Related Articles

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...

Diagnostic performance of classification criteria for systemic lupus erythematosus: A validation study from Singapore

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a broad spectrum of clinical presentation.1 Clinical diagnosis by rheumatologists remains the gold standard,...

Comparing the effectiveness, safety and cost of teleconsultation versus face-to-face model of pharmacist-led anticoagulation clinic: A single institution experience

Dear Editor, Teleconsultation-based (TELE) anticoagulation clinic (ACC) is an alternative modality, but its use in Singapore’s clinical setting has not been well studied. In Tan...

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...

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...

The eye as a window to the brain

Over the last 20 years, it has become evident that the age-old expression, “the eye is the window into the soul”, might in fact...

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...

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...

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...

Neuralgic amyotrophy in COVID-19 infection and after vaccination

Dear Editor, Various neurological manifestations associated with coronavirus disease 2019 (COVID-19) have been described,1 conditions which left a significant proportion of patients with permanent disability....

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...

A 52-year-old woman with beading of intracranial arteries

A 52-year-old woman of Indian ethnicity with a history of well-controlled hypertension, hyperlipidaemia and recurrent transient ischaemic attacks presented with altered mentation and slurred...

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...

The Profile of Hospitalised Patients with Parkinson’s Disease

Prevalence studies in various parts of the world have shown that Parkinson’s disease (PD) is relatively common among the aged in all countries. Crude...

The Alien Hand Sign–Case Report and Review of the Literature

The alien hand sign or “strange hand sign”, first coined by Brion and Jedynak in 1972, refers to a feeling that the hand is...

Electrophysiological Features in the Management of Meralgia Paraesthetica

Meralgia paraesthetica is a condition resulting from entrapment of the lateral femoral cutaneous nerve at the region of the anterior superior iliac spine, when...

A Retrospective Review of Patients with Clinically Definite Multiple Sclerosis

Genetic susceptibility and environmental factors influence the prevalence and clinical manifestations of multiple sclerosis (MS). Since MS is rare in Southeast Asia, descriptions of...

Chronic Subdural Haematoma Presenting with Transient Ischaemic Attacks— A Case Report

Transient ischaemic attacks (TIA) are commonly seen in neurologic practice. They are most commonly associated with cerebrovascular insufficiency, either from a thrombotic or embolic...

Palatal Myoclonus—A Case Report

Palatal myoclonus is a rare movement disorder characterised by rhythmic recurring jerky movements of the soft palate, pharynx, larynx and rarely diaphragm, trunk and...

Potentiation of Acetylcholine-induced Smooth Muscle Contraction in Rat Ileum by Lead

It is known that exposure of animals and humans to heavy metals such as lead can result in neurological dysfunction. Pharmacodynamic effects of lead...

Extensor Pollicis Longus Paralysis Following Thoracoscopic Sympathectomy

A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla. This article is available only...

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...

Role of Magnetic Resonance Imaging and Magnetic Resonance Angiography in Patients with Hemifacial Spasm

Hemifacial spasm (HFS), characterized by intermittent twitching of muscles supplied by one facial nerve is commonly due to compression of the facial nerve by...

The Reliability and Validity of the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the Elderly Chinese in Hong Kong

The Alzheimer’s Disease Assessment Scale (ADAS) is a 21-item scale designed to assess the severity of cognitive and non-cognitive impairment in patients with Alzheimer’s...

The Current State of Multiple Sclerosis Genetic Research

It was Charcot (1868) who first made the formal pathological correlation between lesions in the central nervous system (CNS) and a disorder termed, ‘la...

The Genetics of Human Epilepsies

Epilepsies are one of the most common neurological disorders, affecting about 3% of individuals at least once in a lifetime. It thus represents a...

Sleep/Wake Cycle and Circadian Disturbances in Shift Work: Strategies for Their Management—A Review

Humans have primarily been active/awake during the day and inactive/asleep at night. The discovery of artificial light and introduction of electric power generator have...

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...

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...

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...

Listeria Meningoencephalitis: Two Cases and a Review of the Literature

The general experience of local physicians and available data suggest that listerial infections of the central nervous system (CNS) are uncommon among adults in...

Panhypopituitarism due to Pituitary Cyst of Rathke’s Cleft Origin—Two Case Reports

Rathke’s cleft cysts are non-neoplastic cystic epithelial lesions of the sellar and suprasellar region which are thought to originate from the remnants of Rathke’s...

Book Review

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...

Advances in Neurointensive Care

Neurointensive care has come into being in the past decade as a recognised subspecialty. Pioneering neurointensivists in the United States, such as Allan Ropper...

The Eye in Neurology: Evaluation of Sudden Visual Loss and Diplopia—Diagnostic Pointers and Pitfalls

The first step in the evaluation of sudden visual loss is to determine if the visual loss is monocular or binocular. The first diagnostic...

Neuroprotection in Acute Stroke

The neuronal cells of the central nervous system are especially susceptible to various forms of insult such as trauma and ischaemia. Once the ischaemic...

Current and Emerging Treatments in Parkinson’s Disease

Parkinson’s disease (PD) affects 1% of adults above the age of 65 years. It is characterised histologically by the loss of neurons in the...

Trinucleotide Repeat Analysis of Huntington’s Disease gene in Singapore

Huntington’s disease (HD) is an autosomal dominantly inherited disease, affecting 1 in 10,000 individuals of European origin. The incidence in the Asian population is...

Aseptic Meningitis in Children—The Singapore Experience

Aseptic meningitis is a common diagnosis among infants admitted for fever without an obvious source. In cases where the aetiologic agent could be identified,...

Update in the Management of Stroke

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders...

Stroke Disease Management—A Framework for Comprehensive Stroke Care

Disease management (DM) is an approach to patient care that coordinates medical resources for patients across the entire healthcare delivery system. It requires a...

Variance Analysis Applied to a Stroke Pathway: How This Can Improve Efficiency of Healthcare Delivery

Stroke is the fourth principal cause of death in Singapore, and the leading cause of long-term disability amongst developed countries. Due to the spiralling...

Idiopathic Chronic Fetomaternal Haemorrhage Resulting in Hydrops – A Case Report

Small amounts (<0.1 mL) of fetal blood are commonly found in maternal circulation. Massive fetomaternal haemorrhage (FMH) involves fetal blood loss into the maternal...

Seeing How We Think About Words Using BOLD Contrast fMR Imaging

Functional brain imaging refers to a set of non-invasive imaging techniques that are used to infer linkages between brain structure and function. In this...

Long-term Follow-up and Outcome of Extremely-low-birth-weight (ELBW) Infants

With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great...

Chorioamnionitis and Outcome in Extremely Preterm Infants

Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is...

Nipah Encephalitis Outbreak in Malaysia

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started...

MELAS: A Case Report

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...

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...

Axoglial Interaction via the Notch Receptor in Oligodendrocyte Differentiation

Oligodendrocytes (OLs) derived from the common neural progenitor cells in the central nervous system (CNS) ensheathe the nude axon to form the myelin that...

Hemifacial Spasm in Singapore: Clinical Characteristics and Patients’ Perceptions

Hemifacial spasm (HFS) is a movement disorder characterised by intermittent involuntary contractions of the facial muscles. It begins with contractions of the orbicularis oculi,...

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...

Clinical Indications for Positron Emission Tomography (PET) Scanning

The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their...

Positron Emission Tomography – A Vital Component of Molecular Imaging

Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of...

Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association

The spinocerebellar ataxias (SCAs) are a rare group of neurodegenerative disorders that are clinically and genetically heterogeneous. Almost all SCAs are due to trinucleotide...

Identification of a Common Genetic Risk Variant (LRRK2 Gly2385Arg) in Parkinson’s Disease

For diseases with complex inheritance, the age-old debate regarding the relative contribution of gene-environment interaction never fails to generate interest, discussion and hypothesis within...

Neural Progenitor and Stem Cells in the Adult Central Nervous System

Seminal studies in the 1960s, using -thymidine autoradiography, reported that neurogenesis occurs in discrete areas of the adult mammalian brain, in rodents. Studies in...

Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis

Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes...

Re-defining Neurological Syndromes: The Genotype Meets the Phenotype

Since time immemorial, generations of medical students and physicians have always been taught that a thorough and detailed history and examination is the foundation...

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.

Ultrasound Assisted Thrombolysis in Acute Ischaemic Stroke: Preliminary Experience in Singapore

Most patients with acute ischaemic stroke have arterial thrombi that occlude extra- or intracranial vessels. Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and...

Functional Neuroimaging of Sleep Deprived Healthy Volunteers and Persons with Sleep Disorders: A Brief Review

Most adults have experienced sleep deprivation at some stage of their lives, be it in the context of work, illness or play. Sleep deprivation...

Treatment of Circadian Rhythm Sleep Disorders with Light

In humans, the daily pattern of consolidated sleep and wake is strongly influenced by the timing of exposure to light and darkness. In the...

Basic Science Review on Circadian Rhythm Biology and Circadian Sleep Disorders

The sleep-wake cycle, with its characteristic intervals of activity alternating with restfulness that recur with a periodicity approximating the 24-hour day-night cycle, is the...

Delayed and Extra-pontine Myelinolysis after Osmotic Dysregulation

A 58-year-old Chinese man was admitted because of increasing lethargy and confusion over 4 days. He had been taking hydrochlorthiazide for hypertension and regularly...

Limb-Shaking Transient Ischemic Attack with Distal Micro-Embolic Signals and Impaired Cerebrovascular Reactivity Using Transcranial Doppler

We present a patient with limb-shaking transient ischaemic attack (TIA) associated with extracranial carotid occlusion and suggest that the pathophysiological mechanism is hypoperfusion, as...

Neuropsychiatry – An Emerging Field

Neuropsychiatry can be described as the interface between neurology and psychiatry – the intersecting field of enquiry for both the brain and the mind....

Alzheimer’s Disease – Towards More Patient-centred and Meaningful Clinical Outcomes

More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in...

Sir Gordon Arthur Ransome (1910-1978) – His Teaching Style and His Legacy

Sir Gordon Arthur Ransome was born in Salop, England, in 1910.1 He came to Singapore in 1938, where he taught and practised medicine for...

Corticospinal Tract Degeneration in Amyotrophic Lateral Sclerosis: A Diffusion Tensor Imaging and Fibre Tractography Study

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterised by spinal and cortical motor neuron degeneration. Although electro myography, muscle biopsy and motor...

Biomarkers of Mild Cognitive Impairment and Alzheimer’s Disease

Alzheimer’s disease (AD) is the most prevalent form of age-related dementia in the modern society. Other than symptomatic treatment with acetylcholinesterase inhibitors at its...

Validation of Transcranial Doppler with CT Angiography in Cerebral Ischaemia: A Preliminary Pilot Study in Singapore

Transcranial Doppler (TCD) is routinely performed to assess the blood flow in patients with cerebral ischaemia and provides important real-time information about cerebral haemodynamics....

Superior Sagittal Sinus Thrombosis: Subtle Signs on Neuroimaging

Cerebral venous thrombosis (CVT) is an infrequent but potentially deadly disease. The mortality rate of CVT is 10% to 20%, and surviving patients may...

Embryonic Stem Cells and Parkinson’s Disease: Cell Transplantation to Cell Therapy

Although levodopa is currently a well-endorsed form of treatment for Parkinson’s Disease (PD), the search for a safe, long-term and dyskinesia-free treatment remains an...

Bridging the Gap Between Primary and Specialist Care – An Integrative Model for Stroke

Cerebrovascular disease (CVD) is Singapore’s fourth leading cause of death, comprising 9% of all deaths, a crude death rate of 40.4/100,000, an age- and...

Malignant Syndrome of Two Parkinson Patients due to Withdrawal of Drugs

Neuroleptic malignant syndrome (NMS) is characterised by the impairment of consciousness, high fever, rigidity and autonomic instability. Although originally described in patients taking neuroleptic...

Multimodal Therapeutic Approach in Acute Ischaemic Stroke with Real-time Neurovascular Monitoring

Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for acute ischaemic stroke (IS) within the therapeutic time-window according...

Chewing-induced Facial Dystonia

Dystonia is a movement disorder characterised by sustained muscle contractions, repetitive twisting movements, and abnormal postures of the trunk, neck, face, or arms and...

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...

Alzheimer’s disease–The Inexorable Epidemic

Alzheimer's disease (AD) is the most common form of dementia which refers collectively to syndromes of progressive deterioration of memory along with other cognitive...

Unusual Cause for Unilateral Headache: A Quadrigeminal Cistern Arachnoid Cyst

Young adults are frequently presented with headaches due to various causes. Atypical facial pain, renamed as persistent idiopathic facial pain (PIFP) is a poorly...

Genome-wide Association Studies: Promises and Pitfalls

Genetic testing is an important means to confirm the diagnosis of an inheritable disease. For this to be feasible, genes that are associated with...

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...

Epilepsy: Looking Beyond Seizures

World Epilepsy Day falls on 26 March 2013. As we observe this important date in Singapore, it is perhaps instructive to take a step...

Sleep, Public Health and Wellness: The Elephant in the Room

The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of...

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...

Single-level Anterior Corpectomy with Fusion versus 2-level Anterior Cervical Decompression with Fusion: A Prospective Controlled Study with 2-year Follow-up Using Cages for Fusion

Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive...

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...

Chorea precipitated by phototherapy as initial presentation of systemic lupus erythematosus

Dear Editor, Chorea is a well-recognised albeit rare neuropsychiatric manifestation of systemic lupus erythematosus (SLE). We describe here a case of a 67-year-old woman presenting...

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...

Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore

The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during...

Rare homozygous PRKN exon 8 and 9 deletion in Malay familial early-onset Parkinson’s disease

Little is known about the genetics of Parkinson’s disease (PD) in Southeast Asian populations.1 We extended knowledge of the Southeast Asian monogenic PD landscape...

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...

Neuro-Behçet’s disease presenting as isolated intracranial hypertension

Behçet’s disease (BD) is a chronic multisystem inflammatory disease with a classic triad of painful oral ulcers, genital ulcers and uveitis. Neurological manifestations, though...

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...

Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore

Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million...

Recurrent vascular events in ischaemic stroke patients with diabetes

Stroke is a major cause of death and disability globally, with 6.55 million deaths (95% uncertainty interval 6.00–7.02 million), 101 million prevalent cases...

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...

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...