Malarial drug resistance is now widespread among the world. Chloroquine prophylaxis is no longer sufficient for their travel to endemic malarial regions. As family physicians our role is to advise our patients on their need to take effective chemoprophylaxis for their travels overseas, and be vigilant for patients suffering from possible malaria especially those back from their travels. As anopheles mosquito is still indigenous in Singapore, we should consider doing a malaria workup for those patients presenting with fever of unknown origin, despite their lack of recent travel. This paper gives a an update of the current local epidemiological data; the unique features of the various plasmodium species in Singapore; the current state of drug resistance against malaria drugs, how it affects the chemoprophylaxis and brief discussion on the prevention and management of patients with malaria.

Antimicrobial resistance (AMR) increases the morbidity, mortality and costs of treating infectious diseases. (Hawkey and Jones, 2009)1. The threat from resistant organisms is now a global problem, both in the hospital and to some extent in the community. The key drivers are: medical care complexity; widespread antimicrobial use in animal husbandry; antimicrobial contaminated food distribution; international travel, and food distribution of food contaminated with multidrug resistant organism. Strategies for infection control are: good understanding of what needs to be done, consistent application of infection control measures, use of “search and destroy” techniques; and effective antimicrobial stewardship. This paper reviews the current issues and potential solutions.

Based on the National Health Survey in 2010, almost half a million Singaporeans have diabetes, higher than the global prevalence. Diabetes is associated with a host of complications including heart disease, stroke, kidney failure, blindness and amputation. In 2016, Singapore declared a ‘war on diabetes’ to decrease the incidence of diabetes and its complications. Beyond providing healthcare resources, tackling diabetes requires the shifting of mindsets and changing of habits. The case study illustrates how biopsychosocial factors play a role in the optimal care of a diabetic patient. Self-management, acceptance, empowerment and health literacy are essential components to good diabetic care. System and support factors, as well as excellent communication with healthcare providers, are advocated as strategies to optimise outcome.

Singapore is among the fastest-aging countries in the world. By 2030, about one in every five residents would be 65 years or older and many of them may need long-term home care. Local studies have predicted a rise in disability rates as the population ages. To meet this need, our government has ramped up home care services to enable the elderly to “age in place” at home. In line with the Singapore Ministry of Health's vision of building sustainable healthcare and the initiative of "Beyond Hospital to Home", transitional care programmes in hospitals were renamed Hospital-to-Home in April 2017.

A 50-year-old man was found to have purple discoloration of the urine. He was on long-term urinary catheterization. He was asymptomatic, and urinalysis did not suggest a urinary tract infection. Purple urine bag syndrome resolved with a change of the urinary catheter and bag. He was prescribed regular laxatives and passed stools regularly.

Scabies is a common infestation worldwide, affecting persons of any age and socioeconomic status. In Singapore, it is more common in institutions rather than in homes. The two variants are classic scabies and crusted scabies, with the latter having a significantly higher mite burden. Early identification, isolation of index patients and prophylactic treatment of contacts are essential in dealing with the outbreak. Locally, most primary care practitioners make the diagnosis based on visual inspection and clinical examination. A skin scrape is done to confirm the diagnosis, especially in atypical presentations. Scabietic mites, eggs or faeces can be seen on microscopy. The usual treatment for adult scabies in Singapore is the use of topical malathion or permethrin. A combination of topical permethrin and oral ivermectin is used for crusted scabies.

Humans ; Singapore ; Self-Management ; Diabetes Mellitus, Type 2/therapy* ; Health Knowledge, Attitudes, Practice ; Hospitals