Review Article
Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore
Persons living with dementia experience chronic and progressive cognitive decline in 1 or more cognitive domains, affecting their everyday activities.1 Globally, the number of persons living with dementia is expected to rise from 55 million in 2019 to 139 million in 2050, with an estimated two-thirds in lower- and...
Editorial
Beyond survival: Addressing gaps in psychosocial support for survivors of childhood cancer
I read with great interest the study conducted by Fong et al. published in this issue of Annals, which evaluated psychological symptoms and health-related quality of life (HRQOL) among a cohort of 143 young adult survivors of childhood cancer in Singapore.1 Almost 1 in 4 survivors demonstrated significant psychological...
Original Article
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...
Review Article
Quality of life of family caregivers of children and young adults with Down syndrome: A systematic review and meta-analysis
The family caregiver is “any relative, partner, friend or neighbor who has a significant personal relationship with, and provides a broad range of assistance for a person with a chronic or disabling condition.”1 Family caregivers for children with chronic illnesses are commonly parents, who fulfil their children’s physical and...
Editorial
Living longer and stronger: Are children and young adults with Down syndrome experiencing healthier and better lives?
Down syndrome (DS) is the most common genetic cause of intellectual disability and is associated with multiple medical conditions affecting various organ systems, impacting the individual’s health, development and function.1 In Singapore, the life-birth prevalence of DS was 0.89 per 1000 births in the 1990s, a figure expected to...
Original Article
Trends in fluid overload-related hospitalisations among patients with diabetes mellitus: The impact of chronic kidney disease
Diabetes mellitus (DM) is a major global health problem, contributing to significant clinical disease burden, healthcare expenditure and societal costs.1 In Singapore, DM accounts for 2.9% of disability-adjusted life years and 4.3% of years lived with disability.2,3 By 2030, it is projected to cost approximately USD 1.89 billion in...
Letter to the Editor
Factors affecting outcomes among older trauma patients in Singapore: A retrospective observational study
Dear Editor,
Singapore faces a rapidly ageing population with its median age projected to be above 45 years by 2030. Our greying demographics is accompanied by a rise in chronic diseases and medication use, including polypharmacy.1 Longer life expectancy and increased activity levels have contributed to higher incidence of geriatric...
Review Article
Challenges in genetic screening for inherited endocrinopathy affecting the thyroid, parathyroid and adrenal glands in Singapore
In the current landscape of medicine, it is well known that most diseases incorporate a genetic component to some degree. Genetic testing of human diseases originated in the 1950s, and screening for genetic disorders followed a decade after.1 It is worthwhile noting that the Human Genome Project (1990–2003), which...
Original Article
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...
Original Article
Prevalence of consumption of illicit drugs and associated factors from a nationwide epidemiological survey: The Singapore Health and Lifestyle Survey
Substance use disorders (SUDs) are characterised by the uncontrolled use of a substance by an individual despite its harmful consequences.1,2 The prevalence of consumption of substances and SUDs varies widely across countries. This difference in prevalence can be attributed to factors such as study methodology (the substance included in...
Letter to the Editor
VOWELS: A communication framework for disclosing medical errors in medical oncology and palliative care
Dear Editor,
Recognising the impact of medical errors on patients and the doctor-patient relationship has underscored the need for better communication.1,2 For the most part, these efforts are informed by Chafe et al.’s 6 steps that entail: (1) the identification of the error in a timely fashion; (2) determination of...
Letter to the Editor
Validating two international warfarin pharmacogenetic dosing algorithms for estimating the maintenance dose for patients in Singapore
Dear Editor,
Predicting optimal warfarin dosing is difficult due to complex pharmacodynamics and pharmacokinetics, narrow therapeutic index and susceptibility to many factors.1 Genetic variations of the CYP2C9 and VKORC1 enzymes, occurring in different frequencies in different populations, play a significant role in determining warfarin dosing.1-4 Using pharmacogenetic dosing algorithms to...
Letter to the Editor
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...
Commentary
Value the patient as a person: Answering the call for a person-centred model of care
There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....
Letter to the Editor
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...
Editorial
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...
Commentary
Leveraging ChatGPT to aid patient education on coronary angiogram
Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of healthcare communication comprised the use of chatbots, which is limited by a predetermined set of queries and matched answers.2 However, natural-language AI models prompt a...
Original Article
Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore
Approximately 422 million people worldwide have diabetes and 1.6 million deaths are attributed to diabetes each year,1 contributing to high economic costs worldwide. Diabetes education and awareness of the disease contribute significantly to minimising complications and reducing morbidity and mortality.2 In addition, there is also a strong impetus to...
Letter to the Editor
Association between self-care and chronic kidney disease in patients with type 2 diabetes mellitus
Dear Editor,
Chronic kidney disease (CKD) is one of the key complications occurring in 25–40% of patients with type 2 diabetes mellitus (T2DM).1 Our earlier study also showed that CKD was present in 53% of patients with T2DM recruited from a secondary care diabetes centre and primary care polyclinic...
Letter to the Editor
Surgical margins assessment reduces re-excision rates in breast-conserving surgery
Dear Editor,
Breast-conserving surgery (BCS) followed by radiation therapy for breast cancer offers improved cosmetic results and comparable long-term survival rates as mastectomy.1 However, BCS is associated with a higher risk for local recurrence, and published literature has reported re-excision rates as high as 20–70% due to positive resection...
Original Article
Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis
Non-alcoholic fatty liver disease (NAFLD) is a growing epidemic and has become a major cause of liver-related mortality and indication for liver transplantations globally. It is estimated that nearly 25% of the world’s population and more than 60% of type 2 diabetes mellitus (T2DM) patients have NAFLD. A prior...
Letter to the Editor
Safety and efficacy of combined antiplatelet and low-dose rivaroxaban in patients with chronic limb threatening ischaemia in Singapore
Dear Editor,
Peripheral artery disease (PAD) is characterised by the debilitating atherosclerotic occlusion of arteries in the lower extremities, with chronic limb threatening ischaemia (CLTI) representing the most advanced stage of this disease process. Left untreated, these sequelae will invariably progress to major lower extremity amputation (LEA) and premature death....
Editorial
From Astana to Singapore: Primary Health Care is key to the long-term success of Singapore’s health system
The Ministry of Health, Singapore (MOH) has launched a wide-ranging and ambitious initiative for a life-course approach to drive the population’s health.1 This approach aims at ensuring the sustainability of the healthcare system. Crucially, it also embodies core principles of the health systems orientation that have long been advocated...
Original Article
Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction
Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to 8.5% in 2014.1 DM has been shown to be a common comorbidity in heart failure (HF) patients ranging from 4.3–28%2 and when present, portends a...
Editorial
Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction
With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction (HFmrEF), much has yet to be fully understood with regard to patient demographic, clinical presentation, response to guideline-directed heart failure therapies, and outcome across the...
Letter to the Editor
Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
Dear Editor,
The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an accompanying editorial were published in the January 2022 issue of the Annals.1,2 An evidence-based approach was used with reference made to relevant published literature. The...
Letter to the Editor
Sedation in gastrointestinal endoscopy in Singapore
Dear Editor,
I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during endoscopy in the hospital setting”2 in your journal in January 2022.
The American Society of Gastrointestinal Endoscopy (ASGE) and the European...
Letter to the Editor
Non-anaesthesiologists administering propofol in the Singapore context
Dear Editor,
Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid onset of action and fast post-procedural recovery.1 Nonetheless, propofol depresses cardiorespiratory function and could result in life-threatening adverse effects.
A workgroup, mainly consisting of gastroenterologists and...
Letter to the Editor
Sedation by non-anaesthesiologists in gastrointestinal endoscopy
Dear Editor,
We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. We are especially intrigued by Statement 6, stating that propofol sedation for endoscopy can be safely and effectively administered by trained...
Original Article
Effects of electroconvulsive therapy on cognition and quality of life in schizophrenia
Schizophrenia is a severe mental disorder with a profound impact on patients, their families, caregivers and society. The global prevalence of lifetime schizophrenia is 0.2–0.4% without significant differences between sex and ethnicity, nor between urban and rural environments.1 The health and economic burden of schizophrenia is significant, given the...
Editorial
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...
Letter to the Editor
Perception of disease, well-being and financial burden by patients with chronic hepatitis B: A self-reported assessment
Dear Editor,
Chronic hepatitis B (CHB) infection affects approximately 248 million individuals in the world1 and 3.6% of the Singapore population.2 Given the natural history of CHB, regular surveillance with blood tests is necessary to ensure early detection of complications such as cirrhosis and hepatocellular carcinoma in patients. Our study...
Original Article
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...
Letter to the Editor
Psychosocial impact and treatment trends of hidradenitis suppurativa in Singapore
Dear Editor,
Hidradenitis suppurativa (HS) is a common disease with a prevalence of about 1%.1 Patients commonly suffer from pain, disfigurement and psychosocial embarrassment, and have a worse quality of life compared to other dermatologic conditions.2,3 It is frequently misdiagnosed as other skin infections and delays in diagnosis are associated...
Original Article
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...
Original Article
Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team
Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute myocardial infarction, to save those with “hearts too good to die”.
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Others
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...
Review Article
Diabetic Retinopathy
Diabetes mellitus affects some 9% of Singaporeans. Studies had shown that virtually all insulin dependent diabetes mellitus (Type 1) and 85% of non-insulin dependent diabetes mellitus (Type 2) patients would develop retinopathy after 20 years of disease.
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Others
Hypoglycaemia from Islet Cell Hyperplasia and Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus—A Case Report
A 57-year-old woman was admitted to our hospital for perforated left tubo-ovarian abscess and found to have newly diagnosed diabetes with an admission blood glucose of 23 mM and glycated haemoglobin value of 12% (reference range 4.6% to 6.4%). She denied past symptoms of thirst, polyuria or polydipsia.
This article...
Others
Clinical Drug Trials: Practical Problems of Phase III
There has been a rapid increase in clinical trial activity in Singapore and other parts of Asia. Randomised clinical trials are the “gold standard” in study design, which enable the question of efficacy of different treatments or managements to be effectively compared.
This article is available only as a PDF....
Original Article
Deep Vein Thrombosis after Total Knee Replacement
Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis, its incidence is quoted between 46% and 84% in various studies.
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Others
A Case Report of Aspergillus Hypersensitivity Syndrome with Obstructing Bronchial Aspergillosis
The spectrum of pulmonary aspergillosis includes saprophytic colonisation, hypersensitivity syndromes and invasive lung disease. There has been a tendency to classify these syndromes as separate entities but clinical overlap occurs.
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Original Article
A Rational Alternative for the Diagnosis of Diabetes Mellitus in High Risk Individuals
The “gold standard” for the diagnosis of diabetes mellitus has all along been the oral glucose tolerance test (OGTT). As diabetes mellitus defines a group of individuals at high risk for macrovascular and microvascular disease, it is essential that the diagnosis be made promptly.
This article is available only as...
Others
Active Management of a Patient with Endstage Pulmonary Emphysema Using Lung Volume Reduction Surgery and Intensive Rehabilitation
A 65-year-old Chinese man with a 30-pack year history of cigarette smoking was referred to our institution for further management of chronic obstructive pulmonary disease (COPD). Despite smoking cessation for 5 years, and pharmacological treatment with oral theophylline, inhaled ipratropium bromide and ventolin, his dyspnoea had progressed to the...
Others
Traditional Indian Systems of Medicine
Traditional medicine includes the knowledge and practices that rely exclusively on practical experience and observations handed down from generations to generations, either verbally or in writing. Traditional systems of medicine in India are culturally acceptable and usually inexpensive.
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Others
A Rare Cause of Syncope in a Patient with Diabetes Mellitus—A Case Report
Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma or with symptoms caused by excess of counterregulatory hormones like catecholamines, such as palpitations, sweating and tremulousness. It is most commonly seen in patients with...
Original Article
Malignant Melanoma Seen in a Tertiary Dermatological Centre, Singapore
Unlike in Caucasians, primary malignant melanoma is an uncommon skin malignancy in Singapore. There have been little published data on cutaneous melanoma in Southeast Asia.
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Others
Introduction of Problem-based Learning in a Traditional Medical Curriculum in Singapore—Students’ and Tutors’ Perspectives
The National University of Singapore was started in 1905. Since then, it has trained many generations of medical practitioners.
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Original Article
A Retrospective Study of Melanocytic Naevi at the National Skin Centre
Melanocytic naevi are benign proliferation of melanocytes of congenital and acquired types which usually appear during adolescence or early adult life. Naevi are of three common subtypes i.e. junctional, compound and intradermal melanocytic naevi, with characteristic clinical appearance that aids in clinical diagnosis.
This article is available only as a...
Others
Current Therapeutic Strategies for Type 2 Diabetes Mellitus
Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on glycaemic control to one addressing global cardiovascular risk factors in a particular individual, glycaemic control remains one of the key challenges that the physician faces...
Original Article
Measuring Health-related Quality of Life in Singapore: Normal Values for the English and Chinese SF-36 Health Survey
Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many chronic illnesses. With improvements in survival, patients’ perceptions of health are increasingly being recognised as an important outcome in clinical medicine, especially in illnesses where...
Others
Validity and Reliability of the EQ-5D Self-report Questionnaire in Chinese-speaking Patients with Rheumatic Diseases in Singapore
Health-related quality of life (HRQoL) refers to patients’ perceptions of their own functioning and well-being. HRQoL is increasingly being used as a primary or secondary endpoint in clinical research and is essential in economic evaluation of new and often expensive therapies.
This article is available only as a PDF. Please...
Original Article
Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)
Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point. Most QOL instruments are developed in English, although about one-fifth of the world’s population is ethnic Chinese.
This article is available only as a PDF. Please...
Editorial
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...
Review Article
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...
Review Article
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...
Original Article
Behcet’s Disease: Experience in a Tertiary Rheumatology Centre in Singapore and a Review of the Literature
The only published study on Behcet’s disease in Singapore by Tan E et al (34 patients at the National Skin Centre) found that only 15% had arthritis and 6% had eye complications with no other systemic manifestations. These findings are different from epidemiological studies from other countries published in...
Original Article
How Much do Diabetic Patients Know About Diabetes Mellitus and its Complications?
Diabetes mellitus (DM) is a common and growing healthcare problem in Singapore with a prevalence of 9% in 1998. Since the 1990s, the Ministry of Health, Singapore has identified DM as a priority condition for disease control.
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Original Article
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 the most common cause of acute neuromuscular paralysis.
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Original Article
Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore
Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase in prevalence has also been attributed to the changes in lifestyle and urbanisation in developed countries.
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Original Article
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.
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Review Article
Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations
Diabetes mellitus (DM) is a common and growing global health problem. It is highly prevalent in Asian communities. Hong Kong, Pakistan, and Singapore are among the countries with the highest prevalence of diabetes in the adult population.
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Original Article
Diabetic Retinopathy in Type II Diabetics Detected by Targeted Screening Versus Newly Diagnosed in General Practice
The epidemic of type II diabetes mellitus is now recognised worldwide. In India, it has been estimated that the population with type II diabetes would increase by 150% in 2025. As the population with type II diabetes increases, so does the prevalence of diabetic retinopathy and other microvascular complications.
This...
Original Article
Utility and Validity of the Self-administered SF-36: Findings From an Older Population
The shift towards broader health perspectives and the emphasis on patient preferences have led to the development of many health questionnaires and their inclusion as primary and secondary outcome measures in clinical trials. Measurements of health-related quality of life (HRQOL), a multidimensional concept encompassing physical, emotional and social aspects...
Original Article
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.
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Original Article
The Clinical Predictors of Hypertension and Sleepiness in an Asian Population with Sleep-disordered Breathing
Sleep physicians have only recently began to learn much about the epidemiology of sleep-disordered breathing (SDB) from large, well conducted prospective community-based studies. These studies have helped identify the risk factors for identifying sleep apnoea, particularly in the Western population.
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Others
The Future of Medical Education: The Second 100 Years
This is a proud year for the medical profession in Singapore, as we celebrate 100 years of medical education. As the oldest faculty in Singapore’s first university, we are reminded that it was the Medical School which laid the foundation for tertiary education in Singapore. It is appropriate that...
Others
The Medical Students’ Societies and Medical Students’ Publications
For a very long time, King Edward VII (endearingly abbreviated “KE”) was synonymous with the medical school and its associated hall of residence. The name was first used for the School (later called College) in 1912 in recognition of a substantial gift from the King Edward VII Memorial Fund....
Others
The Teaching of Radiology
A record of Diagnostic Radiology would be incomplete without reference to Wilheim Roentgen, who discovered the rays that he could not comprehend; hence, X-rays. The day was Friday, 8 November 1895, as he worked on cathode ray tubes at the University of Wurzburg, Germany. These rays penetrated opaque substances,...
Original Article
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...
Editorial
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.
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Commentary
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...
Original Article
Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme
Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM) worldwide, with 8.2% of Singapore adults between the ages of 18 and 69 having diabetes and there is little data on the prevalence of diabetic...
Others
A Doctor’s Duty is to Heal the Unhealthy: The Story of Tun Dr Mahathir Mohamad
Mahathir Mohamad was born in 1925 in Alor Setar, Kedah. In 1947, after living through the turbulent times of the Second World War, he entered the King Edward VII College of Medicine in Singapore. He graduated in 1953, and was in government service for the next 4 years before...
Original Article
Concurrent Chemoradiotherapy followed by Surgery in Locally Advanced Squamous Cell Carcinoma of the Oesophagus: A Single Centre Experience
Carcinoma of the oesophagus is a relatively uncommon malignancy in Singapore and incidence rates have been declining since 1968. A total of 506 cases were diagnosed from 1993 to 1997. The age-standardised rate for the same period was 5.8 per 100,000.1 The predominant histologic type is squamous cell carcinoma,...
Original Article
Acceptance of Prophylactic Surgery and Chemoprevention of Cancer in Singapore – A Survey
The Singapore healthcare philosophy aims to establish a healthy population through preventive healthcare programmes and public health education. Public education usually emphasises the adverse consequences of harmful habits like smoking, alcohol consumption, poor dietary habits and sedentary lifestyles that may contribute to chronic and fatal diseases such as ischaemic...
Original 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...
Commentary
Sociodemographic Factors Influencing the Effectiveness of Public Health Education – A Comparison of Two Studies in Singapore
Public health education is a cornerstone in the primary prevention of chronic diseases. In the United States, for example, studies have shown that cardiovascular public health education contributed to increased hypertension detection and control as well as a decline in smoking, thus contributing significantly to the major reduction in...
Original Article
Concomitant Use of Midazolam and Buprenorphine and its Implications Among Drug Users in Singapore
Benzodiazepines (BDZs) (commonly known as “sleeping pills”) are routinely and successfully used in the treatment of sleep and anxiety disorders. However, studies have indicated that BZD use among injecting drug users (IDUs) constitutes a major clinical and public health problem. Misuse has been linked to higher rates of risk-taking...
Others
A Brief History of Pathology and the Chapter of Pathologists
A history of the Chapter of Pathologists would be incomplete without a history of the specialty of Pathology in Singapore. Pathology is in fact the first specialty practiced in Singapore. This was due to the seriousness of the public health situation and infections like water borne diseases in Singapore...
Others
From the Chapter of Physicians, Academy of Medicine, Singapore to the College of Physicians, Singapore
The transformation of the previous Chapter of Physicians, Academy of Medicine, Singapore to the current College of Physicians, Singapore in 2004 was the outcome of a steady progress in and a natural evolution of medical specialty development in Singapore. Just like the Academy which was established in 1957 as...
Others
From the Chapter of Anaesthetists to the College of Anaesthesiologists, Singapore
The arrival of Sir Stamford Raffles in 1819 herald the birth of western medicine in Singapore. Doctors were then sent here from Britain. These early doctors were ‘jack of all trades’ practising everything from public health to pathology. They had difficulties communicating with the locals and had little knowledge...
Others
Academy of Medicine, Singapore – The Next Twenty-Five Years (1982-2007)
The Academy of Medicine was founded in 1957 as the professional corporate body of medical and dental specialists in Singapore. From a modest beginning with only 34 members, it has since grown in membership, activities, stature and international reputation. Of special mention among the major activities in the first...
Original Article
Cross-Cultural Adaptation and Validation of Singapore Malay and Tamil Versions of the EQ-5D
The EQ-5D is a widely used preference-based instrument (available in at least 60 language versions and used in more than 800 published studies to date1 ) that provides both a health profile (for assessing health status) and health utility index for individuals or groups, thus allowing clinical and economic...
Original Article
Epidemiology, Management and Treatment Outcome of Medulloblastoma in Singapore
Medulloblastoma (MBL) is the most common type of malignant brain tumour in childhood. It belongs to the group of tumours known as primitive neuroectodermal tumour (PNET), which is a highly malignant, small round blue cell tumour of the central nervous system. The term “medulloblastoma” is classically reserved for PNETs...
Original Article
Timing of Hospital Presentation After Acute Cerebral Infarction and Patients’ Acceptance of Intravenous Thrombolysi
Intravenous thrombolysis in acute cerebral infarction has been proven to be efficacious in improving functional outcome if given within 3 hours from stroke onset.1 Singapore recently received national licensing for the use of intravenous thrombolysis for this indication. Delay in hospital presentation is an important hindrance to the administration...
Original Article
Diabetes and Associated Cardiovascular Risk Factors in Iran: The Isfahan Healthy Heart Programme
The incidence and prevalence of diabetes mellitus (DM) worldwide is increasing, due almost exclusively to an increase in non-insulin-dependent (type 2) DM, which represents more than 90% of all cases of diabetes.1 Presently, there is a global pandemic of type 2 DM and its clinical sequelae. The World Health...
Original Article
Demographic and Clinical Features of 150 Pathological Gamblers Referred to a Community Addictions Programme
Pathological gambling has been defined as a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and work life. The diagnosis is not made if the gambling behaviour is better accounted for by a Manic Episode .1 Diagnostic criteria are similar to those for substance dependence and include...
Others
Successful Rehabilitation With Cochlear Implant in Post-irradiation Induced Hearing Loss in Nasopharyngeal Carcinoma Patient
Nasopharyngeal carcinoma (NPC) is a common disease in Asia.1 Radiotherapy is the mainstay of treatment. Following radiotherapy, complications like profound sensorineural hearing loss may occur. If functionally active auditory fibres survive and there are no signs of recurrent tumour, we believe that successful rehabilitation is possible with a cochlear...
Original Article
A Prospective Cohort Study on the Impact of a Modified Basic Military Training (mBMT) Programme Based on Pre-enlistment Fitness Stratification Amongst Asian Military Enlistees
Basic military training (BMT) is seen as a vital initiation phase into military service when new recruits are conditioned to the rigours of military training in terms of physical and combat fitness. This training period assumes a great significance in Singapore where all able-bodied males between the ages of...
Original Article
Where the Elderly Die: The Influence of Socio-Demographic Factors and Cause of Death on People Dying at Home
The subject of place of death was brought to the forefront of the medical community in July 2004 when 2 important publications were released; one by the World Health Organization1 and another from the House of Commons Select Committee on Health.2 Both reports highlighted that the proportion of deaths...
Original Article
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,...
Original Article
Staging of Benign Prostate Hyperplasia is Helpful in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostate Hyperplasia
Benign prostate hyperplasia (BPH), one of the most common diseases of ageing men, affects the quality of life by interfering with normal daily activities and sleep patterns. The current treatment options for patients with lower urinary tract symptoms (LUTS) suggestive of BPH mainly depend on the severity of the...
Original Article
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.
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Original Article
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 25% constitute of immigrant workers on work permit, foreigners on employment pass, and student pass holders.
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Original Article
Acceptance of Information and Communication Technologies for Healthcare Delivery: A SingHealth Polyclinics Study
Information and communication technologies, such as internet portal and short message system (SMS), are increasingly used in healthcare delivery worldwide.1,2 Typically, these technologies are used to facilitate or enhance communication and exchange of information between patients and doctors or other health professionals. Both healthcare consumers and providers can benefit...
Original Article
Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure
Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have more severe infections, a different spectrum of bacteriology and a worse outcome. In our experience, of all patients with upper limb infections, those with end-stage...
Original Article
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 onset, utilisation is limited by delayed arrival of most patients to hospital.
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Original Article
Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis
Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the more diffuse and accelerated form of atherosclerosis and endothelial dysfunction which lead to diffuse coronary lesions, small vessel disease, multi-vessel involvement, larger plaque burden as...
Original Article
Measurement Properties of the Chinese Language Version of the Functional Assessment of Cancer Therapy-General in a Singaporean Population
Health-related quality of life (HRQoL) is an increasingly important concern in the care of cancer patients. In the approval of oncology drugs, the United States (US) Food and Drug Administration (FDA) and European Agency for the Evaluation of Medicinal Products consider HRQoL an important end-point.1 Most HRQoL instruments are...
Original Article
Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction
Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study (FHS) cohort and was designed to predict 10-year risk of hard coronary events, including mortality due to coronary heart disease and non-fatal myocardial infarction (MI)...
Review Article
The Relevance of the Metabolic Syndrome
Metabolic syndrome describes a constellation of interrelated metabolic risk factors, in which components coexist more frequently in a given individual than could be expected by chance alone. These risk factors include hypertension, hyperglycaemia, dyslipidaemia and obesity. The underlying pathophysiology is as yet unclear, but has been closely linked to...
Original Article
Diagnostic Accuracy of Anthropometric Indices for Obesity Screening Among Asian Adolescents
Obesity or excess body fat is strongly associated with enhanced risks of morbidity and mortality, and its prevalence is rapidly escalating worldwide. Despite these concerns, no standard definition of obesity for screening, diagnosis and subsequent intervention has been agreed upon internationally. The current definitions are mostly defined statistically, and...
Original Article
Complementary and Alternative Medicine among Singapore Cancer Patients
Worldwide, the use of Complementary and Alternative Medicine (CAM) by cancer patients is highly prevalent. For cancer specialists, knowledge on CAM use in their patients is particularly important as there can be potentially hazardous drug interactions between some forms of oral CAM and chemotherapy or radiotherapy.
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Original Article
Quality of Life in Pathological Gamblers in a Multiethnic Asian Setting
Pathological gambling is categorized under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) as an impulse control disorder not elsewhere classified. The disorder is characterised by an excess preoccupation with gambling, need to gamble with increasing amounts of money in order to achieve the desired excitement,...
Original Article
Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation
The development of new-onset diabetes after transplantation (NODAT) is a serious metabolic complication of kidney transplantation that predisposes patients to graft dysfunction, cardiovascular disease and death. Although NODAT has been recognised for many years, the true incidence has been difficult to establish due to inconsistencies in the definition of...
Original Article
Asian Adaptation and Validation of an English Version of the Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL)
Multiple sclerosis (MS) is one of the most common disorders of the central nervous system with a lifetime risk of 1 in 400. In about 75% of MS patients, activities of daily living will become affected at later stages. In up to 15% of patients, the disabilities will become...
Original Article
Causes of Death in Hospitalised Human Immunodeficiency Virus (HIV)-infected Patients at a National Referral Centre in Singapore: A Retrospective Review from 2008 to 2010
The advent of the highly active antiretroviral therapy (HAART) era has greatly reduced the mortality and incidence of new diagnoses of acquired immune deficiency syndrome (AIDS)-defining illnesses (ADIs) in individuals infected with human immunodeficiency virus (HIV) in many countries. This has led to a paradigm shift in the management...
Original Article
Causes of Death and Factors Associated with Early Death Among Human Immunodeficiency Virus (HIV)-Infected Persons in Singapore: Pre-Highly Active Antiretroviral Therapy (HAART) and Peri-HAART
Since the first case of human immunodeficiency virus (HIV) was diagnosed in Singapore in May 1985, a total of 4845 cases and 1389 HIV/acquired immune deficiency syndrome (AIDS) deaths have been reported as of December 2010. With the introduction of highly active antiretroviral therapy (HAART), AIDS diagnoses declined by...
Original Article
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...
Original Article
Geriatric Syndromes and Depressed Mood in Lower-income Singaporeans with Diabetes: Implications for Diabetes Management and Health Promotion
The prevalence of diabetes mellitus (henceforth referred to as diabetes) has increased significantly in the last decade and it is reaching epidemic levels worldwide due to ageing population, urbanisation, obesity and sedentary lifestyles. In Singapore, the National Health Survey 2004 revealed that 8.2% of the population aged 18 to...
Original Article
Melanoma: Differences between Asian and Caucasian Patients
Cutaneous melanoma is the most common cause of mortality amongst skin cancer in Caucasian populations and incidence rates per 100,000 patient years vary between 21.9 in the United States to 55.9 in Australian males. In contrast, the incidence of melanoma in Asia is significantly lower with incidence rates of...
Original Article
Overcoming Barriers to Mammography Screening: A Quasi-randomised Pragmatic Trial in a Community-based Primary Care Setting
Breast cancer is the leading cancer among women in Singapore, accounting for 29% of all cancers occurring in women between 2006 and 2010. Evidence shows that breast cancer screening with mammography is effective at reducing breast cancer mortality, particularly where the uptake of screening is high, at a recommended...
Original Article
Hoarding in an Asian Population: Prevalence, Correlates, Disability and Quality of Life
Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value, leading to clutter, distress, and disability. The clutter in severe hoarding precludes the use of space to accomplish the activities for which they were designed, such as...
Original Article
Clinical Outcome and Cost Comparison Between Laparoscopic and Open Appendicectomy
Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. The traditional operation of choice was the open appendicectomy (OA) pioneered by McBurney in 1894. In 1981, the laparoscopic technique was introduced by Kurt Semm and since then, laparoscopic appendicectomy (LA) is increasingly...
Original Article
Osteogenic Sarcoma in Children and Young Adults
Osteogenic sarcoma (OS) is a primary malignant tumour of the bone, derived from primitive bone-forming mesenchyme and characterised by the production of osteoid tissue or immature bone by the malignant proliferating spindle cell stroma. Although primary bone tumours are rare in childhood, they are the sixth most common malignant...
Original Article
Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan
Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000
man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...
Original Article
Single Centre Experience of Transjugular Liver Biopsy in 152 Patients
The first reported case of liver biopsy was recorded in 1883 by Ehrlich. Since then, the technique of liver biopsy has been modified tremendously with major advances over the last 50 years, allowing safer and more reliable methods of performing liver biopsy.
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Commentary
Projecting the Number of Older Singaporeans with Activity of Daily Living Limitations Requiring Human Assistance Through 2030
Similar to other developed countries in Asia, including Japan, South Korea and Taiwan, the population of Singapore is ageing rapidly. In 2011, 9.3% of the population was 65 years of age or older. Due in part to decades of sub-replacement level fertility rates and increases in longevity, by 2030...
Original Article
Determinants of Health-Related Quality of Life Among Community Dwelling Elderly
Singapore is experiencing an unprecedented age shift as the post-war baby boomers turn 65 years in 2012. Currently there are 378,700 people aged 65 and above, and these numbers are estimated to go up to 600,000 by 2020. These growing elderly population have multiple coexisting medical conditions which are...
Original Article
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 the world. Studies estimate that between 60% and 90% of people will suffer from low back disorders at some point in their life. Among the...
Original Article
Academic Medicine Education Institute (AM∙EI): Transforming the Educational Culture of Health Professionals
In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their individual strengths to become an integrated academic healthcare cluster. This new academic healthcare cluster has a mission to provide outstanding clinical service, discover and promote...
Original Article
Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases
Over the past few decades, the introduction of laparoscopic surgery has been the biggest game changer in abdominal surgery.1 However, although the first laparoscopic liver resections (LLR) were reported in the early 1990s,2,3 widespread adoption of LLR was met with initial skepticism due to technical concerns and the fear...
Original Article
Assessing the Content Validity of the EQ-5D Questionnaire Among Asians in Singapore: A Qualitative Study
EQ-5D is a tool to measure and value health status. It is a standardised questionnaire that comprises 2 components: a Descriptive System (DS) on the first page and a hash-marked visual analogue scale (EQ-VAS) on the second page. Importantly, responses to the DS can be converted into a utility...
Editorial
Transcatheter Aortic Valve Implantation in Singapore: Reflecting on the First Decade
Transcatheter aortic valve implantation (TAVI) has markedly changed the way aortic valve stenosis is treated. It is 18 years since the first patient was treated with TAVI for severe aortic stenosis. The original concept of TAVI was simple: insert a stent-like device by creating an opening in the obstructed...
Original Article
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...
Editorial
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 (95% UI 93.2–111 million) and 143 million disability adjusted life years lost (DALYs) (95% UI 133–153 million) in 2019. The impact is even higher in...
Letter to the Editor
Adipsic diabetes insipidus and SGLT2 inhibitor: A perplexing conundrum
A 70-year-old man with poorly controlled type 2 diabetes mellitus (DM), hypertension, hypercholesterolemia and alcohol dependence presented intoxicated, with occipital scalp lacerations after a fall. A brain computerised tomography (CT) revealed occipital skull fracture with bilateral subarachnoid haemorrhages, subdural haemorrhages and parenchymal contusions. He was admitted for close observation...
Original Article
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 by 2025, driven in part by marked economic and epidemiologic transition in recent decades.1 In China, the prevalence of diabetes rose from 1% in 1980...