prophylactic antibiotic regimen is: (1) effective against pathogens—generally skin flora—most likely to contaminate the...
Others
A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia
Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy.
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Original Article
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 of their autoimmune disease or from complications of treatment, at times requiring intensive care.
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Others
Case Report: Catheter-Related Epidural Abscess
Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to 12% and about 0.7% are reported to have central nervous system infection e.g. epidural abscess or meningitis.
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Others
Imaging Findings in Acute Neck Infection due to Pyriform Sinus Fistula
Pyriform sinus fistula is a developmental abnormality of the 3rd or 4th branchial pouch. It usually presents in childhood as acute inflammatory swelling of the neck and frequently involves the thyroid gland.
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Others
Recombinant Tissue Plasminogen Activator (r-TPA) in Fibrin Dissolution due to Postoperative Endophthalmitis
Cataract surgery is one of the most successful surgical procedures performed. However, postoperative endophthalmitis, defined as severe inflammation involving both the anterior and posterior segments of the eye secondary to an infectious agent, is an uncommon but devastating complication.
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Review Article
Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations
Diabetes mellitus (DM) is a common and growing global health problem. It is highly prevalent in Asian communities. Hong Kong, Pakistan, and Singapore are among the countries with the highest prevalence of diabetes in the adult population.
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Others
Methicillin-resistant Staphylococcus aureus Control in Singapore – Moving Forward
The significance of methicillin-resistant Staphylococcus aureus (MRSA) is indisputable. Its successful establishment and maintenance as the most important endemic healthcare associated infection (HCAI) results from its reservoir in up to 20% of inpatients and 16% of healthcare workers plus its ability to survive on surfaces for over 12 days.
This...
Original Article
Thirty-day Mortality and Morbidity After Total Knee Arthroplasty
Total knee arthroplasty (TKA) for patients with knee arthritis that is unresponsive to conservative treatment is being increasingly performed all over the world. It is a safe procedure with a low risk of perioperative death. Improvements in surgical techniques, as well as the identification and treatment of comorbidities, have...
Original Article
Predictors of Vancomycin-resistant Enterococcus (VRE) Carriage in the First Major VRE Outbreak in Singapore
Vancomycin-resistant enterococci (VRE) have emerged as one of the most challenging nosocomial threats in the past decade globally.1,2 Although antibiotic exposure may facilitate VRE transmission by providing selective advantage for VRE and increasing the concentration of VRE in the stools, antibiotic use in association with de novo development of...
Original Article
Intramuscular Gentamicin Improves the Efficacy of Ciprofloxacin as an Antibiotic Prophylaxis for Transrectal Prostate Biopsy
Transrectal ultrasound guided prostate biopsy (TRPB) is one of the modalities in the diagnosis of prostate cancer. Its use has increased with the widespread use of serum prostate-specific antigen (PSA). It is generally a safe procedure with acceptable complication rates.1 However, when infective complications occur, it is potentially fatal.2...