INTRODUCTIONLong-term, high-dose corticosteroid therapy is well-known to cause systemic and ocular complications. A lesser known complication is chronic central serous chorioretinopathy (CSCR). Although idiopathic central serous chorioretinopathy (CSCR) is known to be mild with spontaneous recovery and minimal effects on the final visual acuity, chronic CSCR as a complication of long- term steroid therapy behaves differently, and may cause irreversible visual impairment.

CLINICAL PICTUREThree cases of chronic, recurrent CSCR were precipitated by longterm corticosteroids prescribed for post-renal transplant immunosuppressive therapy, postpituitary surgery and pemphigus vulgaris.

TREATMENT AND OUTCOMETwo cases resolved with tapering of corticosteroids while one case was treated by focal laser photocoagulation. Two eyes had severe impairment of vision as a result of subretinal scar formation while the other 4 eyes had mild reduction of visual acuity from retinal epithelium pigment atrophy.

CONCLUSIONLong-term corticosteroid therapy can be complicated by severe, chronic and recurrent CSCR and occasionally peripheral exudative retinal detachment. This may result in subretinal fibrosis and permanent loss of vision.

Adult ; Blindness ; chemically induced ; Choroid Diseases ; chemically induced ; diagnosis ; therapy ; Fluorescein Angiography ; Glucocorticoids ; adverse effects ; Humans ; Hydrocortisone ; adverse effects ; Male ; Middle Aged ; Prednisolone ; adverse effects ; Retinal Detachment ; chemically induced ; diagnosis ; therapy

Aged ; Angiogenesis Inhibitors ; administration & dosage ; pharmacology ; therapeutic use ; Antibodies, Monoclonal ; administration & dosage ; pharmacology ; therapeutic use ; Antibodies, Monoclonal, Humanized ; Asia ; ethnology ; Bevacizumab ; Choroidal Neovascularization ; drug therapy ; ethnology ; Female ; Humans ; Male ; Middle Aged ; Myopia ; physiopathology ; Prospective Studies ; Treatment Outcome ; Vitreous Body ; blood supply

Cephalometric superimposition is unable to evaluate tooth movement along the occlusal plane and the errors of photographing and superimposition of the occlusogram is also inevitable. The purpose of the present study was to evaluate the rotational movements of the maxillary posterior teeth following space closure after extraction of maxillary first premolars, using 3D dental images. In 19 adult females, analysis of rotational movements of the maxillary posterior teeth was performed between the initial and final 3D dental images superimposed on the maxillary hard palate. The results showed a diversity of rotational movements of posterior teeth. The causes of various rotational movements may be different rotation of molars in each case at the beginning of treatment, individual characters of the dental arch and tooth morphology. The results of the study indicate that accurate evaluation of rotational movements of posterior teeth following space closure after extraction of premolars using 3D dental images can be obtained through the subdivision of tooth movement during the initial aligning, space closure and finishing stages.
Adult ; Bicuspid* ; Dental Arch ; Dental Occlusion ; Female ; Humans ; Molar ; Palate, Hard ; Tooth Movement ; Tooth*

INTRODUCTIONThe aim of the study was to describe the prevalence and risk factors for diabetic retinopathy in a multi-ethnic diabetic patient cohort referred for retinal evaluation from a nationwide diabetic retinopathy screening programme in Singapore.

MATERIALS AND METHODSSeven hundred and forty-two patients, aged 21 to 95, referred for suspected diabetic retinopathy on annual one-field non-mydriatic 45 degree retinal photographs (Topcon TRC-NW6, Topcon Corporation, Tokyo, Japan) from primary care to the Singapore National Eye Centre diabetic retinopathy clinic were included. The photographs had been interpreted by 24 trained family physicians accredited every 2 years with a training programme. Patients underwent a standardised interview and examination. Fundi were examined with indirect ophthalmoscopy by 2 examiners. Presence and severity of diabetic retinopathy was graded into none, mild, moderate, severe, very severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. Macular oedema and clinically significant macular oedema were also graded.

RESULTSNinety-nine per cent of patients were type 2 diabetics. The prevalence of diabetic retinopathy was 38.1%, visionthreatening retinopathy was 11.8% and macular oedema was 6.9%. There were no racial differences. Significant predictors of any retinopathy were longer duration of diabetes, lower body mass index, being on treatment for hypertension, hypercholesterolaemia and use of diabetic medication. Predictors for vision-threatening retinopathy were younger age, longer duration of diabetes and lower body mass index.

CONCLUSIONSThe use of one-field non-mydriatic 45 degree photography as a screening tool for diabetic retinopathy resulted in a cohort of which 38.1% had diabetic retinopathy. Risk factors for diabetic retinopathy of this cohort are also presented.

Adult ; Aged ; Diabetic Retinopathy ; diagnosis ; epidemiology ; ethnology ; Female ; Humans ; Male ; Mass Screening ; Middle Aged ; Referral and Consultation ; Singapore ; epidemiology

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Attention Deficit Disorder with Hyperactivity ; diagnosis ; drug therapy ; therapy ; Caregivers ; Child ; Evidence-Based Medicine ; Humans ; Methylphenidate ; therapeutic use ; Parents ; Psychiatry ; methods ; standards ; Singapore ; Societies, Medical

Objectives: To evaluate study designs and citation counts of original research published in the Medical Journal of Malaysia (MJM). Methods: The bibliographic data of the MJM for the period 1980-2016 were retrieved from PubMed and analysed using Endnote bibliographic software. Study designs of original journal articles were analysed according to whether the articles were diagnostic study, prognostic study or clinical trial (collectively known as “evidence papers”). The citation counts of the original articles and case reports for the period 2012-2016 were compared in a sub-study using a case-control design. Results: A total of 3952 MJM journal items were retrieved from PubMed for the period 1980-2016; of these, 58.9% were original articles and 29.5% were case reports. Among the original articles, 14.6% were “evidence papers”; 2.3% were diagnostic studies, 7.7% were prognostic studies, 4.6% were clinical trials. In the study period 2012-2016, “other types of original articles” had statistically significantly more citations than case reports. However, there is no difference between “evidence papers” and case reports. Conclusion Our analysis shows the distribution of the types of articles appearing in the MJM for the period of study and serves as a reference for improving citations counts in the local context.
Bibliometrics

Background/Aims: Despite the high efficacy of direct-acting antivirals (DAAs), approximately 1–3% of hepatitis C virus (HCV) patients fail to achieve a sustained virological response. We conducted a nationwide study to investigate risk factors associated with DAA treatment failure. Machine-learning algorithms have been applied to discriminate subjects who may fail to respond to DAA therapy. Methods: We analyzed the Taiwan HCV Registry Program database to explore predictors of DAA failure in HCV patients. Fifty-five host and virological features were assessed using multivariate logistic regression, decision tree, random forest, eXtreme Gradient Boosting (XGBoost), and artificial neural network. The primary outcome was undetectable HCV RNA at 12 weeks after the end of treatment. Results: The training (n=23,955) and validation (n=10,346) datasets had similar baseline demographics, with an overall DAA failure rate of 1.6% (n=538). Multivariate logistic regression analysis revealed that liver cirrhosis, hepatocellular carcinoma, poor DAA adherence, and higher hemoglobin A1c were significantly associated with virological failure. XGBoost outperformed the other algorithms and logistic regression models, with an area under the receiver operating characteristic curve of 1.000 in the training dataset and 0.803 in the validation dataset. The top five predictors of treatment failure were HCV RNA, body mass index, α-fetoprotein, platelets, and FIB-4 index. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model (cutoff value=0.5) were 99.5%, 69.7%, 99.9%, 97.4%, and 99.5%, respectively, for the entire dataset. Conclusions Machine learning algorithms effectively provide risk stratification for DAA failure and additional information on the factors associated with DAA failure.

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in 2020 in commemoration of the 20th anniversary of the formation of SingHealth, the 55th National Day of Singapore, and the 125th anniversary of the International Day of Radiology. This pictorial essay comprises cardiovascular, respiratory and neurological cases from the archives.

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in commemoration of the International Day of Radiology in 2020, as well as the 200th anniversary of the Singapore General Hospital in 2021. This pictorial essay comprises gastroenterology, musculoskeletal and obstetrics and gynaecology cases from the archives.