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Deep brain stimulation in Parkinson’s disease: Looking back, looking forward

Patients with Parkinson’s disease (PD) may present with prodromal (e.g. hyposmia, sleep disorders, constipation), motor (e.g. tremors, rigidity, bradykinesia, postural dysfunction) and non-motor (e.g. cognitive dysfunction, depression) symptoms.1 Treatment is symptomatic, targeting motor and non-motor manifestations, but there is presently no effective disease modifying treatment.1 Although PD therapies have...

Healthcare burden of cognitive impairment: Evidence from a Singapore Chinese health study

Individuals with cognitive impairment (CI) are predisposed to injuries, infections and treatment complications,1 have poorer treatment compliance, and face greater difficulties with post-discharge care.2 These challenges, exacerbated by comorbidities,3-6 lead to poorer ambulatory care management, reduced contacts with primary and outpatient care providers, and greater use of emergency department...

Outcomes of patients admitted for drowning

Dear Editor, According to the latest Utstein-style consensus, drowning is defined as the primary respiratory impairment resulting from submersion or immersion in a liquid medium.1 Patients may experience hypothermia, acute respiratory distress syndrome and shock.1 The pathophysiology is poorly understood, but could relate to physiological responses to temperature, water swallowing...

Streamlining multidisciplinary care in sarcoma management

Dear Editor, Sarcomas are rare and heterogenous tumours that constitute fewer than 1% of adult solid cancers.1 Owing to their aggressive behaviour, relative rarity and occurrence at multiple anatomical sites, sarcomas can be challenging to treat.2 Timely referral to specialist sarcoma centres is thus paramount and reduces the incidence...

Minimal monitoring is a safe but underutilised strategy for hepatitis C virus treatment in Singapore

Dear Editor, Chronic hepatitis C virus (HCV) infection is estimated to affect 57 million people globally.1 Despite the availability of safe and effective pan-genotypic direct acting antivirals,2-5 many countries have yet to achieve the WHO goal of HCV elimination by 2030.1 To facilitate HCV elimination, current guidelines recommend using a...

Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis

End-stage renal failure (ESRF) is a major cause of morbidity and mortality worldwide, including Asia.1 In Singapore, incidence of chronic kidney disease (CKD) stage 5 has increased from 383.9 per million population (PMP) in 2010 to 414.8 PMP in 2015. Incidence of patients requiring dialysis has increased in tandem....

Survival outcome of haemodialysis and peritoneal dialysis

End-stage renal disease (ESRD) is a challenging and growing health issue, with number of patients increasing globally. The use of dialysis has greatly improved the survival and life expectancy of ESRD patients. Haemodialysis (HD) and peritoneal dialysis (PD) are 2 broad dialysis modalities used for ESRD. Despite the advancement...

Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia

The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix. The impact of the programme depends both on the detection of women with cervical intraepithelial neoplasia (CIN) and upon their being treated effectively. This article is...

Radiotherapy as Local Adjuvant Treatment for Endometrial Carcinoma—A Review of 45 Patients

Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control as well as to achieve excellent survival rates. Over the years, however, the specific role and relative benefit of postoperative radiotherapy for this particular cancer...

A Retrospective Study of Near-drowning Victims Admitted to the Intensive Care Unit

Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Osteoporosis—The Need for a Paradigm Shift

Osteoporosis is becoming an increasing public health problem in most countries. Osteoporosis literally means “porous bones” and involves skeletal fragility leading to an increased risk of fracture. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Managing Problem Gout

Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval gout), followed in about 10% of patients by chronic tophaceous gouty arthritis. Gout is one of the better understood of the arthritic disorders, and certainly...

Aetiology and Distribution of Mandibular Fractures in the National University Hospital, Singapore

Apart from the nasal bone, the mandible is the most commonly fractured bone in the face. It is also the 10th most often broken bone in the body. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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,...

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...

Current Therapeutic Strategies in Glomerulonephritis

Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients with minimal change nephrotic syndrome and lupus nephritis. For those patients who failed to respond, they were treated with oral cyclophosphamide. This article is available only...

Extended Resection of Locally Advanced (T4) Stomach Cancer

Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years, it is the third (10.1%) most common cancer in males and the fifth (6.5%) most common cancer in females in Singapore. This article is available only...

Survival of Colorectal Cancer Patients in Singapore by Anatomic Subsite: A Population-based Study

Colorectal cancer incidence rates rank second in most developed countries and have been rising rapidly in urban societies of East Asia. Despite much effort to detect early-stage disease and to explore more effective treatment methods, the overall 5-year survival rate has remained around 40% based on the reports from...

Case Reports of Low Dose Cyclosporine A Therapy in Adult Minimal Change Nephrotic Syndrome

There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic syndrome (MCNS), including those who fail steroids and cyclophosphamide therapy or who are steroid dependent and frequent relapsers. We report 3 cases which demonstrate the...

Primary Anorectal Malignant Melanoma: Clinical Features and Results of Surgical Therapy in Singapore—A Case Series

Malignant melanoma arising from the anal canal was first described in 1857. It is uncommon, comprising only about 1% of all anal canal tumours. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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

Of the approximately 15,000 deaths that occur in Singapore every year, about 25% are from cardiac causes; of which, some 30% to 40% occur suddenly, outside of a hospital. The mechanism of death is usually a fatal arrhythmia, most often ventricular tachycardia or fibrillation. This article is available only as...

Update in the Management of Stroke

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders has been rising dramatically over the last few years, exceeding 10,400 in 2001. This article is available only as a PDF. Please click on “Download PDF”...

Paediatric Extracranial Germ Cell Tumours: A Retrospective Review

Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Clinical Update on Osteoporosis

Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...

An Asian Perspective to the Problem of Osteoporosis

Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Contemporary Management of Fibroids

Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in most women. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Surgical Management of Colorectal Metastases to the Liver

Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver is the most common site of distant metastases from colorectal cancer. This article is available only as a PDF. Please click on “Download PDF” on top...

The Diagnosis and Management of Hypercalcaemia

Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in women and <1% in men above the age of 60 years. This article is available only as a PDF. Please click on “Download PDF” on top...

Nipah Encephalitis Outbreak in Malaysia

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started in Ulu Piah, Tambun and Ampang near Ipoh in the state of Perak, later involved Sikamat, Sungai Nipah, Kampong Sawah and Bukit Pelanduk areas in...

A Case Report of Occupational Asthma due to Gluteraldehyde Exposure

Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been attributed to an occupational cause. Yet, only 3 cases were reported and confirmed in Singapore in the year 2000 – an incidence of only 0.14/100,000...

Bile Duct Perforation in Children: Is it Truly Spontaneous?

Bile duct perforation (BDP) and biliary ascites in children is a rare clinical entity. The aetiopathogenesis is still elusive. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Swallowed Foreign Bodies in Children: Report of Four Unusual Cases

Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating occasional immediate intervention to avoid serious complications. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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

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

The NORSE (New-onset Refractory Status Epilepticus) Syndrome: Defining a Disease Entity

Status epilepticus (SE) describes a clinical condition characterised by an epileptic seizure or a series of seizures that lasts for at least 30 minutes without consciousness being regained.1 Some authors have added a time line of 60 minutes. The incidence of generalised convulsive status epilepticus (GCSE) is between 40...

Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children

Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty. This article is available only as...

A Walk Through the Management of Parkinson’s Disease

The management of idiopathic Parkinson’s disease is deceptively simple. Current practice, which consists of replacing dopamine on a twice or thrice daily regime may actually be responsible for causing the involuntary movements (dyskinesias) which were formerly thought to be inevitable in the disease and which occur in association with...

The Role of Surgery in High-grade Glioma – Is Surgical Resection Justified? A Review of the Current Knowledge

High-grade glioma (malignant glioma) is the most common primary intra-axial tumour of the central nervous system (CNS). Despite recent therapeutic advances in glioma treatment, the outcome for high-grade glioma has been disappointing. The first reported case of glioma resection was performed by Rickman Godlee in 1884.1 More than a...

Perforated Appendicitis in Children: Benefits of Early Laparoscopic Surgery

Despite perforated appendicitis (PA) being a common surgical emergency in childhood, controversy still exists with regard to its management in this era of minimal access surgery. Open appendicectomy (OA) has been accepted as the standard procedure for PA. However, OA has been associated with prolonged hospitalisation and significant complications...

Survival of Small-cell Lung Cancer and its Determinants of Outcome in Singapore

Lung cancer is the leading cause of cancer mortality around the world.1 Small-cell lung cancer (SCLC) constitutes about 15% to 25% of all lung cancer cases in North America and Europe.2,3 In contrast, SCLC constitutes a smaller percentage of lung cancer cases in Asian countries. In a Taiwanese hospital,...

Retinoblastoma: A Recent Experience at the National University Hospital, Singapore

Retinoblastoma is the most common primary intraocular malignancy in infants and children.1 Worldwide, the incidence is 1 in 18,000 to 34,000 live births with an estimation of 5000 to 8000 new cases.2,3 The Singapore Childhood Cancer Registry (SCCR), a hospital based cancer registry that includes all children less than...

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

Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have better outcomes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

An Eight Year Review of Exercise-related Cardiac Arrests

Exercise-related cardiac arrest is uncommon, however it is devastating when it occurs in otherwise healthy adults. In young adults, vigorous physical exercise trigger cardiac arrest in those affected by silent congenital cardiovascular conditions. In older adults, sudden vigorous physical exercise increases the incidence of acute coronary events in those...

The Need for a System of Prognostication in Skeletal Metastasis to Decide Best End-of-life Care – A Call to Arms

Decisions regarding potential surgery for metastatic disease are influenced by estimates of patient survival. For example, patients with long life expectancy may be appropriately treated with extensive resection and durable reconstruction to provide long lasting function and mobility; in contrast, a patient with a very short life expectancy may...

Vascular Endothelial Growth Factor C as a Predictor of Early Recurrence and Poor Prognosis of Resected Stage I Non-small Cell Lung Cancer

Non-small-cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide, with a 5-year survival of around 15%. Approximately 20% of patients present with stage I disease (T1N0M0 or T2N0M0) and undergo potentially curative surgical resection. However, approximately 30% to 40% of patients with stage I NSCLC after...

Demographic Determinants of Survival in Osteosarcoma

The treatment of osteosarcoma has seen tremendous improvements over the last 3 decades of the twentieth century. Over the last decade it appears that results of treatment have stagnated. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Male Breast Cancer in Singapore: 15 Years of Experience at a Single Tertiary Institution

Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its incidence may be on the rise, although the clinical significance of this is unknown. This rarity has precluded large randomised controlled trials, and most treatment...

Internet Addiction in Young People

The Internet has in recent years become ubiquitous in the lives of young persons and children due to rapid information technology (IT) development, high speed wire connection, easy accessibility and increasing affordability. Its growth has also been fuelled by a huge customer demand created by social and print media,...

Neonatal and Paediatric Extracorporeal Membrane Oxygenation (ECMO) in a Single Asian Tertiary Centre

Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass technique (CPB) introduced by Bartlett in 1972, which provides life-saving support in patients with refractory yet reversible cardiorespiratory failure until organ recovery or organ transplantation. Since the first report of successful ECMO support in an adult was published by Hill in...

Survival and Predictors of Mortality in Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis

Approximately one in ten patients admitted to an intensive care unit (ICU) develops acute kidney injury (AKI), an important complication of ICU patients, and requiring renal replacement therapy (RRT). It is well known that AKI contributes to mortality and chronic kidney diseases which result in health and economic burdens....

Clinical Presentation and Disease Associations of Gout: A Hospital-based Study of 100 Patients in Singapore

Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate monohydrate crystals in the joints and soft tissue giving rise to an acute inflammatory response. This article is available only as a PDF. Please click on...