Tumoral calcinosis is an uncommon condition which has been described to exist in primary and secondary forms. A lack of awareness of this entity can lead to unnecessary procedures and incorrect management. We report a case of a patient on peritoneal dialysis who presented with multiple painful joint swellings to the orthopaedic department. An initial diagnosis of septic arthritis was made, then revised to chronic tophaceous gout and referred to the rheumatology unit.

Objective: To determine the prevalence, correlates andindependent predictors of self-reported depression, anxietyand stress in Rheumatoid arthritis (RA) patients in Hospital Melaka.Methods: This was a cross-sectional survey usingconvenient sampling of 192 RA patients who attended theRheumatology Clinic outpatient appointment, HospitalMelaka from June 2013 to December 2013. Depression,Anxiety and Stress Scale (DASS21) questionnaire was usedto evaluate symptoms of depression, anxiety and stress. RAdisease activity was assessed using the DAS28-ESRformula. Functional status was assessed via the HealthAssessment Questionnaire Disability Index (HAQ-DI).Results: Out of 189 completed questionnaires, 46%(n=86)patients reported psychological distress symptoms, and25%(n=48) experienced more than one negative emotionalstates. The prevalence of depression, anxiety and stressamong our patients were 23.3%(n=44), 42.3%(n=80) and20.1%(n=38) respectively. There were significant positivecorrelations (p<0.05) between these psychologicalsymptoms with disease activity, number of tender joints,general health, pain and HAQ score. Age was inverselycorrelated with depression, anxiety and stress. Highernumber of swollen joints correlated positively withdepression but not with anxiety and stress. HAQ was theonly independent predictor for depression (Odds Ratio[OR]=2.07; 95%CI: 1.19 to 3.61) and anxiety (OR=1.81;95%CI: 1.1 to 3.0) whilst pain was found to be independentpredictor for stress (OR=1.04; 95%CI: 1.0 to 1.1).Conclusion: The incidence of depression and anxiety in ourMalaysian sample of RA patient was comparable to thatobserved in Caucasian populations. Functional status wasan independent predictor of depression and anxiety,whereas pain was an independent predictor of stress.

INTRODUCTION: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. METHODS: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). RESULTS: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020. CONCLUSION Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.
Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Disease Outbreaks ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Patient Acceptance of Health Care/statistics & numerical data* ; Patient Admission/trends* ; Pediatrics ; Retrospective Studies ; Severe Acute Respiratory Syndrome/epidemiology* ; 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