Related Articles

HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?

Dear Editor, Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent...

Singapore tuberculosis (TB) clinical management guidelines 2024: A modified Delphi adaptation of international guidelines for drug-susceptible TB infection and pulmonary disease

Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis complex. For decades, it was the leading cause of death worldwide from a...

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...

Oral antiviral utilisation among older adults with COVID-19 in primary care: A population-wide study during successive Omicron waves in Singapore

Dear Editor, Studies have repeatedly demonstrated the real-world effectiveness of oral antivirals (OAVs) in preventing hospitalisation and death in patients with mild-to-moderate COVID-19 at high...

Development of immediate and chronic spontaneous urticaria following mRNA COVID-19 vaccination: Tolerability of revaccination and immunological study

Dear Editor, Coronavirus 2019 (COVID-19) vaccination remains one of the key public health measures against the SARS-CoV-2 infection, significantly reducing illness severity and mortality...

Perinatal outcomes of pregnancies affected by COVID-19 in Singapore: A cohort study

Pregnant women and infants were not spared from the coronavirus disease 2019 (COVID-19) after it was first identified in December 2019.1,2 In the beginning...

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...

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...

Outcomes of COVID-19 infection in patients on dialysis and kidney transplant recipients: A single-centre audit

Dear Editor, Patients with end-stage kidney disease (ESKD) are at increased risk of adverse outcomes following COVID-19 infection. Their vulnerability stems from multiple factors including...

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...

Value the patient as a person: Answering the call for a person-centred model of care

There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm....

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...

Cardiovascular effects of COVID-19 in children

The global coronavirus disease 2019 (COVID-19) pandemic was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While the respiratory system is  the...

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...

COVID-19: The virus, vaccine and paediatric heart

The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality around the world. The development of vaccines has cushioned the effect...

Transforming radiology to support population health

The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery...

Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening

In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety...

Evaluation on the adoption of eHealth App for electronic health record sharing system in Hong Kong

Dear Editor, In Hong Kong, the eHealth App was launched in January 2021, as part of Stage Two development of the Electronic Health Record Sharing...

Managing and preventing severe hand injuries among sugarcane juicer operators

Dear Editor, Of all hand injuries encountered at an emergency department, 54% are sustained in the workplace,1 in part contributed by occupational injuries among food...

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...

Impact of pre-existing depression on severe COVID-19 outcomes

The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the...

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...

Leveraging ChatGPT to aid patient education on coronary angiogram

Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of...

Clinical outcomes of hospitalised individuals with spin-induced exertional rhabdomyolysis

Rhabdomyolysis is a clinical and biochemical syndrome caused by the breakdown of myocytes and release of intracellular components into the bloodstream.1 A subset of...

Emergency department falls interventions improve osteoporosis management in frail older adults

Dear Editor, Singapore’s population is ageing rapidly and by 2030, around 1 in 4 citizens will be aged 65 and above.1 Older adults represent 21–40%...

Preferences for oral anticoagulant medications for managing atrial fibrillation

Dear Editor, Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against the elevated risks of...

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...

Evaluation of a return to work coordination programme for injured workers in a public hospital in Singapore

Workers who have sustained an injury at work often face difficulties returning to work, according to a study showing that over 40% of injured workers...

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,...

Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore

The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe...

Impact of COVID-19 on mental health and social service provision in Singapore: Learnings from a descriptive mixed-methods study for future resource planning

Coronavirus disease 2019 (COVID-19) was declared a global health emergency by the World Health Organization in January 2020.1 Singapore reported its first case of...

Impact of COVID-19 on mental health and healthcare service delivery

The COVID-19 pandemic has claimed more than 6.8 million lives globally.2 While there is yet a cure for the disease, vaccines are now available...

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...

Artificial intelligence innovation in healthcare: Relevance of reporting guidelines for clinical translation from bench to bedside

Artificial intelligence (AI) and digital innovation have revolutionised many sectors and industries, prominently including healthcare during the coronavirus disease 2019 (COVID-19) pandemic.1 For example,...

Benefits of leisure-related physical activity and association between sedentary time and risk for hypertension and type 2 diabetes

Diabetes mellitus and hypertension are serious public health issues. Approximately 451 million individuals worldwide aged 18–99 years were living with diabetes in 2017, and...

Promoting physical activity for population health

The chronic disease burden has risen globally. In Singapore, between 2007 and 2021, the crude prevalence of hyperlipidaemia (8.2–13.9%), hypertension (12.7–15.7%) and diabetes (4.9–6.9%)...

Delayed treatment with nirmatrelvir/ritonavir could remain effective in patients with Omicron BA2.2 variant of COVID-19

Dear Editor, In late February 2022, the Omicron BA.2.2 subvariant drove the outbreak of COVID-19 and rapidly spread through many parts of the world. Omicron-infected...

Rash characteristics of paediatric patients with COVID-19 in Singapore

Dear Editor, Children with COVID-19 infection can present with a variable spectrum of clinical manifestations, and sometimes mucocutaneous manifestations can be the only manifestation of...

Immune and coagulation profiles in 3 adults with multisystem inflammatory syndrome

A spectrum of immune dysregulation has been described following SARS-CoV-2 infections—from the cytokine storm in the acute phase, to hyperinflammatory syndromes that occur after...

Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma

Endometriosis is a chronic inflammatory gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus.1 Debilitating chronic pelvic pain, dysmenorrhoea, and subfertility...

Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore

Approximately 422 million people worldwide have diabetes and 1.6 million deaths are attributed to diabetes each year,1 contributing to high economic costs worldwide. Diabetes...

Diabetes: Know thy foe

During the COVID-19 pandemic in 2022, Singapore’s Minister for Health Ong Ye Kung mentioned, “After the COVID-19 pandemic has passed, we need to tackle...

Clinical outcome of bacterial endogenous endophthalmitis in 15 patients

Dear Editor, Endophthalmitis refers to the inflammation of the ocular cavities and their immediate adjacent structures without extension beyond the sclera, usually secondary to...

Combating a resurgence of poliomyelitis through public health surveillance and vaccination

Singapore was certified poliomyelitis (polio)-free by the World Health Organization (WHO) on 29 October 2000, together with 36 other countries in the Western Pacific...

Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients

The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with...

Early COVID-19 booster is beneficial in cancer patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in...

Vaccination and surveillance: Two basic tools for a final poliomyelitis eradication

Over the past 3 decades, the Global Polio Eradication Initiative (GPEI) has strived to achieve a poliomyelitis (polio)-free world. Wild poliovirus (WPV) types 2...

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...

Meeting today’s healthcare needs: Medicine at the interface

The demographic of Singapore has undergone dramatic changes. Historically, younger patients with communicable diseases predominated; however, patients are now older with chronic multimorbidity and...

A strategy to make COVID-19 vaccination more accessible to the elderly

Dear Editor, Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the...

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....

The Omicron-transformer: Rise of the subvariants in the age of vaccines

The emergence and evolution of SARS-CoV-2 have been publicly tracked in unprecedented detail through a combination of intensive genomic sequencing and open-access sharing of...

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...

Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations

Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus...

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...

TB or not TB? The axillary lump question

An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule...

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

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

High burden of respiratory viral infection-associated mortality among critically ill children

Dear Editor, Acute lower respiratory infections (ALRIs) are a leading cause of under-5 mortality globally—two-thirds could be attributable to respiratory viral infections (RVIs).1,2 The burden...

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,...

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)...

From Astana to Singapore: Primary Health Care is key to the long-term success of Singapore’s health system

The Ministry of Health, Singapore (MOH) has launched a wide-ranging and ambitious initiative for a life-course approach to drive the population’s health.1 This approach...

Teaching and learning during the COVID-19 pandemic: Perspectives of medical students in Singapore

Dear Editor, The coronavirus disease 2019 (COVID-19) pandemic has resulted in many changes to medical education, including the site and mode of teaching, conducting of...

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...

Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore

Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED)...

Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns

Emergency department (ED) overcrowding is a growing issue that threatens public health in various parts of the world,1 including the US,2 UK,3 Australia,4 Japan5...

Global monkeypox outbreak 2022: First case series in Singapore

Monkeypox has been declared a public health emergency of international concern. Up until 2022, most cases of monkeypox have been reported in parts of...

Frequent attenders to multiple emergency departments in Singapore

The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its...

The global emergence of monkeypox

Monkeypox is so named because the poxvirus was first identified in 2 outbreaks among cynomolgus monkeys housed at the Statens Serum Institut, Denmark, in...

Treating acutely ill patients at home: Data from Singapore

Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations...

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....

Attitude towards screening for congenital cytomegalovirus infection in newborns in Singapore

Dear Editor, Cytomegalovirus (CMV) infection is the most common congenital infection.1 A systematic review that included 77 studies from 36 countries reported that the overall...

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...

Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore

Within 3 weeks of the World Health Organization declaring the COVID-19 pandemic on 11 March 2020, the Society of Critical Care Medicine (SCCM) and...

Challenges and considerations in delivering nutritional therapy in the ICU during COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) has created unprecedented challenges for healthcare workers in Singapore and across the world. Providing clinical nutrition and metabolic care to...

BNT162B2 COVID-19 mRNA vaccination did not promote substantial anti-syncytin-1 antibody production nor mRNA transfer to breast milk in an exploratory pilot study

Dear Editor, Vaccine hesitancy still threatens global efforts to end the COVID-19 pandemic caused by SARS-CoV-2 and its emerging variants. Social media-driven “conspiracy theories”...

COVID-19 vaccination acceptance of healthcare workers in Singapore

The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end...

The Lancet Commission on diagnostics: What it means for Singapore

Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and...

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 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...

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...

Injection site reactions after COVID-19 mRNA vaccination

Dear Editor, The Pfizer-BioNTech (BNT162b2 mRNA) and Moderna (mRNA-1273) COVID-19 vaccinations were approved for use in Singapore in December 2020 and February 2021, respectively. To...

Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore

Polycystic ovary syndrome (PCOS) is a common endocrine disorder estimated to affect 4–21% of women, depending on the diagnostic criteria used.1 Clinical manifestations of the...

Change in hepatitis B virus DNA status in patients receiving chronic immunosuppressive therapy for moderate-to-severe skin disease

Dear Editor, Hepatitis B virus (HBV) infection poses a global health burden. Clinically, patients may present with chronic HBV infection, occult HBV infection, and fulminant...

Intravascular large B-cell lymphoma associated with sudden stridor arising from thyroid mucormycosis and concomitant bacterial infection

Dear Editor, Mucormycosis is a life-threatening fungal infection that mainly affects immunocompromised patients. It typically has low prevalence, but fatality rate is as high...

Evaluation of a health screening protocol for recovered COVID-19 patients before “return-to-play” and strenuous physical activity

Dear Editor, We conducted a prospective, single-centre cohort study to develop guidance for military personnel returning to strenuous activities following SARS-CoV-2 infection. The patients underwent...

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,...

Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial

Critically ill patients in the emergency department (ED) have shorter safe apnoea times due to physiological distress from decreased cardiac output, increased shunting and...

Cryptococcal Prostatic Abscess in an Immunocompromised Patient: A Case Report and Review of the Literature

Cryptococcosis is a well-recognised infection in immunocompromised patients, although its prevalence varies with the type of immune defect. We report a patient with myasthenia...

A Randomized Trial of the Use of Print Material and Personal Contact to Improve Mammography Uptake Among Screening Non-attenders in Singapore

Breast cancer is the most common cancer among females in Singapore. Although lower than incidence rates in North America and the United Kingdom the...

A Review of Pedestrian Fatalities in Singapore from 1990 to 1994

Fatal road accidents are by no means uncommon in Singapore, a modern tropical metropolis with a population of approximately 3 million. Statistics provided by...

Risk Factors for Predicting Mortality in a Paediatric Intensive Care Unit

Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care,...

Emerging Therapies for Sepsis and Septic Shock

Septic shock remains a major cause of morbidity and mortality among hospitalised patients despite advances in antimicrobial therapy and medical support. This article is available...

Serum Selenium in the General Population of Singapore, 1993 to 1995

The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3%...

Serum Ferritin and Iron Status in the General Population of Singapore, 1993 to 1995

Iron, a dietary constituent, is an essential element. Body iron stores can be measured by haemoglobin, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin. This article...

Infections in Acute Lymphoblastic Leukaemia

Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy....

Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore

In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has...

Epidemiological Surveillance of Melioidosis in Singapore

Melioidosis was first described in 1911 among vagrants and morphine addicts brought into the mortuary in Rangoon, Burma. However, the disease received little attention...

Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...

A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)

Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill...

Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia

Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously...

Use of Central Venous Lines in Paediatrics—A Local Experience

Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique...

Patients Admitted to an Intensive Care Unit for Poisoning

The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed...

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...

The Global Pandemic of Dengue/Dengue Haemorrhagic Fever: Current Status and Prospects for the Future

The world has experienced unprecedented population growth in the past 50 years that continues unabated in the waning years of the 20th century. It...

Survey of Aerobic Bacterial Infections in Paediatric Surgical Intensive Care Unit Patients

Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric...

Population-based Mammographic Screening in Singapore: What are Participants’ Views?

Breast cancer is the most common cancer among women in Singapore and has been increasing in incidence since 1968. This rise is particularly marked...

Perinatal Drug Abuse in KK Women’s and Children’s Hospital

In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance...

Palm Printing on Agar Plates of Hands of Health Care Workers from the Intensive Care Units of the National University Hospital of Singapore

Nosocomial infections are one of the major causes of morbidity and mortality in hospitals resulting in increasing health care costs. The intensive care unit...

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...

A Clinical Study of Seven Cases of Trichotillomania in Singapore

Trichotillomania was first described by a French dermatologist Hallopeau (1889) of a young man who pulled out his hair in tufts. The word trichotillomania...

A Comparison of Antigen Dipstick Assays with Polymerase Chain Reaction (PCR) Technique and Blood Film Examination in the Rapid Diagnosis of Malaria

According to the 1996 epidemiological studies in Singapore done by the Ministry of the Environment, a total of 364 cases of malaria were reported...

Parainfluenza Type 3 Viral Outbreak in a Neonatal Nursery

Parainfluenza viruses are relatively large RNA paramyxoviruses. Four serologic types cause disease in humans. This article is available only as a PDF. Please click on...

T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report

T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T...

The Future of Medicine from the Standpoint of the Practising Paediatrician

From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had...

Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children

Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are...

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...

Extent and Appropriateness of Emergency Department Services Usage by Foreign Workers in Singapore

Singapore employs more than 350,000 foreign workers currently. With this influx of foreign workers into our city-state which has limited land and resources, it...

Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship...

Drowning and Near-drowning—Some Lessons Learnt

Drowning is defined as suffocation from submersion in a liquid with death within the first twenty-four hours. Near-drowning implies that recovery has occurred, at...

Echocardiographic Features and Management of Neonatal Ductal Aneurysm

Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few...

Transaminitis in Duchenne’s Muscular Dystrophy

Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine...

Correlation of Baseline Quantitative Plasma Human Immunodeficiency (HIV) Type 1 RNA Viral Load with Clinical Status and CD4+ T-cell Counts in Treatment-Naïve HIV-Positive Patients in Singapore

Quantitative plasma human immunodeficiency virus type 1 (HIV-1) ribonucleic acid (RNA) viral load is used clinically as a predictor of progression of HIV-1 infection...

A Case of Mycobacterium scrofulaceum Osteomyelitis of the Right Wrist

Whilst infections caused by Mycobacterium tuberculosis may be a common occurrence in this part of the world, those caused by atypical mycobacteria are rarely...

Case Report of Staphylococcus lugdunensis Native Valve Endocarditis and Review of the Literature

Coagulase-negative staphylococci cause 5% of native valve endocarditis. Of the 30 species identified currently, Staphylococcus epidermidis is a well-recognised cause of native valve endocarditis;...

Twenty-four hour, Non-invasive, Neonatal Chromosome Analysis—Application in a Case of Mixed Gonadal Dysgenesis

Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but...

Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies

Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of...

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

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

Minimal Change Nephrotic Syndrome—A Complex Genetic Disorder

Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia,...

Cardiovascular Disease: Genes and Public Health

The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is...

Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months

Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay,...

DNA Testing for Fragile X Syndrome in 255 Males from Special Schools in Singapore

Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It...

Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients

Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations,...

Case Reports of Nocardiosis in Patients with Human Immunodeficiency Virus (HIV) Infection

Nocardiosis is an infection caused by a soil-borne aerobic filamentous bacterium in the genus Nocardia and the order Actinomycetales. Within the genus Nocardia, N....

Pericardial effusion and tamponade in a young woman

A young woman presented to the Singapore General Hospital with a history of cough in the 2 weeks prior. She had no significant past...

Graves’ disease after COVID-19 vaccination

Dear Editor, Case 1 was a 41-year-old man with a history of primary hyperthyroidism. At the time of diagnosis, thyroglobulin antibodies were elevated although no...

Impact of COVID-19 infections among kidney transplant recipients

Dear Editor, More than 2 years since the start of the COVID-19 pandemic, cases continue to climb despite global efforts at viral control. This is...

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...

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...

Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality worldwide. The development of mRNA vaccines has heralded much hope in...

Histoplasmosis Presenting with Progressively Worsening Backache—A Case Report

A 55-year-old man presented with intermittent low back pain of 2 months’ duration which was progressively worsening, fever, anorexia and a 10-kg weight loss....

In vitro Activity of Moxifloxacin against Local Bacterial Isolates

The introduction of newer generation fluoroquinolones has generated great interest, especially in this era of increasing antimicrobial resistance. Among gram-positive resistant bacteria, the most...

Diagnosing and Prognosticating Acute Meningitis in Young Infants within 24 Hours of Admission

Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which...

Body Mass Index Profile in Hong Kong Chinese Adults

Obesity is considered a chronic disease and not just a social stigma due to the associated morbidity and early mortality. Obesity has now become...

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...

Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci: Emerging Problems and New Prospects for Management

The prevalence of nosocomial infections due to Gram-positive bacteria has increased dramatically over the last two decades. In North America, Gram-positive cocci now are...

Bugs for the Next Century: The Issue of Antibiotic Resistance

Emerging antibiotic resistance is a global problem. Antibiotic resistance results in morbidity and mortality from treatment failures and increased health care costs. This article is...

Enteral Nutrition of the Very Low Birth Weight (VLBW) Infant

Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely...

A Case Series of Six Children with Primary Pulmonary Hypertension

Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of...

2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore

When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think...

Melioidosis Splenic Abscess—An Unusual Presentation as Osteomyelitis of Rib

A 74-year-old Chinese gentleman first presented in February 1999 with an abscess over his left lower chest. He was treated for pulmonary tuberculosis in...

Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome

Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the...

The Use of Vigabatrin in Infantile Spasms in Asian Children

Infantile spasms are a form of age-dependent myoclonic epilepsy that is difficult to control. Agents such as adrenocorticotrophic hormone (ACTH) and prednisolone have been...

Intravenous Adrenaline or Vasopressin in Sudden Cardiac Arrest: A Literature Review

Of the approximately 15,000 deaths that occur in Singapore every year, about 25% are from cardiac causes; of which, some 30% to 40% occur...

Evidence-based Health Promotion: Applying it in Practice

There has been a growing interest in health promotion among health professionals and policy makers in Singapore. This is partly in response to the...

Paediatric Orthopaedics in Singapore

The name “Orthopaedic Surgery” is derived from the words “orthos” (meaning straight or to straighten) and “paido” (meaning child). Thus, it is not unexpected...

Fluconazole Susceptibility of Candida Species in Singapore by Disc Diffusion Test

Candida species is becoming increasingly important as a cause of serious infections particularly in immunocompromised patients. Surveillance in the USA between April 1995 and...

Audit of Total Parenteral Nutrition in an Adult Surgical Intensive Care

Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to...

Acute Coronary Syndrome—Factors Causing Delayed Presentation at the Emergency Department

Acute coronary syndrome (ACS) refers to a continuum of clinical entities ranging from unstable angina pectoris (UAP) to Q-wave myocardial infarction. Mortality rates from...

The Acute Presentation of Pulmonary Thromboembolism: A Retrospective Viewpoint

Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition...

Paediatric Extracranial Germ Cell Tumours: A Retrospective Review

Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous...

Two-year Outcome of Normal-birth-weight Infants Admitted to a Singapore Neonatal Intensive Care Unit

With the rapid advances in the field of neonatal intensive care, the focus of interest has been on the very-low-birthweight (VLBW) infant in recent...

Influenza in Singapore: Assessing the Burden of Illness in the Community

Influenza is a major cause of morbidity and mortality worldwide. Morbidity in the working age group gives rise to frequent doctor visits and considerable...

Bronchopulmonary Dysplasia and Chronic Lung Disease of Infancy: Strategies for Prevention and Management

Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal...

Intussusception: A Three-Year Review

Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into...

Is Healthcare Competition Healthy?

There are many problems which all Health Ministers worry about. But we can generally boil them down to one common problem: “money no enough”. This...

Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations

It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in...

Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital

Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly...

Public Disclosure of Healthcare Performance Information and Its Application to the Singapore Context

It has been said that apart from the prevention of diseases, the best chance of improving health is through improving the quality of care...

Severe Newborn Encephalopathy Unrelated to Intrapartum Hypoxic Events: 3 Case Reports

Since Little’s article of 1862, it was popularly believed that brain damage in the majority of cases of cerebral palsy occurs during labour and...

A Case Series of Pre-Viable Severe Twin-Twin Transfusion Syndrome

Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta. This article is available only...

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...

The Role of Influenza Vaccine in Healthcare Workers in the Era of Severe Acute Respiratory Syndrome

The new coronavirus responsible for severe acute respiratory syndrome (SARS) found its first victims in healthcare workers with attack rates of more than 50%...

Imaging of Paediatric Mediastinal Masses

A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for...

The Relationship Between Scoring Systems and Cytokine Levels in Neonatal Sepsis

In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm...

Clinical Characteristics of an Outbreak of Hand, Foot and Mouth Disease in Singapore

The enterovirus family causes a wide array of illnesses, some easily recognised clinically and others diagnosed as non-specific viral illnesses. This large family of...

Perinatal Care at the Threshold of Viability—From Principles to Practice

One of the major challenges in neonatal-perinatal medicine in the new century is the optimal management of the mother and infant when delivery is...

Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital

The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and...

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...

Exogenous Surfactant Therapy in Newborn Infants

Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of...

The Use and Abuse of Steroids in Perinatal Medicine

Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality....

Mass Newborn Screening in Singapore—Position and Projections

Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome...

Neonatology In Singapore: The Way We Were, The Way Forward

Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore....

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...

Challenges in Perinatal Medicine

One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This...

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...

Predicting Significant Hyperbilirubinaemia and Early Discharge for Glucose-6-Phosphate Dehydrogenase Deficient Newborns

Glucose-6-phosphate dehydrogenase (G6PD) deficiency occurs in 2.5% of Singapore’s population, and affected newborns are at risk for severe neonatal hyperbilirubinaemia and kernicterus. In the...

Autoimmune Liver Disease in Children

Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1)...

HIV/AIDS in Children

The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major...

Adolescent Health Education Programmes: Theoretical Principles in Design and Delivery

Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually...

Art and “the Language of Well-Being” in Adolescent Health Care

Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration....

From Recreation to Creative Expression: The Essential Features of an Adolescent Inpatient Psychosocial Support Programme

In 1984, the Royal Children’s Hospital (RCH) in Melbourne, Australia opened a new ward specifically for adolescent inpatients. This initiative was the result of...

Adolescent Admissions to a Tertiary Paediatric Hospital: A Dynamic Pattern

The nature of paediatric practice is changing worldwide. In developing countries, infant mortality from infectious diseases continues to fall with improved immunisation, medical care...

Clinical Assessment, Management and Outcomes of a Group of Adolescents Presenting with Complex Medico-psychosocial Conditions

Increased sensitivity to biological change can make adolescents particularly vulnerable to non-organic symptomatic disorders. A variety of pains, headaches, dizziness and fatigue may remain...

Adolescent Chronic Illness: A Qualitative Study of Psychosocial Adjustment

Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many...

Strategies to Promote Better Outcomes in Young People with Chronic Illnesses

The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to...

Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent...

Sexually Transmitted Infections in Singapore Teenagers

Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and...

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...

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...

Five-Year Review of Adolescent Mental Health Usage in Singapore

The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in...

The Perils of Puberty

Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such...

Adolescent Health—A New Perspective in Singapore

In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field...

Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study

Dear Editor, The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of...

Patterns and predictors of sound levels in hospital rooms

Dear Editor,      Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also...

Pressure injuries related to N95 respirator masks among healthcare workers during the COVID-19 pandemic

Dear Editor, The coronavirus disease 2019 (COVID-19) pandemic outbreak, which started in 2019, has affected millions of patients globally.1 Singapore is not spared, being one...

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...

Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey

Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an...

A Clinical Audit of Presentation and Outcome of Salmonella Septicaemia

Salmonella infection occurs globally and has diverse presentations including enteric fever, gastroenteritis, localised infection, chronic enteric or urinary carrier state and bacteraemias. Enteric fever,...

Post-SARS Psychological Morbidity and Stigma Among General Practitioners and Traditional Chinese Medicine Practitioners in Singapore

Severe acute respiratory syndrome (SARS) is the first severe and readily transmissible new disease to emerge in the 21st century (WHO). The countries most...

The Role of Public Health and Occupational Physicians in the New Millennium

I want to thank the Chapter and organisers for honouring me with this kind invitation to speak to you. This millennium is only 4...

A Study on SARS Awareness and Health-seeking Behaviour – Findings from a Sampled Population Attending National Healthcare Group Polyclinics

There was a worldwide outbreak of Severe Acute Respiratory Syndrome (SARS) caused by the novel coronavirus between November 2002 and July 2003. Singapore was...

Laboratory Safety Aspects of SARS at Biosafety Level 2

In Singapore, the majority of patients suffering from the severe acute respiratory syndrome (SARS) were cared for at Tan Tock Seng Hospital. The dramatic...

Varicella Screening and Vaccination for Healthcare Workers at KK Women’s and Children’s Hospital

Due to the increased morbidity and mortality of varicella zoster (VZ) in adults and increased exposure to chickenpox in hospitals, especially in paediatric hospitals,...

Work-related Injury Sustained by Foreign Workers in Singapore

Singapore has a resident population of 3.26 million and 0.53 million foreign workers. Of these half a million foreigners, 450,000 are work permit holders,...

A Fatal Turkish Case of Campomelic Dysplasia

Paediatric Medicine (CD) is a rare form of congenital short-limbed dwarfism, classically characterised by campomelia (bowing of the long bones of the lower extremities)...

Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context

Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44...

Severe Adult Chickenpox Infection Requiring Intensive Care

Chickenpox (varicella) in adults can be severe. It is frequently associated with pneumonia and immunosuppression as well as increased mortality rates. This article is available...

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...

Issues and Challenges for Myopia Research

Myopia is an ocular disorder of major public health and socioeconomic significance in many East Asian urban cities. In Singapore, the prevalence of myopia...

Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome

Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first...

Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article

Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital...

Gender Disparity in Paediatric Hospital Admissions

Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories...

Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience

Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an...

Does Visual Turbidity Correlate With Serum Triglyceride Levels in Babies on Total Parenteral Nutrition?

Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles...

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...

Seroepidemiology of Pertussis in the Adult Population of Singapore

Pertussis is a highly communicable, vaccine-preventable respiratory disease and is a frequent but often underestimated cause of prolonged cough illness in adults. Whereas in...

Corticosteroids are not Present in a Traditional Chinese Medicine Formulation for Atopic Dermatitis in Children

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have...

Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore

Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the...

The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004

Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8...

Travel Characteristics and Health Practices Among Travellers at the Travellers’ Health and Vaccination Clinic in Singapore

The South-east Asian region has seen recent increases in travel, and pre-travel health advice is important in protecting these travellers from risks. Travellers now...

A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia

Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an...

Environmental Planning and Urban Health

Environmental exposures to the adverse effects from climate change are expected to increase for many urban populations in the United States during the next...

Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis

Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this...

Understanding the Super-spreading Events of SARS in Singapore

Severe acute respiratory syndrome (SARS) was the first emerging infectious disease of this century with true epidemic potential. Worldwide, the virus caused a total...

Paediatrics to Geriatrics: The Continuum

In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it...

SARS Plague: Duty of Care or Medical Heroism?

SARS has been described as a Chinese plague because it emerged from the colourful markets of wild animals and the exotic kitchens of Guangdong,...

SARS: How to Manage Future Outbreaks?

Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV), which crossed from wild animals at live markets to man in mid-November...

SARS Revisited: Managing “Outbreaks” With “Communications”

In the short span of 3 years since SARS first appeared on the Asian landscape, terms like “risk communications” and “outbreak communications” have assumed...

Laboratory Containment of SARS Virus

Severe acute respiratory syndrome (SARS) emerged in November 2002 in Guangdong Province in China and quickly spread to 26 countries/areas with local transmission in...

SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity above National Sovereignty

The majority of the world’s information about infectious disease outbreaks no longer comes from voluntary reporting by countries, the willingness of which is influenced...

SARS in Singapore – Key Lessons from an Epidemic

The 2003 severe acute respiratory syndrome (SARS) outbreak represented the most severe communicable disease challenge to the public health system and the government and...

Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore

Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection...

Clinical and Laboratory Findings of SARS in Singapore

An outbreak of atypical pneumonia was recognised in Singapore soon after the release of a global alert by the World Health Organization (WHO) on...

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...

The Outbreak of SARS at Tan Tock Seng Hospital – Relating Epidemiology to Control

Severe acute respiratory syndrome (SARS) is an emerging infectious disease caused by a novel coronavirus. Worldwide, the virus caused a total of 8098 reported...

Epidemiology and Control of SARS in Singapore

Since the 1990s, a number of infectious diseases have emerged in Singapore, despite its high standard of environmental hygiene, comprehensive childhood immunisation programme and...

Lessons From the SARS Crisis – More Relevant Than Ever

This issue of the Annals contains articles on the severe acute respiratory syndrome (SARS). One might wonder what else there is to write about...

Modelling the Utility of Body Temperature Readings From Primary Care Consults for SARS Surveillance in an Army Medical Centre

There has been increasing interest in building surveillance systems capable of detecting outbreaks of infectious diseases, at the stage where clinical presentation would still...

Rising Trends of STIs and HIV Infection in Singapore – A Review of Epidemiology Over the last 10 Years (1994 to 2003)

A review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1977 to 1996 showed a declining number of all...

Variables Determining Perceived Global Health Ranks: Findings from a Population-based Study

In 1982, Mossey and Shapiro first demonstrated that global self-rating of health was a better predictor of 7-year survival than medical records or self-reports...

Public Healthcare – Welfare, Market Share or Laissez-faire? – A Sentosa Carlsberg Skytower View

Recently, two doctor-administrators commented to me separately, “Singapore probably has the best public healthcare system in the world.” While I understand the basis for...

Potentially Fatal Paracetamol Overdose and Successful Treatment with 3 Days of Intravenous N-acetylcysteine Regime – A Case Report

Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in...

Clinical Features Associated with Nasal Staphylococcus aureus Colonisation in Chinese Children with Moderate-to-severe Atopic Dermatitis

Atopic dermatitis (AD) is a common chronic relapsing disease in children. It was estimated that about 15% of children suffer from this disease.1-3 Bacterial...

Clinical Cases Seen in Tsunami Hit Banda Aceh – From a Primary Health Care Perspective

Earthquakes and tsunamis can cause massive destruction over large areas, affecting the lives of many in areas hit by such disasters. The local health...

A Rotavirus Vaccine for Infants: The Asian Experience

Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20%...

Therapeutic Hypothermia for Neonatal Hypoxic-Ischaemic Encephalopathy

Hypoxic-ischaemic encephalopathy (HIE) is an important cause of death and later neurological disability in full-term neonates worldwide. Perinatal asphyxia causes about 19% of the...

Outcome of Organic Acidurias in China

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

Organising Services for IMD in Thailand: Twenty Years Experience

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

Newborn Screening in Pakistan – Lessons from a Hospital-based Congenital Hypothyroidism Screening Programme

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

Newborn Screening in Bangladesh

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

Newborn Screening in China: Phenylketonuria, Congenital Hypothyroidism and Expanded Screening

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

Minimising Harm from Newborn Screening Programmes

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

Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?

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

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.

Inborn Errors of Metabolism Presenting as Neonatal Encephalopathy: Practical Tips for Clinicians

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

Legal Issues in Neonatal Screening

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

Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening

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

External Quality Assurance Programme for Newborn Screening of Glucose-6-Phosphate Dehydrogenase Deficiency

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

Glucose-6-Phosphate Dehydrogenase Deficiency: Correlation between the Genotype, Biochemistry and Phenotype

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

Disorders of Vitamin B12 Metabolism Presenting Through Newborn Screening

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

Diagnosis of Tetrahydrobiopterin (BH4) Responsive Mild Phenylketonuria in Japan over the Past 10 Years

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

Fatty Acid Oxidation Defects

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

Disorders of the Carnitine Cycle and Detection by Newborn Screening

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

Spectrum of Inherited Metabolic Disorders in Malaysia

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

Establishing a Universal Newborn Hearing Screening Programme

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

Current Understanding of Auditory Neuropathy

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

A Multidisciplinary Approach to Paediatric Hearing Loss: Programme at the Centre for Hearing Intervention and Language Development, National University Hospital, Singapore

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

Early Intervention For Hearing Impairment: Appropriate, Accessible and Affordable

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

Impact of the National Hearing Screening Programme in China

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

Outcome of Early Cochlear Implantation

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

Eliminating Iodine Deficiency: Obstacles and Their Removal

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

Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism

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

Issues on Universal Screening for Galactosemia

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

Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case

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

Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: Supporting Arguments

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

My Early Experiences in Establishing Neonatal Screening and the Reason for Regional Meetings of the International Society for Neonatal Screening

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

Disaster Relief and Initial Response to the Earthquake and Tsunami in Meulaboh, Indonesia

A massive earthquake and tsunami hit the South Asian region on 26 December 2004, killing more than 200,000 people and displacing countless more.1 The...

Diagnosis and Management Support for an Expanded Newborn Screening Programme

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.

Clinical Applications of Molecular Genetics: The Model of Congenital Adrenal Hyperplasia

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

Newborn Screening in Japan: Restructuring for the New Era

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

Improved Health and Development of Children who are Deaf and Hard of Hearing Following Early Intervention

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

Towards Universal Newborn Screening in Developing Countries: Obstacles and the Way Forward

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

Improving Child Health – Newborn Screening for All?

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

Neonatal Screening – A Global Perspective

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

Graduate Public Health Education – Singapore’s Contribution to Strengthening Capacity in the Region and Beyond

The effectiveness with which the world tackles its most pressing public health problems depends crucially on the calibre of its public health workforce. Institutions...

Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia

Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected...

Anaerobic Culture of Diabetic Foot Infections: Organisms and Antimicrobial Susceptibilities

Singapore has a relatively high prevalence of diabetes mellitus, with a recent survey showing an age-standardised prevalence of 7.8% in 2004. Diabetic soft-tissue infections...

Infection Control Practices at the Singapore General Hospital: From a Swedish Point of View

Methicillin-resistant Staphylococcus aureus (MRSA) is the most common antibiotic resistant pathogen in many parts of the world, and is associated with significant in hospital...

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...

“Future” Threat of Gram-negative Resistance in Singapore

Gram-negative bacteria are important causes of urinary tract infections, bloodstream infections, healthcare-associated pneumonia, and intra-abdominal infections. The increasing resistance of Enterobacteriaceae is a significant...

Polymyxins: A Review of the Current Status Including Recent Developments

Polymyxins are polypeptide antibiotic that becomes available for clinical use in the 1960s, but was replaced in the 1970s by antibiotics considered less toxic....

Vancomycin-resistant Enterococcus – A Review From a Singapore Perspective

The first isolates of high-level vancomycin-resistant enterococci (VRE) were reported from the United Kingdom in the late 1980s. Since then rates of VRE infection...

Methicillin-resistant Staphylococcus aureus Control at the National University Hospital, Singapore: A Historical Perspective

The National University Hospital (NUH) was established in 1985 as the first restructured hospital and medical centre in Singapore. At its official opening in...

Gram-negative Resistance in Singapore: A Historical Perspective

Standardised antimicrobial susceptibility testing was first introduced to Singapore in the mid-1970s. The earliest Singapore antibiogram the author is aware of was published in...

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...

A Retrospective Analysis of Antifungal Susceptibilities of Candida Bloodstream Isolates From Singapore Hospitals

Nosocomial infection with Candida species is increasing in significance worldwide. A recent review of positive blood cultures noted the relative increase in importance of...

Ertapenem for Treatment of Extended-spectrum Beta-lactamase-producing and Multidrug-resistant Gram-negative Bacteraemia

Extended-spectrum beta-lacatamase (ESBL)-producing gram-negative bacteraemia is optimally treated with carbapenem. In our institution, Escherichia coli and Klebsiella pneumoniae are the most common and third...

Independent Predictors for Mortality in Patients with Positive Stenotrophomonas maltophilia Cultures

Stenotrophomonas (formally Pseudomonas or Xanthomonas) maltophilia is a gram-negative bacillus emerging as an opportunistic, nosocomial pathogen associated with a high mortality rate. Although it...

Antibiotic Resistance in Gram-negative Bacilli: A Singapore Perspective

In contrast to recent media reviews on gram-positive pathogens such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and Clostridium difficile, the increasing complexity and multiplicity...

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...

Assessment of Medical Graduates Competencies

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate...

When Words Really Matter

I think a lot these days about doctors giving advice. Nobody taught me, back in medical school, how to give advice. This article is available...

Observational Study to Determine Factors Associated with Blood Sample Haemolysis in the Emergency Department

Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in...

Behavioural Sleep Disorders in Children and Adolescents

Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are...

Cardiovascular Changes in Children with Snoring and Obstructive Sleep Apnoea

Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the...

Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children

Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a...

Sleep Disorders in Children: The Singapore Perspective

Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in...

Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children

Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share...

The Scope of Paediatric Sleep Medicine

Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of...

Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most...

Inflammatory Cytokines and Childhood Obstructive Sleep Apnoea

Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway occlusion during sleep that are associated with daytime behavioural changes and abnormalities...

Nasal Obstruction in Children with Sleep-disordered Breathing

Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in...

Infectious Respiratory Illnesses and their Impact on Healthcare Workers: A Review

With the recent outbreak of severe acute respiratory syndrome (SARS) and its exceptionally high transmission rate in healthcare settings, healthcare workers (HCWs) and administrators...

The Emerging Challenge of Age-related Eye Diseases in Singapore

Singapore has one of the fastest ageing populations in the world today. The current elderly population, defined as persons 65 years or older, comprises...

Healthcare Workers and HIV Health Issues

This paper aims to present a comprehensive review of issues related to HIV testing in healthcare workers (HCWs) and proposes appropriate measures in response...

Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative

Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms...

Immunogenicity, Reactogenicity and Safety of a Diphtheria-Tetanus-Acellular Pertussis-Inactivated Polio and Haemophilus Influenzae Type b Combination Vaccine in a Placebo-controlled Rotavirus Vaccine Study

Singapore’s national immunisation programme for the 6 traditional Expanded Programme on Immunisation (EPI) vaccines (i.e. BCG, diphtheria, tetanus, pertussis, polio and measles) and hepatitis...

The 2005 Dengue Epidemic in Singapore: Epidemiology, Prevention and Control

Dengue is the most important human viral disease transmitted by arthropod vectors. Some 2500 million people – two-fifths of the world’s population – are...

Risk Communications: In Search of a Pandemic

The first decade of the new millennium has seen a string of disasters worldwide – earthquakes, tsunamis, floods, typhoons and acts of terrorism –...

Antiviral Drugs for the Control of Pandemic Influenza Virus

Over the past 100 years there have been 3 major influenza virus pandemics, which have among them claimed millions of lives. In 1918 the...

Vaccines for Pandemic Influenza. The History of our Current Vaccines, their Limitations and the Requirements to Deal with a Pandemic Threat

The ongoing epizootic of avian influenza due to A (H5N1) viruses, the growing count of associated human fatalities, and the fear that this may...

Prevention and Control of Avian Influenza in Singapore

Avian influenza (AI) or “bird flu” is a highly infectious disease of birds. AI viruses are negative single-stranded enveloped RNA viruses that belong to...

Preparing for an Influenza Pandemic in Singapore

The last influenza pandemics occurred in 1957 and 1968. Few remember the pandemic in 1968 in Singapore as it was relatively mild. This article is...

Avian Influenza and Pandemic Influenza Preparedness in Hong Kong

In 1997, Hong Kong became reputed by identifying the first instance of human infection with avian influenza H5N1. A total of 18 cases occurred...

Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia

Since July 2005 to December 2007, Indonesia has reported the highest number of influenza A (H5N1) human cases in the world, i.e., 116 cases...

A Global Perspective on Avian Influenza

The world is confronted by many important public health challenges, some of which constitute potentially devastating global threats. Prime among these is the threat...

Twentieth Century Influenza Pandemics in Singapore

Tropical countries such as Singapore, although without well-defined influenza seasons, are also affected by influenza epidemics and pandemics. Twenty per cent of Singapore’s population...

The Efficacy of Influenza Vaccination in Healthcare Workers in a Tropical Setting: A Prospective Investigator Blinded Observational Study

Influenza causes significant morbidity, mortality and economic impact in Singapore. According to a recent report, there are about 4.2 million cases of influenza-like illness...

A Cross-sectional Study of Primary-care Physicians in Singapore on Their Concerns and Preparedness for an Avian Influenza Outbreak

Outbreaks of avian influenza (AI) caused by the H5N1 subtype in several Asian countries have raised concern all over the world. AI is endemic...

Clinical and Epidemiological Features of Patients With Confirmed Avian Influenza Presenting to Sulianti Saroso Infectious Diseases Hospital, Indonesia, 2005-2007

The first human cases of H5N1 avian influenza (AI) virus infection were reported in Indonesia in July 2005. On 19 September 2005, the Ministry...

To Kill a Mocking Bird Flu?

Why devote an entire issue of the Annals to pandemic influenza when there are so many other pressing health needs around us? With a...

Transfusion-dependent Microcytic Anaemia in a 10-year-old Girl

A 10-year-girl from Bangladesh presented with a moderately severe anaemia (lowest recorded haemoglobin level of 5.6 g/dL) and a mild jaundice (latest serum bilirubin,...

Caudal Regression Syndrome

A white female with an uncomplicated history of birth delivery and a familial history of diabetes mellitus presented to the orthopaedic clinic at the...

Renal Artery Embolism in a Patient with Vague Abdominal Pain

Thromboembolism is a well-known complication of mitral stenosis especially when it is associated with cardiac dysrhythmias. However, renal artery embolism is a disease that...

3rd College of Paediatrics and Child Health Lecture – The Past, the Present and the Shape of Things to Come…

In the post-war days of the 1950s, Singapore children were faced with problems of malnutrition and infectious diseases. There was poverty, overcrowded housing and...

Clinical Characteristics of Renal Infarction in an Asian Population

Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months. This article...

Auricular Anthropometry of Newborns at the Singapore General Hospital

Abnormalities of the external ear are described in many syndromes and genetic conditions. Melnick et al reported an incidence of 1 in 90 births...

Singapore and the Tobacco Pandemic

The World Health Organization, in its 2008 Report on the Global Tobacco Epidemic, has framed the problem in almost apocalyptic terms, in stating that...

Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation

Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations,...

Screening Tools for Bacteraemia in a Selected Population of Febrile Children

Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from...

Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined

Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications...

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...

Public Perceptions of Healthcare in Singapore

Healthcare is increasingly dominating the policy agenda in developed countries. In the United States, healthcare has been ranked only behind the war in Iraq...

Laboratory-acquired Brucellosis

Brucellosis is a serious disease seen worldwide and has been historically known as undulant fever, Bang’s disease, Gibraltar fever, Mediterranean fever, and Malta fever....

The Utility of Liver Function Tests in Dengue

Dengue infection is endemic in many countries along the tropical and subtropical belt, with more than 100 million cases and 24,000 deaths annually worldwide....

Treatment Gets Better, but Leprosy Remains a Global Problem

Rising standards of living and the provision of effective medical treatment have resulted in good control of leprosy in many parts of the world,...

Public Misperceptions About Transmission of Hepatitis B Virus in Singapore

Chronic hepatitis B (CHB) is an important global health problem, with more than 350 million individuals affected worldwide. CHB is particularly important in Asia,...

A History of the Chapter of Public Health and Occupational Physicians

The history of the Chapter of Public Health and Occupational Physicians began with the founding of the Academy of Medicine in 1957. It was...

Pharmacologic Treatment of SARS: Current Knowledge and Recommendations

Acute respiratory failure, which occurred in 20% to 25% of severe acute respiratory syndrome (SARS) patients and necessitated ICU admission, was the primary cause...

Paediatric perineal skin pit: More than skin deep?

A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth,...

A New Method for the Removal of Safety Pins Ingested by Children

Foreign body ingestion is a relatively common problem, with an estimated incidence of 120 per 1 million population, resulting in approximately 1500 deaths each...

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the...

The case for better hospitalisation selection in cancer patients

Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been...

The Annals: Welcoming the future of Medicine

What started as a cluster of cases of pneumonia in Wuhan, the capital city of China’s Hubei Province, in December 2019, has since evolved...

Factors Predictive of Outcome in Childhood Stroke in an Asian Population

Strokes in childhood are generally considered to be rare with an incidence of about 2.7 per 100 000 children per year.1 The aetiologies of...

Development of Ceftazidime Resistance in Burkhoderia pseudomallei in a Patient Experiencing Melioidosis with Mediastinal Lymphadenitis

Melioidosis caused by Burkholderia pseudomallei is endemic to Southeast Asia and Northern Australia. Melioidosis was nicknamed the “greater mimicker” because of its diverse clinical...

Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis

Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis...

Human Rights as a Cornerstone of AIDS Prevention, Treatment and Public Health Measures

The International AIDS Conference (IAC) and the Singapore AIDS Conference (SAC) are biannual meetings held on even years. Both these meetings are occasions for...

Changing Epidemiology of Enteric Fevers in Singapore

Typhoid and paratyphoid fever – collectively referred to as enteric fevers - are serious systemic infections caused by Salmonella enterica serovar Typhi (S. Typhi)...

Expanding the Scope of Antiretroviral Therapy for HIV Infection

The 2010 Global Report on AIDS contains some welcome news: the number of annual AIDS-related deaths has continued to decrease from a peak of...

The Evolving Role of the Community Pharmacist in Chronic Disease Management – A Literature Review

Pharmacy has matured as a clinical profession and is presently well positioned to transform itself from a product and task oriented (dispensing) to a...

Morbidity of Parainfluenza 3 Outbreak in Preterm Infants in a Neonatal Unit

Parainfluenza type 3 virus (PIV-3) is an important nosocomial pathogen. It closely mimics respiratory syncytial virus (RSV) in its clinical presentations, and in infants....

Pathological Video-Gaming among Singaporean Youth

Video-gaming and internet use are a part of the lives of children and adolescents today. Among countries that are highly wired with high speed...

Reply from Author: Putting the Wedge under Pressure

We thank the authors for their interest in our study and their insightful comments. We agree that filling pressures such as the central venous...

Putting the Wedge under Pressure

We would like to thank Dr Huck Chin Chew et al for sharing their findings and we are appreciative of their work, “Oesophageal Doppler...

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...

A Cross-Sectional Study on Reference Ranges of Normal Oral Temperatures Among Students in Singapore

Severe acute respiratory syndrome (SARS), an infection caused by the SARS Coronavirus (SARS-CoV), was imported into Singapore in late February 2003 by a local...

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...

Multi-disease Health Screening in an Urban Low-income Setting: A Community-based Study

With the burden of chronic disease rising amongst rapidly urbanising Asian populations, active participation in health screening would allow for early detection and management...

An Unexpected Outcome following Radial Head Excision for Jeffrey Type II Fracture-Dislocation of the Proximal Radius in a Child

We present a case of a 10-year-old child who sustained a traumatic fracture-dislocation of his proximal radius and subsequently underwent surgical removal of the...

Temporary Tattoo Associated Type IV Delayed Hypersensitivity Dermatitis in a Child – A Case Report and Call for Parental Caution in Singapore

A 5-year-old, previously healthy French Caucasian boy was seen at a Paediatric Emergency Department for a skin rash over his left forearm. This article is...

The Pedagogical Value of a Student-run Community-based Experiential Learning Project: The Yong Loo Lin School of Medicine Public Health Screening

Experiential learning brings medical students out of the comfort zone of learning in their classrooms to acquire and apply knowledge and skills in an...

A Case of Congenital Haemolytic Anaemia and Thrombocytopenia

A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to...

An Exanthem with An Annular Pattern in a 2-year-old Girl

A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the...

Clinical Features Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis

Causes of neonatal cholestasis (NC) are long and diverse but the responses of newborn liver, either physiological or anatomical, are limited. This is because...

Epidemiology of Snakebites from A General Hospital in Singapore: A 5-year Retrospective Review (2004-2008)

Snakes are present even in an industrialised country like Singapore. A bite from a venomous snake can inflict much morbidity and occasionally, it can...

Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children

Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can...

Changing Seroprevalence of Hepatitis B Virus Markers of Adults in Singapore

In Singapore, epidemiological surveillance and research on hepatitis B virus (HBV) infection were initiated when acute viral hepatitis was made a notifiable disease under...

Bannayan Riley Ruvalcaba Syndrome

Bannayan-Riley-Ruvalcaba syndrome (BRRS) classically presents with macrocephaly, subcutaneous and visceral lipomata, haemangiomata, hamartomatous intestinal polyps and pigmented macules involving the genitalia. This autosomal dominant...

Are New Resuscitation Guidelines Better? Experience of an Asian Metropolitan Hospital

Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have...

Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics

In recent decades, medical advances and economic pressures have shifted medical student training from hospital inpatient to ambulatory settings such as hospital outpatient and...

An Eight Year Review of Exercise-related Cardiac Arrests

Exercise-related cardiac arrest is uncommon, however it is devastating when it occurs in otherwise healthy adults. In young adults, vigorous physical exercise trigger cardiac...

Evaluation on the Effectiveness of the National Childhood Immunisation Programme in Singapore, 1982-2007

Singapore has a comprehensive National Childhood Immunisation Programme (NCIP) which first covered smallpox (1862), followed by diphtheria (1938), tuberculosis (TB) (1957), poliomyelitis (1958), pertussis...

Peripheral Arterial Disease in Community-based Patients with Diabetes in Singapore: Results from a Primary Healthcare Study

Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In...

Epidemiological Characteristics of Cholera in Singapore, 1992-2007

Cholera is an acute diarrhoeal disease that usually presents as abrupt massive watery diarrhoea and vomiting. The causative organism is Vibrio cholerae which is...

Dyke-Davidoff-Masson Syndrome

An 8-year-old boy presented with uncontrolled seizures. He was born as the second child to non-consanguineous parents. He had significant perinatal asphyxia in the...

Influenza B Outbreak among Influenza-vaccinated Welfare Home Residents in Singapore

Influenza has a major impact on the health of residents of long-term residential care facilities (LTCF). Residents of LTCFs are especially vulnerable to influenza...

Knowledge, Attitudes and Practices of the Advance Medical Directive in a Residential Estate in Singapore

The Advance Medical Directive (AMD) Act was passed in Parliament in May 1996. The AMD is a legal document that an individual can sign...

Beyond Blood Safety

World Blood Donor Day takes place on 14 June each year. Established in 2005 by the World Health Assembly, it aims to raise global...

Childhood Food Allergy: A Singaporean Perspective

Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the...

Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?

Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of...

A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore

Our tertiary hospital has a 9-bed Surgical Intensive Care Unit (SICU) that caters to all surgical disciplines except Cardio-Thoracic and Vascular Surgery (which has...

Afterword

My first involvement with pandemic influenza preparedness planning began in January 2004, when I attended an urgent meeting organised by the Ministry of Public...

Use of Healthcare Worker Sickness Absenteeism Surveillance as a Potential Early Warning System for Influenza Epidemics in Acute Care Hospitals

The global spread of emerging infectious diseases can strain resources and result in healthcare staff absenteeism, as was the case during the severe acute...

Streptococcus pneumoniae Bacteraemia in a Young Man with Pandemic Influenza A (H1N1) 2009

The contributory role of bacterial infection to severe influenza illness during a pandemic is not entirely clear. The post-mortem samples of those who died...

Surveys of Knowledge, Attitudes and Practices on the Influenza A (H1N1) Pandemic

Statistical surveys are in general an efficient and flexible means of collecting a wide range of information from large numbers of respondents. These are...

2009 Pandemic Influenza H1N1: Paediatric Perspectives

The pandemic H1N1 influenza virus, containing genes from avian, human and swine influenza viruses, emerged in North America, and caused illness in more than...

Severe Infection with H1N1 Requiring Intensive Care – Lessons for Preparedness Programmes

Severe cases of influenza have traditionally generated much interest. The pandemic of 1957 provided instructive materials on the subject, with publications on the pulmonary...

International Health Regulations: Lessons From the Influenza Pandemic in Singapore

By virtue of the International Health Regulations (IHR) which came into force on 15 June 2007, countries are required to report specific infectious diseases...

Influenza A (H1N1-2009) Pandemic in Singapore – Public Health Control Measures Implemented and Lessons Learnt

The novel influenza A(H1N1) outbreak was officially declared a pandemic by the World Health Organization (WHO) on 11 June 2009. We describe the public...

Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns

Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise...

Attitudes of Patients, Visitors and Healthcare Workers at a Tertiary Hospital Towards Influenza A (H1N1) Response Measures

Following the announcement by the World Health Organization (WHO) that outbreaks of a novel influenza virus had occurred in Mexico and several parts of...

Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club

Influenza A (H1N1-2009) is a novel strain of influenza virus. The infection is thought to have first occurred in Mexico in March 2009, and...

Obstetric Outcomes of Influenza A H1N1 (2009) Infection in Pregnancy – Experience of a Singapore Tertiary Hospital

Influenza A H1N1 (2009) is a new viral strain containing gene segments from human, swine and avian lineages. Soon after reports of human cases...

Tracking the Emergence of Pandemic Influenza A/H1N1/2009 and its Interaction with Seasonal Influenza Viruses in Singapore

The global preparedness that followed the severe acute respiratory syndrome (SARS) outbreaks of 2003 and the re-emergence of a potentially pandemic avian influenza A/...

An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza Admitted to Singapore Hospitals from July to September 2009

On 17 April 2009, the US Centers for Disease Control (CDC) determined that febrile respiratory illness occurring in 2 children residing in adjacent counties...

Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009

The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas...

Pandemic (H1N1) 2009: Clinical and Laboratory Findings of the First Fifty Cases in Singapore

Just over a year ago, the swine-origin influenza A (H1N1) virus emerged in Veracruz, Mexico, and rapidly alarmed public health and influenza experts by...

The Influenza A (H1N1) 2009 Pandemic in Singapore

Just over a year ago, the swine-origin influenza A (H1N1) virus emerged in Veracruz, Mexico, and rapidly alarmed public health and influenza experts by...

Tuberculosis – An Under-appreciated Disease

Tuberculosis (TB, as usually abbreviated) is a major cause of morbidity and mortality in many countries, and a significant public health problem worldwide. The...

Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?

In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence...

Trends in Long-term Cancer Survival in Singapore: 1968-2002

With increasing health awareness and the greater extent of healthcare provision over the years, the life expectancy of Singaporeans has increased from 75.3 in...

Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?

We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the...

Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?

I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than...

Knowledge and Practice of Household Mosquito Breeding Control Measures between a Dengue Hotspot and Non-Hotspot in Singapore

Dengue is the most common mosquito-borne viral disease in the world and its severity is reflected by a 30-fold increase over the last 50...

Dedicated Cytogenetics Factor is Critical for Improving Karyotyping Results for Childhood Leukaemias – Experience in the National University Hospital, Singapore 1989-2006

Acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) make up the bulk of childhood leukaemia cases. With risk stratified therapy being one of...

Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007

Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is...

Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study

The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health...

A Missed Bilateral Choanal Atresia

What do you see in the image? a) Deviated posterior nasal septum b) Nasopharyngeal tumour c) Rhinolith with mucous plug d) Bilateral choanal atresia e) Nasal pyriform aperture stenosis This...

Health-related Quality of Life in Children with Cancer Undergoing Treatment: A First Look at the Singapore Experience

Health-related quality of life (HRQOL) has been progressively acknowledged as an essential health outcome measure in clinical trials and health services research and evaluation....

Challenges Facing the Control of Leprosy in the Indian Context

Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects the skin, peripheral nerves, the eyes and the mucosa of the...

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...

The Ethics of Responding to a Novel Pandemic

“A man without ethics is a wild beast loosed upon this world.” -Albert Camus (1957 Nobel Prize for Literature) As the microscopic ‘wild beasts’ of infectious...

Plasma IP-10 could identify early lung disease in severe COVID-19 patients

Dear Editor, The global pandemic of SARS-Coronavirus-2 (SARS-CoV-2) infection has imposed tremendous strain on healthcare resources worldwide, as a significant proportion of patients require...

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...

An Interesting Finding in a Patient with Chronic Diarrhoea

A 25-year-old man presented with intermittent selflimiting episodes of diarrhoea for 5 months. At times, he opened his bowel 8 times a day with...

Adverse reactions and safety profile of the mRNA COVID-19 vaccines among Asian military personnel

The COVID-19 pandemic has led to significant changes in the way of life for many around the world.1,2 After more than a year, many...

Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study

Since the first case of coronavirus disease 2019 (COVID-19) was reported in China in late December 2019, the pandemic has spread throughout the world,...

Healthcare cost of patients with multiple chronic diseases in Singapore public primary care setting

The rising occurrence of individuals suffering from multiple chronic diseases, namely multimorbidity, is of public health concern globally.1 The current prevalence of multimorbidity in...

Prevention and management of multimorbidity to ensure healthcare sustainability

Singapore has a healthcare system that is distinguished by its ability to achieve top health outcomes at very low healthcare expenditures.1 Yet one of...

Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore

The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist...

Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?

Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values. —Louis D Brandeis As a...

Cognitive Aspect of Diagnostic Errors

It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were...

Short- and Long-Term Outcomes at 2, 5 and 8 Years Old for Neonates at Borderline Viability—An 11-Year Experience

Singapore was listed consistently among the top 3 countries in the world with the lowest infant mortality rate. In particular, Asia had seen its...

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...

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...

Re: An Alternative Diagnosis: Bartonella Neuroretinitis

I would like to thank the authors for the reply to our case report. The differential diagnosis of Bartonella neuroretinitis in this patient was...

An Alternative Diagnosis: Bartonella Neuroretinitis

We refer to the letter ‘Lyme Neuroretinitis in Singapore: A Diagnostic Dilemma’ published in the April 2012 Vol. 41 No. 4 issue of the...

How do English-speaking Cancer Patients Conceptualise Personhood?

Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral...

Too Much Medicine: Time to Stop Indiscriminate Cancer Screening

Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in...

Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma

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

MERS-CoV: Where Are We Now?

Prior to 2002, coronaviruses were known mainly for causing mild human upper respiratory tract infections (URTIs) and enteric and respiratory infections in many animals....

Diagnosing Bacteraemia Early in Older Adults

Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop...

An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit

Over the past 30 years, different versions of severity of illness scoring systems and prognostic models have been developed for prediction of patient outcomes...

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...

Emergency Medicine Residency Programme in Singapore—Where Are We at Since Inception?

It has been 4.5 years since the Accreditation Council for Graduate Medical Education (ACGME-I) accredited competency-based emergency medicine residency programmes were started in July...

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...

Anaerobic Bacteraemia Revisited: Species and Susceptibilities

Over the last 2 decades, the importance of anaerobic bacteraemia has undergone various shifts in opinion. Early studies in the 1970s reported that anaerobes...

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...

Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study

Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the...

Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions

Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue...

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...

Safety and side effect profile of Pfizer-BioNTech COVID-19 vaccination among healthcare workers: A tertiary hospital experience in Singapore

The newly emerged coronavirus virus 2019 (COVID-19) disease was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on...

The Greying Pandemic: Implications of Ageing Human Immunodeficiency Virus-Positive Population in Singapore

Human immunodeficiency virus (HIV) remains a global public health issue. It is estimated that there are 37.9 million people living with HIV (PLHIV) today....

Health professions education in pandemics and epidemics: A proposed framework for educators

The COVID-19 pandemic has disrupted healthcare systems and health professions education (HPE). There are few frameworks to help educators manage HPE before, during and...

The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown

Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties...

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...

Merits of a harmonised system to classify drug-related problems in Singapore

A drug-related problem (DRP) is commonly defined as an event or circumstance involving drug treatment that actually or potentially interferes with the optimal outcome...

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...

Factors influencing protective behaviours during haze episodes in Singapore: A population-based study

Southeast Asia suffers from recurrent episodic air pollution from biomass smoke known as haze, which is mainly caused by human activities such as the...

Seasonal haze: Knowledge gaps and risk perception behaviours

The seasonal haze in Southeast Asia has been a recurrent concern whenever we enter the southwest monsoon season (June–September). This phenomenon, caused by agricultural...

ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series

Coronavirus disease 2019 (COVID-19) has been associated with thromboembolic phenomenon in the early phase of disease. Growing evidence suggests a hypercoagulable state as well...

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...

Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study

Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely...

Pelvic mass mimicking advanced tubo-ovarian malignancy with hepatic metastasis

A 49-year-old woman presented with mild pain in her lower abdomen and changes in bowel habits for 2 months. She also experienced 20kg of...

Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 Panel for early diagnosis of COVID-19

An effective response to the SARS-CoV-2 that has caused the coronavirus disease 2019 (COVID-19) pandemic1 requires rapid and accurate diagnostic testing. We evaluate the...

Antibiotic stewardship algorithm to rationalise antibiotic use among hospitalised COVID-19 patients

As presentation of COVID-19 may mimic that of bacterial pneumonia, antibiotics are often prescribed. Concerns regarding overuse of antibiotics are now being raised particularly...

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...

Radiological changes on chest CT following COVID-19 infection

COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution...

Stress and resilience of paediatric healthcare workers during COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has caused multiple changes in healthcare systems as governments implement measures to boost acute services. Healthcare workers (HCWs)...

Severe COVID-19 and coagulopathy: A systematic review and meta-analysis

Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications....

Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits

Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work...

Accuracy of self-reported height, weight and BMI in a multiethnic Asian population

Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight...

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...

Impact of COVID-19 on mental health and occupational burnout in a surgical unit in Singapore

In this study, we assessed the impact of COVID-19 on the psychological well-being and burnout among staff who manage critically ill general surgery and...

Optimum early orthopaedic surgery in COVID-19 patients

Multiple guidelines have been established regarding the management of COVID-19 patients. However, there remains a paucity regarding specific guidelines on the optimal timing for...

Vulnerability to rumours during the COVID-19 pandemic in Singapore

The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found...