Mr Tan, 60, a smoker with diabetes mellitus (DM), hypertension and chronic kidney disease (CKD) Stage 3, and recurrent gout flares last five weeks of increasing intensity and duration. He assumes it is due to frequent travel and lack of exercise. He comes today for routine review of his chronic diseases. Current laboratory results are creatinine 106, eGFR 56, uric acid 490, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is on glipizide 5mg bd, Metformin 250mg BD, Amlodipine 5mg OM. He complains of severe gout pain. He had always been reluctant to start definitive treatment which you had previously mentioned. What will you do next?

Mr Tan, 60, a smoker with diabetes mellitus (DM), hypertension and chronic kidney disease (CKD) Stage 3, and recurrent gout flares last five weeks of increasing intensity and duration. He assumes it is due to frequent travel and lack of exercise. He comes today for routine review of his chronic diseases. Current laboratory results are creatinine 106, eGFR 56, uric acid 490, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is on glipizide 5mg bd, Metformin 250mg BD, Amlodipine 5mg OM. He complains of severe gout pain. He had always been reluctant to start definitive treatment which you had previously mentioned. What will you do next?

Sleep deprivation is not uncommon among children in Singapore. Children with deprived sleep may present with poor academic performance, learning disabilities and behavioural disorders. As a result of sleep deprivation, performance in complex tasks involving higher brain functions is affected more than simple memory tasks. Sleep quality rather than sleep quantity is associated with good cognitive learning and memory function. Regular sleep-wake patterns with good sleep schedules will reinforce this. Causes of sleep deprivation include insufficient sleep, fragmentation of sleep and increased need for sleep. The BEARS questionnaire is a useful screening tool for sleep deprivation. A clinical approach to exclude medical conditions that may cause excessive daytime sleepiness should be conducted and focused physical examination be performed. A two-week sleep log about the child's sleep habits and sleep-wake cycles should be recorded. Referrals to a sleep specialist should be made if any sleep disorders is suspected.

More people are traveling to remote places for leisure and business. It is not uncommon for patients to get medication and advice for travel to high altitudes. Although high altitude cerebral and pulmonary oedemas are more frequent at very high and extreme altitudes, they may sometimes occur at lower altitudes and lead to fatalities. Even though acute mountain sickness (AMS) is generally deemed benign, it can easily wreck a holiday. The Lake Louise Score Questionnaire is a useful screening tool for AMS and it can be self-administered during travel. Non-pharmacological means in the prevention and treatment of AMS, especially acclimatisation, are the most important. Pharmacological prevention and treatment strategies should be used as a useful adjunct. This paper provides an approach to the provision of education and advice for high altitude travel in the primary care setting.

In the complex developmental period of puberty, adolescents experience biophysical changes and adapt to societal and cultural expectations of adulthood. Development of their sexuality is an important biopsychosocial change during this period that, when neglected, may result in unmet sexual and reproductive health needs. Patterns of behaviour in adolescence have repercussions across the lifespan. HEADSSS (home, education/employment/eating, activities, drugs, sexuality, sleep, suicide/depression and safety) is a systematic clinical screening tool for use with adolescents. Adolescents may view risk-seeking lifestyle patterns as appropriate behaviours, and physicians can help them recognise the risks and develop less harmful alternatives and strategies. Personal biases should not affect healthcare providers' duty to respect the rights of adolescents and ability to provide developmentally appropriate care. Healthcare professionals should be familiar with the relevant legal statutes in Singapore and refer suspected sexual abuse or violence, risk of self-harm, teenage pregnancy, newly diagnosed sexual transmitted infections or multiple risk-seeking behaviours for further evaluation and help.