Children with genetic syndromes are increasingly surviving to adulthood in Singapore. This is due to early detection and significantly improved multi-dimensional care. Congenital heart disease is one of the characteristic abnormalities in patients. However, the cardiac anomalies of some of these patients may only manifest later in early adulthood. A significant number of such patients are not on regular medical follow-ups to monitor for future complications. This article describes based on the common syndromic conditions that are present in Singapore. Advanced genetic tests like chromosomal microarray analysis can help diagnose these syndromes that are not obvious clinically, thus instituting appropriate management and treatment for such patients. Creating awareness of such syndromes and its cardiac complications will translate to them being referred to the cardiologists to prevent further morbidity and mortality. Timely counselling regarding fertility, prenatal testing and complications due to pregnancy are also discussed in this article.

This article shows how a typical patient with multiple chronic medical problems can be managed well by a Family Physician despite the pressure of time in Singapore. Resources like the Agency for Integrated Care, Community Health Centres, Centre-based Services, and Social Service Offices will be discussed in the context of how they help the busy Family Physician to stabilise multiple chronic medical problems in the community based on a multidisciplinary team care model. Optimal utilisation of such resources by family physicians can significantly alleviate the chronic patient load in the hospitals and government polyclinics. Furthermore, this will promote the Ministry of Health’s vision of “One Singaporean, One Family Doctor.”

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.

This article shows how Primary Care Physicians can manage stable chronic schizophrenia with complex psycho-social issues in the community. This is made possible through improved access to mental healthcare services. The case study highlights the utilisation of the Mental Health-GP Partnership Programme and Community Mental Health Team to facilitate a smooth transition and maintenance of mental well-being in the community. Resources like Aged Psychiatry Community Assessment and Treatment Service, Assessment and Shared Care Teams, Community Intervention Teams are discussed as well as future directions to strengthen care in the community.

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.

Objective: This case illustrates how a patient with medically unexplained symptoms was “cured” using symbolic healing rituals of Christianity and traditional Malay black magic. Method: We report a case of a 49-year-old lady who presented with unexplainable weight loss and dysphagia despite extensive outpatient and inpatient medical investigations. She later attributed these symptoms to a “curse” by a Boyanese man with whom she had disagreements. After catharsis with a Roman Catholic priest and cleansing with a Bomoh (Malay witch doctor), the patient’s health improved. Results: We believe this patient had a conversion disorder due to recent multiple stressors in her life and she attributed her symptoms to the “curse” inflicted to her. The symbolic healing rituals by the Catholic priest and Bomoh “cured” her of her illness which concurred with the patient’s own beliefs for her illness. Conclusion: This article illustrates the importance of the physician being familiar with various local traditional beliefs, and how the interplay between various different religions and customs can come together to treat medically unexplained symptoms in a country like Singapore.

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.

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.