Related Articles

Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore

Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...

Isolated remote site musculoskeletal Mycobacterium bovis infections after BCG immunisation in immunocompetent children

Dear Editor, The Bacillus Calmette–Guerin (BCG) vaccine, derived from wild-type Mycobacterium bovis, is administered in an attenuated form to prevent Mycobacterium tuberculous (MTB) infections in children residing in endemic regions. Since the introduction of the Singapore Tuberculosis Elimination Programme in 1997—specifying mandatory BCG-immunisation at birth—the incidence fell drastically to 32.6...

Transcranial magnetic stimulation in psychiatry: A Singapore perspective

The use of repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) has not been described in Singapore. Reports on the effectiveness of rTMS in populations outside of Western countries are also limited. Thus, Ye et al.’s study on the naturalistic outcomes of rTMS...

Quality of life of children and young adults with Down syndrome from caregivers’ perspective: A systematic review and meta-analysis

Down syndrome (DS), with an incidence of about 1/1000 to 1/1100 live births1 is the most common autosomal trisomy and genetic cause of intellectual disability. Individuals with DS may have multiple comorbidities including congenital cardiac and gastrointestinal anomalies, obesity, sleep disorders, and visual and hearing impairments.2,3 Despite the comorbidities,...

The emergence of otter attacks in Singapore: A case series and strategies for management

Dear Editor, Singapore is experiencing an unprecedented increase in the number of smooth-coated otters (Lutrogale perspicillata). Since 2017, the local otter population has more than doubled to at least 170. This has led to an increase in the number of otter-human attacks since 2021.1,2 While common animal attacks like dog...

Gaps in primary care management of urinary tract infections in Singapore

Dear Editor, Urinary tract infection (UTI) is a common presentation in primary care, but gaps of care have not been well established in Singapore. UTIs are one of the most common bacterial infections worldwide,1 constituting around 1% of all ambulatory clinic visits.2 The healthcare burden of UTIs remains highly significant,...

Seroprevalence of cytomegalovirus over the last 2 decades (2001–2020): A retrospective data analysis from a single laboratory in Singapore

Dear Editor, Cytomegalovirus (CMV) is ubiquitous and infects human of all ages, where it remains latent after primary infection and can reactivate upon various triggers.1 Reactivated CMV may cause complications and end organ damages in immunocompromised hosts, leading to increased morbidity and mortality.2 In addition, the presence of actively replicating...

Prevalence and risk factors of depression and anxiety in primary care

The global prevalence of individuals living with a mental disorder in 2019 was 970 million, with anxiety and depressive disorders being the most common.1 The Singapore Mental Health Study 2016 showed that the lifetime prevalence of at least one mood, anxiety or alcohol use disorder was 13.9% in the...

Illicit drug consumption in Singapore: Where are we in the fight against drugs?

Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be a growing problem worldwide. In 2021, 1 in 17 people aged 15–64 in the world had used a drug in the past 12 months. Notwithstanding...

Asian media reporting on suicide: Concerning trends

Asharani et al. present an enlightening study of media influences on suicidality and suicides from multinational data, all within Asia.1 This is important, as knowledge based on media and suicide has been dominated by Western cultures and English and other European languages. Pulling together various independent studies, as Asharani...

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 single infectious disease before being displaced by COVID-19 during the pandemic years.1 TB is endemic in Singapore, with over 2000 cases of TB disease (formerly active TB)...

Hantavirus haemorrhagic fever and renal syndrome, caused by the Hantaan virus in Singapore: A case report

Dear Editor, We outline a case of a 59-year-old Malaysian man of Indian origin with no known past medical history apart from diabetes mellitus and hypertension, who presented with a 7-day history of unrelenting fever, myalgia, confusion and unsteady gait. He worked as a shipyard engineer and travelled between Singapore...

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 risk for progression to severe COVID-19 when initiated within 5 days of symptom onset, even during waves of Omicron transmission.1 However, there is a need...

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 rates. Urticaria and/or angioedema are cutaneous reactions that have been reported in response to messenger RNA (mRNA) COVID-19 vaccination and potentially affect fitness for revaccination.1...

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 of the pandemic, a lack of data on transmission risks and outcomes of pregnancies affected by SARS-CoV-2, impacted perinatal clinical decision-making.1,3 We report the perinatal...

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 kidney failure, comorbid illnesses, close contact in the haemodialysis centre, and transplant immunosuppression. European registry data in the pre-vaccination era report a COVID-19 mortality rate...

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 isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....

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 primary infectious target of SARS-CoV-2, systemic symptoms are fairly common and organ systems throughout the body can be affected with multisystem organ failure in 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 longer constituted a public health emergency. Despite high numbers of children and younger persons (CYPs) having acute COVID-19,1 information on the quality of health and...

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 of the virus and thus, provided hope in the fight against the disease.1 Yet, there are still small battles with COVID-19, at the bench and...

Consensus statement on Singapore perinatal mental health guidelines on depression and anxiety

Perinatal mental health conditions have been recognised as a key area of focus by the World Health Organization, with the new guide published in September 20221 highlighting the importance of screening, diagnosis and management of perinatal mental health conditions that are integrated into maternal and child health (MCH) services....

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 symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a...

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 lives of billions of individuals around the world.1 Public healthcare around the work have mainly focused on the clinical manifestations and treatment of the deadly...

Investigating the stressors and coping mechanisms of students in medical school: A qualitative study

Dear Editor, Medical school can be a stressful experience for students, with burnout being increasingly common.1 Stressors in medical education include a heavy academic workload, pressure of good academic performance, and comparison with peers of high aptitude.2 Stress can be either beneficial or detrimental to development, depending on personal regulation...

Healthcare worker job burnout, anxiety and depression: A one-year comparison during COVID-19 in Singapore

Dear Editor, The mental health of our healthcare workforce has never been as scrutinised as it has the last three years since the COVID-19 pandemic. Worldwide, appreciation of healthcare workers (HCWs) as the first line of defence during the pandemic soared, even as studies of HCW mental wellness increased exponentially.1,2...

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 symptoms of COVID-19, losing loved ones to the disease, financial insecurity, and social isolation. Furthermore, children and youths experienced disruption to their usual routine such...

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 COVID-19 on 23 January 2020 and the subsequent emergence of clusters led to a string of restrictions to contain the outbreak and protect the health...

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 to minimise transmission risk and protect against severe infection. However, COVID-19 vaccines have had a mixed reception, with concerns of their side effects and of...

Self-esteem and positive body image to overcome female sexual dysfunction

Human sexuality is arguably one of the main pillars of health, like nutrition and sleep. Improvements in diagnostic and therapeutic biotechnologies have enabled focus on not only deadly diseases, but also on the quality of life and sexual functions of men and women. Digital media also play a considerable...

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 individuals aged ≥80 years who are unvaccinated are particularly at high risk of poor outcomes. COVID-19 vaccines and antiviral therapeutics have protected individuals most at risk...

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 COVID-19 infection in children.1,2,3 We report 4 cases of paediatric patients who had COVID-19 with mucocutaneous involvement, admitted to a tertiary children’s hospital in Singapore....

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 the resolution of the initial infection.1 Multisystem inflammatory syndrome (MIS) was first reported in children in April 2020 as a hyperinflammatory syndrome with features similar...

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 infection. Endogenous endophthalmitis (EE) results from haematogenous spread of microorganisms in patients with bacteraemia or fungaemia into the eye and represents 2–15% of endophthalmitis cases.1-3...

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 Region.1 Prior to certification, there were multiple outbreaks in 1958, 1960 and 1963 with 415, 196 and 74 paralytic polio cases, respectively.2-4 The nationwide immunisation...

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 solid and haematological malignancies to SARS-CoV-2 infections.1,2 Global efforts to combat SARS-CoV-2 led to the unprecedented rapid development of multiple vaccines, with reported efficacies of...

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 Wuhan, China, on 31 December 20191 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare systems around the world, and rendered...

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 and 3 were eradicated in 2015 and 2019, respectively. The World Health Organization (WHO) South-East Asia Region was declared free of poliovirus in 2014, 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 Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services. While the...

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 data.1 This surveillance information describes how waves of COVID-19 infections have been driven by the emergence of new variants of concern (VOCs) and their subvariants....

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 rare multisystem inflammatory syndrome leading to multiorgan failure and shock (multisystem inflammatory syndrome in children ) has been recognised to affect children with exposure to...

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 with comorbidities. One of the most challenging aspects of paediatric SARS-CoV-2 infection has been the discovery of a unique late manifestation of infection characterised by...

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 disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into an ongoing global pandemic.2 In May...

Exploring loss and grief during the COVID-19 pandemic: A scoping review of qualitative studies

As of mid October 2022, the World Health Organization recorded that more than 620 million people worldwide have been infected by SARS-CoV-2, the virus causing COVID-19, while over 6.5 million have succumbed to the disease. Many have lost family members and friends as well as jobs and familiar lifestyles,...

The impact of COVID-19 pandemic on loss and grief

As of 17 October 2022, the COVID-19 pandemic has claimed more than 6.5 million lives globally, with 1,639 deaths reported in Singapore.1 With numerous countries imposing measures such as lockdowns and social distancing measures that isolate individuals, there has been a steady increase in a variety of mental disorders...

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 with a central keratinous plug in the right axilla (Fig. 1). The surrounding skin was pigmented, non-tender and indurated. Sonography of the nodule demonstrated an...

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 (ACA), IgG anti-β2-glycoprotein I antibodies (aβ2GPI) and IgA aβ2GPI, though not for the lupus anticoagulant (LAC). In a Singapore study comprising 47,527 patients, 19 (0.04%) developed...

Employers’ attitudes towards employing people with mental health conditions

Dear Editor, The advantages of employment for young people with mental health conditions (PMHC) are well known and documented,1 but many remain unemployed. Besides offering monetary benefits, employment provides a better self and social identity, helps the person gain a sense of personal achievement, and enhances mental well-being. Being unemployed...

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 examinations and a shift towards prioritising the mastery of clinical skills relevant to infection control. Hence, Ng et al.’s suggestions on how to maximise learning...

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 iceberg as youths with undiagnosed mental health disorders often present to the healthcare system with non-psychiatric symptoms.3 These psychosomatic symptoms do not have an organic...

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 Africa. On 7 May 2022, a returning traveller from Nigeria to the UK was confirmed to have contracted monkeypox. By the end of May 2022,...

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 1958.1 Both outbreaks occurred approximately 2 months after the monkeys arrived by plane from Singapore.1 However, the natural reservoir of the virus is not monkeys...

Prevalence of burnout among healthcare professionals in Singapore

Burnout was first described in 1974 by Herbert Freudenberger, where he discussed the concept based on physical signs, behavioural indicators, judgment, emotional factors, and the preventive measures to avoid burnout.1 In 2019, the World Health Organization defined burnout as an occupational phenomenon in the International Classification of Diseases 11th...

Bridging electroconvulsive therapy in schizophrenia with cognition and quality of life

Schizophrenia is one of the most debilitating severe mental illnesses with significant impact,1 irrespective of culture or socioeconomic class.2 Over the decades, antipsychotic medication has been the mainstay of treatment for patients with schizophrenia. Nevertheless, about 25% of patients do not respond to first-line antipsychotic medication, with more than...

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. Continued vigilance is crucial with emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants that cause the disease. Vaccination against COVID-19 remains the...

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 prevalence of CMV was 0.67% in their newborn population.1 Among newborns with CMV, it was estimated that 15–20% will suffer from potentially deleterious effects including...

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 birth and 25% of deafness at age 4 years.1 It can also give rise to other serious sequelae such as cerebral palsy, cognitive impairment, seizures...

Epidemiological trends and outcomes of children with aural foreign bodies in Singapore

Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to their inquisitive minds and experimental nature.1 Aetiologies for aural FBs include accidental or intentional insertion of FBs into body orifices, ear irritation caused by rhinitis...

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 American Society for Parenteral and Enteral Nutrition (ASPEN) developed a set of nutrition guidelines that addresses issues on nutrition assessment; timing and feeding route; caloric...

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 patients with COVID-19 has been highly challenging. In this issue of the Annals, Lew et al.1 reported the results of a multicentre retrospective observational study...

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” cast doubts on vaccine safety for reproductive health,1 including concerns that vaccine-induced SARS-CoV-2-neutralising antibodies (NAb) cross-react with human syncytin-1—a protein involved in gamete fertilisation and...

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 April 2022.1 With the introduction of vaccines that are effective in reducing severe COVID-19 illnesses and deaths, Singapore had since pivoted from a COVID-19 elimination...

Prevalence and correlates of psychological distress and coronavirus anxiety among hospital essential services workers in Singapore

The Coronavirus Disease 2019 (COVID-19) has affected almost all geographies in the world since 2020. Many countries have imposed strict isolation measures to contain the spread of this disease. While the majority of the population has been working from home, essential workers continue manning the frontlines, facing risks such...

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 date, over 10 million doses of mRNA vaccines have been administered for the primary series and booster doses.1 Initial studies have shown that 0.8% of...

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 hepatic failure. In 2010, the hepatitis B surface antigen (HBsAg) seroprevalence in Singapore was 3.6%.1 Patients with dermatological conditions receive prolonged corticosteroid and other immunosuppressive therapy...

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 as 50%. We present a patient with intravascular lymphoma with secondary bacterial infection and invasive mucormycosis involving the thyroid gland, who experienced good outcomes following surgical...

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 a clinical review followed by a protocol to screen for cardiac, respiratory, haematological, endocrine/renal and neurological complications after recovery from infection. Both the study and screening...

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 gravis (MG) on steroid therapy and non-insulin dependent diabetes mellitus (NIDDM) who developed cryptococcal meningitis and in whom a search for a persistent focus by...

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

Use of Atypical Neuroleptics in a State Mental Institute

Schizophrenia is the most severe of all mental disorders and affects about 1% of the population. The main disturbances of schizophrenia comprise positive symptoms, negative symptoms and disorganisation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 until the Vietnam War when French and US military personnel were affected by it. This article is available only as a PDF. Please click on “Download...

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 is projected that by the year 2025, the global population will be 8.3 billion people, and by 2050, 10 billion people. This article is available only...

Somatisation among Asian Refugees and Immigrants as a Culturally-shaped Illness Behaviour

During the past two decades, close to one million Southeast Asian refugees of war have resettled in North America. Together with the already significant Asian immigrant population, they represent one of the fastest growing minority groups in the United States. This article is available only as a PDF. Please click...

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 (ICU) is ideal for the acquisition of nosocomial pathogens. This article is available only as a PDF. Please click on “Download PDF” on top to view...

How the Mental Hospital was Renamed Woodbridge Hospital in 1951

In the 1920s the government embarked on an ambitious programme to build hospitals, staffed largely by graduates of the King Edward College of Medicine. The “Mental Hospital”, commissioned and built by the British in 1928, was sited at Yio Chu Kang and spread out over 80 hectares of sprawling...

Disseminated Penicillium marneffei Infection: A Report of Five Cases in Singapore

Penicillium marneffei is a dimorphic fungus that can cause infection in immunocompromised hosts. Reports on infection with this organism were initially uncommon, but after the first report of disseminated P. marneffei infection in a HIV-infected individual from Bangkok in 1989, the incidence has increased markedly, almost exclusively in patients...

Selective Serotonin Reuptake Inhibitor Discontinuation Symptoms

Selective serotonin reuptake inhibitors (SSRIs) are a new class of antidepressants which are effective, better tolerated with less side effects and more specific in receptor activity than the older tricyclic antidepressants. However, like tricyclic antidepressants and other groups of antidepressants such as the monoamine oxidase inhibitors (MAOIs) and the...

Under-diagnosed Psychiatric Syndrome II: Pathologic Skin Picking

Pathologic skin picking may be defined as the habitual picking of skin lesions, which when chronic and extensive, can lead to significant distress, dysfunction and disfigurement. The underlying skin lesions may range from benign ones, e.g. barely noticeable irregularities of the skin, to more severe ones, e.g. acne, eczema,...

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 is derived from the Greek thrix which means hair; tillein, to pull; and mania, madness or frenzy. This article is available only as a PDF. Please...

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 in 1995. 90.4% of the cases were imported. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Under-diagnosed Psychiatric Syndrome I: Trichotillomania

Trichotillomania (TTM) is a chronic psychiatric condition characterised by uncontrollable, self-inflicted, hair pulling, resulting in noticeable hair loss. First described by Hallopeau a century ago, it was previously regarded as an obscure condition. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 to acquired immunodeficiency syndrome (AIDS) and death, and as a marker of treatment response to anti-HIV agents. Higher viral load levels have been correlated with...

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 encountered. Many of the cases of atypical mycobacterial infections have been associated with underlying immunocompromised states. This article is available only as a PDF. Please click...

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; however, it more commonly causes prosthetic valve endocarditis. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Psychological Trauma, Physical Health and Somatisation

Trauma does not respect persons or culture. While Singapore is fortunate to have been spared large-scale disaster and war for decades, it has nevertheless had its share of traumatic incidents. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Medical Leave Granted to Psychiatric Inpatients—A One-year Retrospective Review

The Department of Psychological Medicine, National University Hospital (NUH) has a 26-bedded inpatient unit. This study retrospectively examines the medical leave granted to all admitted patients over a one-year period in 1998. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Mental Health Literacy in Singapore: A Comparative Survey of Psychiatrists and Primary Health Professionals

The management of mental health disorders within a nation requires a system of care extending from the primary health care setting to tertiary and specialist care settings. To that end, professional knowledge of the recognition, management and prevention of mental disorders is critical. This article is available only as a...

Identification of Genes for Schizophrenia Susceptibility

Schizophrenia, described as “the most human of all diseases,” affects about 0.5 % to 1% of the population and typically develops in the early 20s in men and the late 20s to early 30s in women. It is one of the most severe, if not the most severe, of...

Muscle Dysmorphia in a Young Chinese Male

In 1891, Morselli described “dysmorphophobia” in 78 patients who were severely miserable, preoccupied and distressed by perceived deformities. The word “dysmorphia” in Greek means ugly. Body dysmorphic disorder appeared in DSM-III in 1987. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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. asteroides, N. brasiliensis and N. caviae are responsible for nearly all nocardial infections in man. This article is available only as a PDF. Please click on...

Contrasting Clozapine Prescribing Patterns in the East and West?

Schizophrenia is a severe mental illness which causes enormous suffering, impaired social and occupational functioning, as well as higher mortality among the sufferers. The mainstay of treatment is neuroleptics which are largely effective for certain symptoms of this illness. This article is available only as a PDF. Please click on...

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 medical history and no history of immunocompromised state. Chest radiograph showed cardiomegaly. Electrocardiogram showed low voltages in precordial leads (Fig. 1A). A computed tomography scan...

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 thyrotropin receptor antibodies (TRAB) were available. The patient was treated with carbimazole for 20 months. At the time of cessation of carbimazole in May 2020,...

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 largely driven by the emergence of viral variants. In the later part of 2021, the Delta variant was the predominant variant circulating globally, and was...

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 living-donor SOT during COVID-19, which took into account safety considerations for living donors, paediatric recipients and the transplant healthcare team. The US Centers for Disease...

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 within the wider community. Children still represent the minority of cases in Singapore, with around 8,000 paediatric cases as of 6 November 2021 out of...

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 the fight against the disease. The safety and efficacy of these vaccines have been well demonstrated in clinical trials,1,2 and also against severe disease from...

The moderating effect of employment status on the relationship between lifetime major depressive disorder and positive mental health

Studies across the world have reported a high prevalence of mental disorders,1-3 highlighting that mental disorders remain one of the major causes of “non-fatal burden”.4 In particular, major depressive disorder (MDD) has been identified as a highly prevailing mental disorder and the leading cause of disability worldwide. More than...

The relationship between major depressive disorder and employment status

Major depressive disorder is associated with executive dysfunction that includes impairment in problem-solving and decision-making,1 as well as with occupational impairment.2 One of the challenges during the COVID-19 pandemic has been to maintain employment status. It has been reported that employment status is associated with measures of quality of...

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. He has travelled several times in the past few years to caves in Kuala Lumpur for worship. This article is available only as a PDF. Please...

Cardiac Effects of Psychotropic Drugs

The incidence of mortality is higher among psychiatric patients than among the general population and the cause of which may be the psychiatric disorder itself or other related factors like life-style and medications. Reports of sudden deaths among patients taking psychotropic drugs have raised concerns that some of the...

Men Who Commit Rape in Singapore

Of all the sexual crimes committed, rape stands out as one of the most serious forms of sexual assault, yet there is a general lack of clinical information on convicted rapists in Singapore and elsewhere. We believe this to be the first such study in Singapore. This article is available...

Psychiatric Illness, Personality Traits and the Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder seen by gastroenterologists and has been found to account for 50% of referrals to a Gastroenterology clinic. It has an estimated prevalence of between 15% and 25% in the non-patient population. This article is available only as a PDF....

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 important are methicillin-resistant Staphylococcus aureus (MRSA), β-lactam resistant and multidrug-resistant Streptococcus pneumoniae, and vancomycin-resistant enterococci. This article is available only as a PDF. Please click on...

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 responsible for nearly two thirds of all bloodstream and skin and soft tissue infections. This article is available only as a PDF. Please click on “Download...

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

Behavioural Disorders in Childhood: A Singapore Perspective

A review of five Western epidemiological studies of children aged 6 to 11 years revealed an average prevalence of 25% for psychiatric disorder (ranging from 12.4% to 48%). Asian studies show a similar prevalence range, with a 6.1% prevalence in a Malaysian study of 1- to 15-year-old children, a...

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 1977. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Views of Mental Health Professionals Towards Psychotherapy—A Singapore Survey

There is a trend in Asia towards a greater application of psychotherapeutic approaches in multidisciplinary settings to emotional and behavioural disturbances. The inaugural issue of Asian Psychologist announced landmarks in the education and training of clinical psychology in two major Asian communities. This article is available only as a PDF....

Pilot Study to Assess the Viability of a Rape Trauma Syndrome Questionnaire

In their 1974 study, Burgess and Holmstrom1 interviewed a heterogeneous sample of 92 adult females admitted between 1972 and 1973 to the emergency ward of the Boston City Hospital with the presenting complaint of being raped. From the analysis of the responses of these women, the authors identified “an...

Thyroid Dysfunction in Chronic Schizophrenia Within a State Psychiatric Hospital

Thyroid dysfunction can give rise to various psychiatric symptoms. While there is a persistent interest in the role of thyroid axis in affective disorders, there is limited data on the interaction of thyroid dysfunction with psychotic disorders such as schizophrenia. This article is available only as a PDF. Please click...

Mental Disorders and Public Safety of the Community at Large—Does the Tarasoff Principle Apply in Singapore?

In the course of their work, psychiatrists treat patients who, because of their mental disorders, may pose a danger to themselves and/or to others. What is the duty of the psychiatrist treating this patient? This article is available only as a PDF. Please click on “Download PDF” on top to...

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 June 1996 revealed that Candida was the fourth leading cause of nosocomial bloodstream infections, accounting for 8% of such infections. This article is available only as...

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 sickness absence from work. Influenza in the elderly population and in high-risk groups results in hospitalisations and deaths due to complications of pneumonia. This article is...

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% before infection control measures were instituted; and this led to the near collapse of healthcare systems in some of the affected countries. In Singapore, healthcare...

Preventing Youth Suicide

This letter is in reference to Dr Ung’s article published in the Annals which investigated youth suicide and parasuicide in Singapore. The study of suicide has a very respectful tradition as many studies have led to the recognition of cultural and environmental risk factors. This article is available only as...

Severe Acute Respiratory Syndrome (SARS) — 150 Days On

The Severe Acute Respiratory Syndrome (SARS) has been identified as a new clinical entity in the year 2003. It was on 12 March 2003 that the World Health Organization (WHO) issued a global health alert on the disease then known as atypical pneumonia. This article is available only as a...

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 public health threat with wide-ranging medical, social and economic consequences. First gaining foothold among intravenous drug users and commercial sex workers, HIV quickly spreads to...

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 changes. The transition from childhood to adulthood includes the formation of successful intimate relationships and avoidance of the pitfalls of sexually transmitted infections (STI), including...

Eating Disorders in Singapore: A Review

Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms of shape/weight dissatisfaction and eating abnormalities. Anorexia nervosa is characterised by significant self-induced weight loss secondary to fear of fatness, amenorrhoea (cessation of menstruation for...

Youth Suicide and Parasuicide in Singapore

The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or herself in the knowledge, or expectation, of its fatal outcome. Parasuicide or attempted suicide is distinguished from suicide by the non-fatal outcome. This article is available...

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 almost every area, including epidemiology, classification and treatment. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

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 stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response. We present our qualitative study, guided by...

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 of the first countries to import COVID-19 cases from China.2 Nosocomial transmission of SARS-CoV-2 had been reported in various cohort studies of healthcare workers (HCWs),...

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 area of considerable interest, and many unanswered questions surround this organism and the types of diseases it causes. This article is available only as a PDF....

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, caused by Salmonella typhi (S. typhi) and Salmonella paratyphi (S. paratyphi), occurs mostly in developing tropical countries but is increasingly seen as imported infections in...

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 severely affected by this epidemic were Hong Kong, China, Taiwan, Canada and Singapore. This article is available only as a PDF. Please click on “Download PDF”...

A Risk Reduction Approach for Schizophrenia: The Early Psychosis Intervention Programme

Schizophrenia is a serious mental disorder with a profound impact on patients, their caregivers and society. The Global Burden of Disease lists schizophrenia among the top 10 contributors to health burden and disability around the world. This article is available only as a PDF. Please click on “Download PDF” on...

Interleukin-2 Levels in Chronic Schizophrenia Patients

Autoimmune processes have been implicated in the pathogenesis of schizophrenia. Several pieces of indirect evidence point towards a role of autoimmune processes in at least some cases of schizophrenia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 and serious nature of this outbreak in 2003 focussed unprecedented attention on laboratory safety practices. This article is available only as a PDF. Please click on...

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, healthcare workers (HCWs) are encouraged to be vaccinated against varicella. Pregnant HCWs who are exposed to chickenpox also face the risk of transmitting VZ to...

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 per 100,000 in the year 2001. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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

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 setting, such as nebulisers, water baths, dialysis machines and intravenous fluids. This article is available only as a PDF. Please click on “Download PDF” on top...

Early Dengue Infection and Outcome Study (EDEN) – Study Design and Preliminary Findings

Dengue fever/dengue haemorrhagic fever (DF/DHF) is a re-emerging disease that is endemic in the tropical world. It is caused by 4 closely-related dengue viruses which are transmitted by the Aedes mosquitoes, principally the Aedes aegypti mosquito. This article is available only as a PDF. Please click on “Download PDF” on...

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 children pertussis is characterised by paroxysmal cough, whooping cough and post-tussive vomiting, in adults the disease is often atypical, sometimes manifested only by a protracted,...

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 travel to destinations with high disease risks. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Abuse of Prescription Buprenorphine, Regulatory Controls and the Role of the Primary Physician

Buprenorphine is an opiate partial agonist that has been used for pain management, and in the past few years has been approved for the treatment of opioid dependence in Singapore and other countries. Buprenorphine is available in primary care clinics and can be prescribed by all licensed physicians who...

Reducing Polypharmacy Through the Introduction of a Treatment Algorithm: Use of a Treatment Algorithm on the Impact on Polypharmacy

The use of 2 or more antipsychotic medications (polypharmacy) for an episode of psychosis is pervasive despite the lack of evidence-based data. It is also associated with higher daily dosing, more frequent use of adjunctive medications such as anticholinergic agents, higher rate of adverse effects and under-utilisation of atypical...

Socio-demographic Profile and Help-seeking Behaviour of Buprenorphine Abusers in Singapore

Opiate dependence is a major health and social concern in many countries across the world. The burden of disease is considerable, with surveys indicating that up to 2% of the population had used opiates for non-medicinal reasons. This article is available only as a PDF. Please click on “Download PDF”...

Medicalising the Treatment of Opioid Dependence

Traditionally the treatment of opioid dependence in Singapore has not been viewed as a public health problem, but rather as a social problem that necessitated custodial and other punitive approaches. The turning point came in 1996, when, after a pilot programme in the Prisons Department, naltrexone was introduced as...

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 of 8098 reported infections and 774 deaths before it was brought under control. This article is available only as a PDF. Please click on “Download PDF”...

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, southern China in mid-November 2002. In late February 2003, the Metropole Hotel in Hong Kong became the epicentre where SARS crossed intercontinental boundaries through rapid...

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 2002 in Guangdong, southern China. SARS was the first pandemic of the 21st century. This article is available only as a PDF. Please click on “Download...

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 greater import and found common usage in the lexicon of governance by public health systems in our part of the world. This article is available only...

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 Hong Kong, Singapore, Vietnam and Canada. The causative agent was identified as SARS coronavirus (SARS-CoV), not seen before in human. This article is available only as...

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 by fears of severe decreases in travel, tourism and trade as a result of aggressive protective measures undertaken by other countries. It now comes from...

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 people of Singapore. The SARS outbreak in Singapore began on 1 March 2003 and the last case of the outbreak was isolated on 11 May...

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 12 March 2003. This disease was later named severe acute respiratory syndrome (SARS). This article is available only as a PDF. Please click on “Download PDF”...

SARS in Singapore – Predictors of Disease Severity

Severe acute respiratory syndrome (SARS) is a recently defined illness caused by a novel coronavirus. The outbreak in Singapore originated from Hong Kong via mainland China. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 infections and 774 deaths before it was brought under control. This article is available only as a PDF. Please click on “Download PDF” on top to...

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 strict control of imported food and livestock. These emerging diseases include Bengal cholera caused by a new cholera biotype, Vibrio cholerae O139, multi-drug-resistant salmonellosis caused...

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

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 be undifferentiated. The thrust of such systems is to detect both intentionally induced and naturally occurring outbreaks in their earliest stages, and if possible, at...

“The one” Annoying Patient

Schizophrenia – a mind torn asunder – is a difficult illness to live with, both for the patient as well as for the caregiver; thus, it is not an uncommon sight to see the authorities bring such patients to our psychiatric practice, whether abandoned or simply lost. What was...

The Risk of Suicidality with Selective Serotonin Reuptake Inhibitors

The first antidepressants were discovered 50 years ago by chance. Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) dominated the treatment of depression from the late 1950s until the late 1980s, when selective serotonin reuptake inhibitors (SSRIs) were introduced. This article is available only as a PDF. Please click on...

Clinical and Social Correlates of Duration of Untreated Psychosis in First-episode Psychosis Patients

First-episode studies of schizophrenia have reported that the longer the duration of untreated psychosis (DUP), the poorer the response to antipsychotic medication and treatment outcome. The findings of these studies have led to the assertion that by reducing DUP, treatment outcome for schizophrenia and other related psychosis might be...

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 result in significant morbidity in this population of patients. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 morbidity and mortality. The majority of MRSA infections are hospital acquired, and the prevalence of such cases can be affected by infection control practices such...

Methicillin-resistant Staphylococcus aureus Control in Singapore – Moving Forward

The significance of methicillin-resistant Staphylococcus aureus (MRSA) is indisputable. Its successful establishment and maintenance as the most important endemic healthcare associated infection (HCAI) results from its reservoir in up to 20% of inpatients and 16% of healthcare workers plus its ability to survive on surfaces for over 12 days. This...

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

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. Presently, polymyxins have re-emerged as a “no choice” alternative for treatment of multidrug-resistant (MDR) gram-negative bacilli infections, which are not infrequent, in Singapore and Asia...

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 and colonisation have been steadily rising. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 1986, the then Director of Medical Services, Dr Kwa Soon Bee, Chairman NUH, hoped that the new teaching hospital would set the pace for “an...

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 1974 by Tan et al (Fig. 1) based on a limited number of isolates from sterile and non-sterile sites at the Department of Pathology, Ministry...

In vitro Activities of Antifungal Drugs Against Yeasts Isolated from Blood Cultures and Moulds Isolated from Various Clinically Significant Sites in Singapore

Fungaemia carries with it high mortality rates and appropriate as well as timely antifungal therapy has been shown to be life saving. Amphotericin B has the broadest coverage amongst the antifungal drugs against fungal infection, and was regarded the gold standard treatment for severe fungal infection. This article is available...

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 fungal bloodstream infections (BSI), and Candida was reported as the fourth most common blood stream pathogen in the United States. This article is available only as...

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 most common causes of bacteraemia, and 21% of E. coli and 51% K. pneumoniae produced ESBL. This article is available only as a PDF. Please click...

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 was previously considered to have limited pathogenicity, recent reports suggested that infection with S. maltophilia was associated with significant morbidity and mortality, particularly in severely...

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 of antibiotic resistance in gram-negative bacilli has generally gone unnoticed by the general public. Antimicrobial resistance in gram-negative bacilli has increased worldwide over the past...

Antimicrobial Resistance: A New Beginning and the Need for Action

In this issue, the articles (historical, original and review papers) highlight the extent and problem of antimicrobial resistance in Singapore. The authors should be congratulated on their efforts. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Media and Suicide

Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020. This is equal to the burden due to wars and homicide, roughly twice the burden of diabetes and equal to the...

Performance Measures for Mental Healthcare in Singapore

Mental disorders are prevalent worldwide and while they are disabling and costly, they have not received that amount of attention and resources needed. A recent survey of low-income and middle-income countries (as per World Bank classification) revealed that government spending on mental health is much lower than what is...

Mental Health Professionals’ Perceived Barriers and Benefits, and Personal Concerns in Relation to Psychiatric Research

Epidemiological research has shown that mental disorders can result in considerable healthcare and other opportunity costs. There are some reports that have highlighted the negligence of mental health and the lack of recognition of the importance of mental disorders. This article is available only as a PDF. Please click on...

Pathways to Specialist Care in an Insomnia Clinic at a Psychiatric Hospital: A Comparative Analysis of Two Periods

The complaint of insomnia is common and patients generally either self-medicate and/or consult primary healthcare providers. Referrals to a specialist for further management largely depends on the initial assessments and findings, the presence of comorbidity and/or difficulties in treating the underlying problems. This article is available only as a PDF....

Suicide

The word suicide is derived from the Latin word suicidium, itself derived from sui (of oneself) and cidium (a killing; caedere = to kill. The word appears to have been first used around 1651, although the self-killing act itself is recorded in antiquity. This article is available only as a...

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

Hypnotherapy for Sleep Disorders

Derived from ‘Hypnos’, the Greek God of sleep, the word hypnosis literally means sleep. Ironically, hypnosis is not a form of sleep but a state of increased concentration and awareness. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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 current version of the Diagnostic and Statistical Manual of Diseases (DSM), fourth edition, has 2 lists of behavioural symptoms grouped under “inattentive” and “hyperactive-impulsive” symptoms,...

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 have expressed heightened concern about respiratory illnesses and their impact on health services. Some infectious diseases have long been known to pose hazards in acute-care...

Neuropsychiatry – An Emerging Field

Neuropsychiatry can be described as the interface between neurology and psychiatry – the intersecting field of enquiry for both the brain and the mind. In more practical terms, it often, though not necessarily, narrows down to psychiatric comorbidities of neurologic diseases (e.g. depression in a patient with stroke) and...

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 to implications of a positive test result. It reflects an attempt to address the need to protect patients, preserve public confidence in the healthcare system...

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

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 first of these pandemics occurred suddenly, and without warning. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 be the forerunner to a severe human pandemic have focussed new attention on the status, and in particular the shortcomings, of our current human influenza...

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 the influenza A genus of the Orthomyxoviridae family. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

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

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 that year resulted in 6 deaths. The outbreak was completely terminated after the culling of over 1.5 million chickens. This article is available only as a...

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 with an extremely high fatality proportion of 81% . Those patients were reported from 12 out of 33 provinces (Fig. 1). This article is available only...

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

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 is clinically infected by seasonal influenza annually, and excess mortality over the past decade was about 14.8 per 100,000 person-years – comparable to temperate United...

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 (ILI) annually in Singapore, leading to 3.5 million doctor visits and 2.1 million days of documented medical leave. This article is available only as a PDF....

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 in several parts of Asia. To date, there have been more than 200 human cases of AI virus infection, mainly as a result of poultry-to-human...

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 of Health of Indonesia confirmed an established outbreak of AI in humans in Indonesia. This article is available only as a PDF. Please click on “Download...

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 potential mortality comparable to tuberculosis, malaria or HIV/AIDS but occurring within a much shorter timeframe, pandemic influenza remains a real possibility. This article is available only...

Providing Integrated Mental Health Services in the Singapore Primary Care Setting – the General Practitioner Psychiatric Programme Experience

Mental disorders are recognised as a major public health problem worldwide, and the management of mental health problems places an enormous burden on health services. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care

The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the threat of an avian influenza (AI) pandemic is imminent. Healthcare institutions are expected to be key players during a pandemic, with healthcare workers (HCWs) at...

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. Brucellosis has a limited geographic distribution but remains a major problem in Mediterranean and Middle Eastern countries. This article is available only as a PDF. Please...

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. Hepatic dysfunction is common in dengue infection, and is attributed to a direct viral effect on liver cells or as a consequence of dysregulated host...

Prevalence and Correlates of Excessive Internet Use among Youth in Singapore

There has been an explosive growth of Internet usage worldwide and this is expected to continue with its use becoming an integral part of everyday life. The Internet has become more accessible in homes, schools, colleges, libraries and Internet cafes; access is further aided with the increasing affordability of...

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, but WHO-led efforts for the global elimination of leprosy by 2000 did not succeed. In several countries, however, ambitious and ill-advised attempts to meet the...

The personal recovery movement in Singapore – past, present and future

Early psychiatric conceptions of successful mental health recovery traditionally focused on reducing or eradicating symptoms.1 The personal recovery movement of the early 1990s in the US prioritised a more holistic and consumer-driven understanding of recovery.2 This paradigm shift emphasises that recovery is best defined by people with lived experiences,...

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 into a pandemic with devastating consequences to health and livelihoods.1 Hardly a day passes without the term COVID-19, the disease caused by the severe acute...

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 manifestations. We report a case of melioidosis manifested as mediastinal lymphadenitis and ceftazidime-susceptible B. pseudomallei bacteremia. This article is available only as a PDF. Please click...

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 discussion and sharing of updated information on epidemiology, biomedical advances, behavioural and social science, and to provide a platform for broadcasting results of research and...

Impact of Depression on Health Related Quality of Life in Patients with Diabetes

Diabetes Mellitus (DM) is a serious chronic illness that imposes significant morbidity and mortality and has a major impact on the quality of life of the individuals suffering from this illness. Singapore, a multi-ethnic country in Southeast Asia, with Chinese, Malay and Indian as the three main ethnic groups,...

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) and Salmonella enterica serovar Paratyphi (S. Paratyphi), respectively. Humans are the reservoir of infection and transmission occurs through food and water contaminated by acute cases...

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 2.1 million in 2004 to an estimated 1.8 million in 2009. This is mainly attributable to the huge expansion in access to anti-retroviral therapy (ART). This...

Management of a Patient with Schizophrenia and Underlying Pituitary Macroadenoma

Hyperprolactinemia was found to be prevalent in a multi-centred study of 402 patients with schizophrenia, schizoaffective disorder and schizophreniform disorder treated with conventional antipsychotics and Risperidone. Antipsychotics inhibit the dopamine receptors and induce hyperprolactinemia via the tubulo-infundibular pathway, with subsequent downstream effects on multiple systems. This article is available only...

Psychological Symptoms in People Presenting for Weight Management

Multiple factors contribute to the genesis and maintenance of obesity which is a difficult condition to treat and weight loss is often not maintained. The psychological problems found in obese patients have recently received increasing attention. This article is available only as a PDF. Please click on “Download PDF” on...

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 resident who came back to Singapore from a holiday in Hong Kong. The 2003 SARS outbreak in Singapore began on 1 March 2003 and the...

Preventive Psychiatry

In medicine, measures that save the most lives and improved the quality of life of millions have largely been public health measures that in most instances, had been preventive measures. The most obvious examples are the infectious diseases which were – to use the cliché – the scourge of...

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 the Infectious Diseases Act in 1976. Based on the findings of epidemiological investigations of reported cases and the results of seroepidemiological studies, a national hepatitis...

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 and tetanus (1959) and measles and rubella (1976). In October 1985, hepatitis B vaccination was introduced into the programme for babies born to hepatitis B...

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 divided into serogroups based on the somatic O antigen. Only O1 and O139 serogroups are known to cause epidemic and pandemic disease. This article is available...

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 infections, due to the closed proximity that they live in. A number of influenza outbreaks involving residents in LTCFs have been reported in the medical...

Monthly Take-Home Methadone Maintenance Regime for Elderly Opium-Dependent Users in Singapore

The misuse of illicit opiates remains a global problem, placing a heavy burden on society. Literature on the effectiveness of opiate substitution pharmacotherapies in reducing consumption of illegal drug use, criminal activities, injecting and sharing behaviours, the spread of blood-borne diseases and mortality, now spans several decades and countries. This...

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 awareness of the need for safe blood and blood products for transfusion and of the critical contribution made by voluntary unpaid blood donors to national...

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 Health in Thailand in response to infections caused by the influenza A (H5N1) avian virus. A number of countries together with the World Health Organization...

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 respiratory syndrome (SARS) outbreak in Singapore in 2003. The recent emergence of a novel influenza A (H1N1-2009) pandemic has again reminded us of the potential...

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 between 1918 and 1919, the pre-antibiotic era, exhibited severe changes indicative of bacterial pneumonia; these are less well substantiated in the subsequent 2 pandemics in...

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 now the method of choice to study knowledge, attitudes, values and beliefs. This article is available only as a PDF. Please click on “Download PDF” on...

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 190 countries and resulted in more than 4500 deaths worldwide. According to Taiwan Centres for Disease Control (Taiwan CDC) data, among 2,089 typed influenza isolates...

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

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 and public health events to the World Health Organization (WHO). The first novel Influenza A (H1N1) patient in the US was confirmed by laboratory testing...

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 health control measures instituted in Singapore to limit the spread of H1N1-2009 and mitigate its effects on our society. This article is available only as a...

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 the United States of America,1 the Emergency Preparedness Teams of the Singapore General Hospital and its sister institutions on the Outram Campus were activated. Measures...

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 then spread worldwide, resulting in the first influenza pandemic of the 21st century. This article is available only as a PDF. Please click on “Download PDF”...

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 of the infection in April 2009, the World Health Organization declared the situation a public health emergency of international concern. This article is available only as...

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/ H5N1, was still found to be inadequate to deal with the rapid spread of pandemic influenza A/H1N1/2009 as it emerged from the Americas in March/April...

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 in southern California was caused by a novel influenza A (H1N1) virus. The virus is thought to be a re-assortment of 4 known strains of...

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 in the United States in late April 2009. This was linked to outbreaks of influenza in Mexico, which included reports of large numbers of cases...

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 rapidity of its spread as well as by its novel genomic structure. The latter consisted of a triple re-assortment of swine, avian and human...

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 the rapidity of its spread as well as by its novel genomic structure. The latter consisted of a triple re-assortment of swine, avian and human...

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 World Health Organization (WHO) estimates that there are about 8.8 million new cases of TB and 1.6 million deaths from TB every year. This article is...

Panic Attack and its Correlation with Acute Coronary Syndrome – More Than Just a Diagnosis of Exclusion

Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for a physician not to consider it as a possible diagnosis in any patient presenting with acute symptoms of chest tightness or discomfort, palpitations, dyspnoea, diaphoresis,...

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 light of some of the points raised such as frequent comorbidities that occur with ADHD as is the case of Autistic disorder and other conditions...

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 curing for attention deficit hyperactivity disorder (ADHD) is taking place. There are some evidence-based points that should be noted. This article is available only as a...

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 years. Today, 2.5 billion people over 100 endemic countries remain susceptible to this disease with an estimated annual incidence of 50 million leading to 22,000...

Socio-demographic Profile and Psychiatric Comorbidity of Subjects with Pathological Gambling

Gambling has been defined as a wager of any type of item or possession of value upon a game or event of uncertain outcome in which chance, of a variable degree, determines the outcome. The failure to resist the impulse to gamble despite disruption to personal, family and vocational...

Weight Gain in Asian Patients on Second-generation Antipsychotics

Weight gain is a serious side-effect with antipsychotic medication use. There is increasing evidence that with certain second-generation antipsychotics (SGA) weight gain liability is greater than with the high potency first-generation antipsychotics (FGA). This article is available only as a PDF. Please click on “Download PDF” on top to view...

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 upper respiratory tract. There has been a decline in the global annual new case detection rate (NCDR) for leprosy since 2001. This article is available only...

The Health-Related Quality of Life of Junior Doctors

It is widely reported that junior doctors experience a large amount of work-related stress and fatigue. This has detrimental effects both on the well-being of the junior physicians and the health and well-being of the patients that they are treating. Junior doctors, especially those undergoing traineeship, have shown high...

Where do People with Mental Disorders in Singapore go to for Help?

Not only are mental disorders prevalent in any country, it is also common that many of those with mental disorders are neither seeking nor receiving help. This is the case even in developed countries: of the 31% of the US population affected by at least one mental illness, 67%...

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 intensive care. Although the majority have mild infections, up to 20% are estimated to become critically ill from severe disease.1 Age, concurrent comorbidities, more severe...

Effectiveness of Assertive Community Management in Singapore

In Asia, various community programmes have been adopted and studied in several countries in an effort to promote de-institutionalisation, community psychiatric services and reduce relapses or readmission rates. In Manila, Philippines, the National Mental Hospital has successfully reduced hospitalisation by 70% after introducing the Acute Crisis Intervention Services (ACIS),...

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 small stool volume. His stool consistency ranged from soft to watery. Apart from a weight loss of 3 kg, no other constitutional or extraintestinal symptoms...

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 countries continue to struggle with rising infection rates, and economic and social impact of the pandemic.3-5 COVID-19 vaccines have become available since the end of...

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, with the World Health Organization (WHO) reporting over 206 million cases and over 4 million deaths globally as of 15 August 2021.1 To contain the...

Height and Mental Health and Health Utility Among Ethnic Chinese in a Polyclinic Sample in Singapore

Several studies have found adult height predictive of mental health and emotional well-being. A study of Swedish conscripts demonstrated an inverse association between height at age 18 to 19 and suicide mortality over 15 years of follow-up. Similarly, a study of Filipinos demonstrated an inverse association between height at age...

You Are Worth More Than What You Weigh: Preventing Eating Disorders

Times have changed. Maternal mortality rates at the start of the 1900s were around 1 in 100 live births in the best maternity institutions. This has declined by around 3 orders of magnitude in the last 100 years to about 3 in 100,000 live births in places like Singapore. Perinatal...

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 considered, but it would definitely not be on the top of my list due to the following reasons. This article is available only as a PDF....

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 Annals, Academy of Medicine. We propose a differential diagnosis of Bartonella neuroretinitis for the case reported. This article is available only as a PDF. Please click...

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. However, their full pathogenic potential was only realised when an outbreak of severe pneumonia with a high fatality rate occurred in southern China, and they...

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 severe sepsis each year. Of this, more than 60% are patients older than 65 years. Morbidity and mortality remain high in spite of advances in...

An Analysis of Blinding Success in a Randomised Controlled Trial of Fish Oil Omega-3 Fatty Acids

There has been growing interest in the use of dietary supplementation to treat psychiatric disorders. In particular, supplementation of omega-3 fatty acids has been researched as a potential means of preventing and managing psychopathology. These fatty acids are ingested through dietary sources (e.g. fish), with inadequate concentrations implicated in...

Schizophrenia as a Lifelong Illness: Implications for Care

The management of schizophrenia has advanced considerably since the term was first coined in 1911, with Kraepelin’s early pessimism tempered by more recent evidence examining outcome. The discovery of antipsychotics represented a major breakthrough in the treatment of schizophrenia, while more recently we have witnessed promising initiatives such as...

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 accounted for 2% to 20% of bacteraemia. However, by the mid 1980s, multiple centres reported declining rates of anaerobic bacteraemia, and several authors suggested that...

Integrating mental healthcare in primary care in Singapore

Management of mental health conditions can be both resource-intensive and costly. The rigour of obtaining appointments and the long waiting time at tertiary hospitals, coupled with the need to obtain leave from work form a significant financial and logistical burden on patients for the treatment of mental health conditions....

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 30 January 2020, and subsequently designated a pandemic on 11 March 2020.1 Globally, over 209 million cases have been reported, with more than 4.4 million...

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. With advances made in efficacy and tolerability of combination antiretroviral therapy (ART) and increased access to health services in developed and developing countries, PLHIV are...

Prehabilitation and Its Role in Geriatric Surgery

The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As the life expectancy of the population has improved significantly in the past few decades, a substantial portion of this rapidly ageing population will place a...

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 in the care of patients with communicable diseases like COVID-19. PPE is also worn by ancillary staff such as security personnel, porters, medical transport crew...

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 fires, has vast effects on multiple countries in the region. This article is available only as a PDF. Please click on "Download PDF" to view the...

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 as abnormal platelet activation, impaired fibrinolysis, and endothelial dysfunction in COVID-19 patients, resulting in thrombosis. The lungs are thought to be the epicentre of thrombosis,...

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 bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health...

Dietary intake of persons with depressive and psychotic disorders in Singapore

Unhealthy diet is a modifiable risk factor in many health conditions, including mental disorders. Nutritional psychiatry is an emerging field that examines the role of diet and nutrition in mental health. Since its beginnings in the 2000s, a notable change in the field was a switch in focus from...

Nutritional psychiatry: The next frontier in mental health treatment

The World Health Organization has envisioned for every human being’s fundamental right to be able to enjoy the highest attainable standard of health, even in the presence of disease or infirmary. Singaporeans’ average life expectancy is projected to reach 85.4 years by the year 2040 and the burden of...

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 weight loss over 7 months. She previously had an intrauterine device (IUD) for 5 years, removed 2 years prior to presentation. Vital signs were stable,...

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 QIAstat-Dx® Respiratory SARS-CoV-2 Panel—a multiplex real-time polymerase chain reaction (RT-PCR) assay—against an E-gene RT-PCR assay2 that successfully identified cases at the start of the COVID-19...

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 as we learn of the low rates of bacterial and fungal co-infection. To limit unnecessary antimicrobial exposure, we posit an algorithm for antibiotic guidance. This article...

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 COVID-19-related lockdowns. Notably, there have been reports that patients with acute emergencies such as strokes and heart attacks are either not seeking treatment, or are...

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 computed tomography (HRCT) features of the lungs during the onset of COVID-19; however, few studies have described the radiological changes and outcome of residual lesions...

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) across different specialties are reported to have decreased quality of life and increased stress, further aggravated during the pandemic. This article is available only as a...

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. Our understanding of the pathophysiology of the disease process is still evolving. As part of the host response to viraemia, it has been postulated that...

Estimating the impact of COVID-19-induced coagulopathy

The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...

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 trauma patients as part of the Acute Care Surgery (ACS) service at the Singapore General Hospital, Singapore. The ACS team may be exposed to COVID-19...

A resuscitation course designed for a psychiatric hospital

It is challenging to maintain the resuscitation skills of doctors in a psychiatric hospital. Our study describes a resuscitation course designed specifically for the Institute of Mental Health in Singapore to address competency gaps, which proved to be relevant and helpful to the trainees.   This article is available only as...

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 surgeries in COVID-19 patients requiring early orthopaedic surgery. This paper aims to provide evidence-based recommendations regarding the timing to proceed with early orthopaedic surgeries in...

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 to be elevated among healthcare workers and the general population. Others have reported a higher incidence of stress-related symptoms or post-traumatic stress disorder. These findings...

Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore

In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community transmission began early in the outbreak, the government started emphasising the role that individuals had to play by adopting health-preventive behaviours. This article is available only...

Psychosocial impact of the COVID-19 pandemic on paediatric healthcare workers

Early studies done in China during this COVID-19 pandemic have shown considerable mental health impact on healthcare workers (HCWs), especially those working on the frontline. HCWs exposed directly to COVID-19 may be affected not only by fears of contracting the virus and spreading it to their loved ones, but...

The impact of COVID-19 pandemic on global mental health: From the general public to healthcare workers

The COVID-19 pandemic began in late 2019 and was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. To decrease the spread of the virus and demand on the healthcare system, governments globally executed multiple public health measures including lockdown, social distancing, significant closure of...

Living with COVID-19: The road ahead

The COVID-19 pandemic has made an unprecedented impact on global morbidity, mortality and healthcare measures to contain the infection.1 Multiple waves of infections in 2020 and 2021 have resulted in significant disruptions to healthcare, economies and societies globally, with few countries able to avoid major epidemics. In the initial...

The Novel Coronavirus (SARS-CoV-2) Pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and was reported to the World Health Organization (WHO) on 31 December 2019. An outbreak of unknown aetiology was suspected because many early cases were linked...

Precautions When Providing Dental Care During Coronavirus Disease 2019 (COVID-19) Pandemic

Coronavirus disease 2019 (COVID-19) is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported to the World Health Organization (WHO) as pneumonia of unknown aetiology in the Chinese city of Wuhan on 31 December 2019. Since then, COVID-19 has spread across the globe and...

Autism Spectrum Disorder and COVID-19: Helping Caregivers Navigate the Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has disrupted societies globally. As of 11 May 2020, 53 children have been infected with COVID-19 in Singapore (Ministry of Health, Singapore, unpublished data). Children generally have mild disease, although there is emerging literature on paediatric multisystem inflammatory syndrome temporally associated with COVID-19....

Cross-reaction of Sera from COVID-19 Patients with SARS-CoV Assays

SARS-CoV-2 is a new zoonotic coronavirus (CoV) that emerged in Wuhan, China, which was first reported to the World Health Organization (WHO) on 31 December 2019. This coronavirus disease (COVID-19) causes mild to moderate respiratory illness in the majority of patients, but can cause serious complications in the elderly...

COVID-19 and Singapore: From Early Response to Circuit Breaker

The COVID-19 pandemic first broke out in Wuhan, China, in December 2019, where a cluster of pneumonia cases was reported and the novel coronavirus later identified. Since then, the virus has spread rapidly across the world, registering a total of 85000 reported cases across 53 countries/territories by 29 February...

Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children

Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...

Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre

As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...

Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months

Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...

Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore

Since the first cases of coronavirus disease 2019 (COVID-19) in pregnancy were described, significant concerns have been raised about the potentially increased susceptibility of pregnant women to severe disease, and the unquantified risk of mother-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the fetus and neonate....

Resuming otolaryngology services following a COVID-19 lockdown in Singapore

When the COVID-19 outbreak first occurred, we tweaked our department workflows to cope with the various demands of our practice and the pandemic. When Singapore’s Multi-ministry Taskforce on COVID-19 deemed that it was safe to begin reopening the economy in 3 phases,3,4 our department adopted a gradual resumption of...

COVID-19: Lessons from Thailand

The COVID-19 pandemic has massively disrupted the social and economy of many countries. Thailand has been successful in controlling the spread of the disease and treating COVID-19 patients. We discuss Thailand’s strategy in containing the disease, management of severe COVID-19 patients, as well as future perspectives of COVID-19. This article...

Hypervirulent Klebsiella pneumoniae carriage in polyclinic attendees and national servicemen presenting with diarrhoea

Klebsiella pneumoniae liver abscess is an invasive syndrome that mainly affects people living in East Asia. It especially affects adults with diabetes and is caused by hypervirulent strains that possess the rmpA gene (regulator of mucoid phenotype A), iron sequestering genes, and usually belong to capsule types K1 and...

Videoconsultation to overcome barriers during COVID-19

Since February 2020, Government Restructured Hospitals in Singapore began deferring non-urgent outpatient appointments. This aimed to facilitate physical distancing and reallocate healthcare resources to combat the pandemic. As the pandemic becomes increasingly prolonged, this strategy is unsustainable. There is increasing interest in using videoconsultations to ensure that patients receive...

Positive RT-PCR detected in patients recovered from COVID-19

Positive real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acid following 2 consecutive negative RT-PCR tests have been reported in China and Korea. This has led to speculation regarding “persistent carrier states”, “re-infections” or “re-activations” and raises questions about using negative RT-PCR as part of de-isolation criteria. We...

Cerebral venous thrombosis in a patient with mild COVID-19 infection

Emerging reports suggest venous and arterial thromboembolic diseases can complicate recovery from COVID-19. Postulated mechanisms include hypercoagulability, hypoxia, immobilisation, excessive inflammation and diffuse intravascular coagulation, especially in patients with severe COVID-19 infection. Nauka et al. provided vital insight that thrombotic complications can happen in a patient with non-critically ill...

Decrease in emergency department attendances during COVID-19 especially in school-going children

Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with minor ailments, but these observations have yet to be evaluated in Singapore. We investigated ED attendances during the coronavirus disease 2019 (COVID-19) pandemic in Singapore. This...

Paediatric emergency department attendances during COVID-19 and SARS in Singapore

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...

Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review

Coronavirus disease 2019 (COVID-19) has spread rapidly from China to other countries around the world, with the World Health Organization characterising it as a global pandemic on 12 March 2020. The number of fatalities owing to COVID-19 is escalating rapidly. COVID-19 is caused by the Severe Acute Respiratory Syndrome...

Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review

The World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern on 30 January 2020. To control the outbreak, many countries have implemented nationwide lockdowns and social distancing measures, which have brought challenges to accessibility of healthcare services and continuation of long-term medical care,...

Obesity in COVID-19: A Systematic Review and Meta-analysis

Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is established that increasing age and comorbidities such as cardiovascular diseases are associated with risk of infection, more severe disease and adverse outcomes. Obesity is an epidemic globally, causing...

Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection

In this report, we describe a patient who developed acute respiratory distress syndrome (ARDS) with rapid clinical deterioration. Unfortunately, not much is known about the clinical features and risk factors for ARDS and critical illness even as the number of COVID-19 cases continues to climb at an alarming rate...

Epidemiology and Control of Hand, Foot and Mouth Disease in Singapore, 2001-2007

Hand, foot and mouth disease (HFMD) is a common childhood viral infection, which is typically mild and self-limiting. It is characterised by a brief prodromal fever, followed by pharyngitis, mouth ulcers and rash on the hands and feet. The disease is caused by numerous members of the Enterovirus genus...