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

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

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

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

Creutzfeldt-Jakob Disease Presenting with Visual Blurring, Diplopia and Visual Loss: Heidenhain’s Variant

The electroencephalographic pattern is distinctive in many but not in all patients with Creutzfeldt-Jakob disease (CJD). Often, it is one of diffuse and non-specific...

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

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

The Profile of Hospitalised Patients with Parkinson’s Disease

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

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

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

Electrophysiological Features in the Management of Meralgia Paraesthetica

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

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

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

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

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

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...

A Retrospective Review of Patients with Clinically Definite Multiple Sclerosis

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

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

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

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

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

Palatal Myoclonus—A Case Report

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

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

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

Extensor Pollicis Longus Paralysis Following Thoracoscopic Sympathectomy

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

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

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

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

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

The Current State of Multiple Sclerosis Genetic Research

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

The Genetics of Human Epilepsies

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

Cardiovascular Disease: Genes and Public Health

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

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

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

Incidence and risk factors of delirium in post-anaesthesia care unit

Post-anaesthesia care unit (PACU) delirium is defined as a disorder in thought processes that affect cognition in terms of memory, comprehension and attention.1 It...

Delirium in patients following general anaesthesia

Delirium is a disturbance of consciousness characterised by an acute onset and fluctuating course of inattention, accompanied by either a change in cognition or...

Listeria Meningoencephalitis: Two Cases and a Review of the Literature

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

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

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

Body Mass Index Profile in Hong Kong Chinese Adults

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

Book Review

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

Advances in Neurointensive Care

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

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

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

Neuroprotection in Acute Stroke

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

Current and Emerging Treatments in Parkinson’s Disease

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

Trinucleotide Repeat Analysis of Huntington’s Disease gene in Singapore

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

Aseptic Meningitis in Children—The Singapore Experience

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

Update in the Management of Stroke

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

Evidence-based Health Promotion: Applying it in Practice

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

Stroke Disease Management—A Framework for Comprehensive Stroke Care

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

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

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

Is Healthcare Competition Healthy?

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

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

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

Seeing How We Think About Words Using BOLD Contrast fMR Imaging

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

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...

Patterns and predictors of sound levels in hospital rooms

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

MELAS: A Case Report

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

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

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

Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore

Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to...

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

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

Axoglial Interaction via the Notch Receptor in Oligodendrocyte Differentiation

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

Hemifacial Spasm in Singapore: Clinical Characteristics and Patients’ Perceptions

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

Characteristics and Acute Rehabilitation of Guillain-Barré Syndrome in Singapore

The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is...

Clinical Indications for Positron Emission Tomography (PET) Scanning

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

Positron Emission Tomography – A Vital Component of Molecular Imaging

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

Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association

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

Issues and Challenges for Myopia Research

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

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

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

Neural Progenitor and Stem Cells in the Adult Central Nervous System

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

Environmental Planning and Urban Health

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

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...

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

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

SARS in Singapore – Key Lessons from an Epidemic

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

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

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

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

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

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

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

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

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

Re-defining Neurological Syndromes: The Genotype Meets the Phenotype

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

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

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

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

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

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

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

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

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

Treatment of Circadian Rhythm Sleep Disorders with Light

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

Basic Science Review on Circadian Rhythm Biology and Circadian Sleep Disorders

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

The Emerging Challenge of Age-related Eye Diseases in Singapore

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

Delayed and Extra-pontine Myelinolysis after Osmotic Dysregulation

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

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

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

Neuropsychiatry – An Emerging Field

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

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

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

Risk Communications: In Search of a Pandemic

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

Prevention and Control of Avian Influenza in Singapore

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

Preparing for an Influenza Pandemic in Singapore

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

Avian Influenza and Pandemic Influenza Preparedness in Hong Kong

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

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

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

A Global Perspective on Avian Influenza

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

Twentieth Century Influenza Pandemics in Singapore

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

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...

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

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

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

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

Biomarkers of Mild Cognitive Impairment and Alzheimer’s Disease

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

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

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

Superior Sagittal Sinus Thrombosis: Subtle Signs on Neuroimaging

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

Singapore and the Tobacco Pandemic

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

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

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

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

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

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

The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the...

Public Perceptions of Healthcare in Singapore

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

Malignant Syndrome of Two Parkinson Patients due to Withdrawal of Drugs

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

Public Misperceptions About Transmission of Hepatitis B Virus in Singapore

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

A History of the Chapter of Public Health and Occupational Physicians

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

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

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

Pathological Video-Gaming among Singaporean Youth

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

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

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

Trends in Importation of Communicable Diseases into Singapore

Singapore is a city-state in Southeast Asia, with a total population in 2007 of 4,839,400, of which 3,642,700 (75.3%) are Singaporean residents. The remaining...

Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden

Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from...

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

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

Chewing-induced Facial Dystonia

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

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

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

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

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

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

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

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

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

Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later

Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom...

Alzheimer’s disease–The Inexorable Epidemic

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

Unusual Cause for Unilateral Headache: A Quadrigeminal Cistern Arachnoid Cyst

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

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

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

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...

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

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

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

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

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...

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

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

Genome-wide Association Studies: Promises and Pitfalls

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

Epilepsy: Looking Beyond Seizures

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

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

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

Prevention and management of multimorbidity to ensure healthcare sustainability

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

Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore

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

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

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

A Review of Back Injury Cases Notified to the Ministry of Manpower from 2011 to 2012

Work-related low back disorders consist of both low back pain (LBP) and low back injuries. They are a significant and increasing problem all over...

How do English-speaking Cancer Patients Conceptualise Personhood?

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

Too Much Medicine: Time to Stop Indiscriminate Cancer Screening

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

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

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

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....

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

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

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...

Chorea precipitated by phototherapy as initial presentation of systemic lupus erythematosus

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

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

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

Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions

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

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

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

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

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

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

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

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

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

Seasonal haze: Knowledge gaps and risk perception behaviours

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

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...

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

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

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

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

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

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

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

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

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...

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...

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...

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...

Neuro-Behçet’s disease presenting as isolated intracranial hypertension

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

Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury

The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range...

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

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

Recurrent vascular events in ischaemic stroke patients with diabetes

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

Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore

Primary care in Singapore is set to face challenges in managing a rapidly ageing population. The expected population of older adults aged 65 years...

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...

The Singapore Cerebral Palsy Registry: An important new resource for cerebral palsy research

Cerebral palsy (CP) is a common, lifelong disorder of movement and posture resulting from an insult or maldevelopment of the developing brain. The movement...