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King Edward VII Hall of Residence--a link with the medical school since 1916

Lee HP

Ann Acad Med Singap, 2005 Jul;34(6):159C-162C.
PMID: 16010400

King Edward VII ("KE") had been synonymous with the medical school and its associated hall of residence at Sepoy Lines since the 1910s. After the school became the Medical Faculty, the illustrious name remained with the Hall, which was rebuilt in 1957. For almost 90 years, KE has kept alive the rich history and traditions of a bygone era that embodied the passion and pride of both Singapore and Malaysia. The heroism of some Keviians during the Second World War and other exploits have led to many legends of the Hall. In 1987, it moved to its present location at Kent Ridge, and opened its doors to students from all other faculties. We count many personalities among our alumni, including some of the most prominent physicians in our country. The exuberant hall life, cultural pursuits and achievements of the residents contribute to the strong spirit of endeavour. Keviians over the decades have lived, worked, played and served to uphold the motto that means so much to all of us: TO STRIVE, TO SEEK, TO SERVE.
Prevalence and determinants of cervical cancer screening: a community-based study in Singapore

Seow A, Lee HP

Ann Acad Med Singap, 1994 May;23(3):342-7.
PMID: 7944247

A cross-sectional survey of 568 married women aged 21-65 years in the Pasir Panjang Constituency was conducted to determine the prevalence of cervical cancer screening in the community and the factors affecting acceptance of this screening test. Results show that 309 (54.4%) of the respondents had ever had a Pap smear. The women who reported having had a smear were more likely to be below 45 years of age (prevalence ratio 1.47, 95% confidence interval 1.15 to 1.88), Chinese and of a higher socioeconomic status (1.68, 1.33 to 2.12). They were also more likely to have married at a later age (1.68, 1.21 to 2.31) than women who had not had a smear. Age and socioeconomic status remained independent predictors on multivariate analysis. The findings suggest that an important task of public health practitioners is to increase the uptake of screening among older and socially disadvantaged women who are known to be at the highest risk of cervical cancer. In addition, strategies to encourage younger women to continue regular attendance at screening clinics beyond their childbearing years will be important for the future.
Cancer incidence in Singapore: 1973-77

Lee HP, Shanmugaratnam K

Natl Cancer Inst Monogr, 1982;62:57-60.
PMID: 7171371

The Singapore Cancer Registry started operations on January 1, 1968. It is a population-based registry that seeks to obtain basic epidemiological and clinical data on all cases of cancer diagnosed in Singapore. The results presented pertain only to Singapore citizens and permanent residents and cover the period from 1973 to 1977. Of special interest are the cancer patterns of the main ethnic groups in Singapore. Generally, the Chinese (76% of total population) have significantly higher risks for cancer; the most prevalent sites are the nasopharynx, esophagus, stomach, liver, and lung. Within the Chinese group are also dialect group differences. The Malays (15% of population) have the lowest rates for most sites, whereas among the Indians (7% of population), mouth cancer is an important site for both sexes. All these variations provide useful clues in the search for etiological factors.
Classification of Chinese cancer patients by dialect group: is it still valid?

Lee HP, Gourley L

Ann Acad Med Singap, 1988 Jul;17(3):431-3.
PMID: 3265301

In Singapore, cancer incidence is documented separately for the different Chinese dialect groups, as a means of providing a possible insight into environmental or genetic factors which may be involved in the aetiological process. Thus, it would be useful to determine whether or not the Chinese population in Singapore still comprises distinct dialect groups. In view of this, an investigation into the dialect group of the parents of 792 hospital in-patients (cases and controls) was carried out. It was found that the vast majority of patients (94.2%), most of whom were born before 1940, had parents of the same dialect group. The percentages of within-dialect marriages were only slightly less for offspring born in Singapore or Malaysia as opposed to China, and decreases with time were small. Thus in 1985-87 Chinese cancer patients and controls in Singapore, of the ages represented in this study may indeed be classified according to their father's dialect and this is likely to be the case for at least the next decade or so. This finding will be of use to cancer epidemiologists as well as others studying Chinese dialect group variations in disease patterns.
Fulltext Pyloric stenosis in the ethnic groups of Singapore

Chong AYH, Lee HP

Singapore Med J, 1976 Sep;17(3):181-3.
PMID: 1019617

The incidence of congenital hypertrophic pyloric stenosis among 141,215 Chinese, Malay and Indian live births in Singapore from 1972 to 1974 was determined. The incidence per 100,000 live births among these ethnic groups are: Chinese 21.2, Malay 9.7 and Indian 35.0. Pyloric stenosis is not absent although rare in oriental babies.
Incidence of primary liver cancer in Singapore, 1968-1982

Chia KS, Lee HP, Lee J

Ann Acad Med Singap, 1989 May;18(3):313-6.
PMID: 2549842

Based on data collected by the population-based Singapore Cancer Registry over the period 1968 to 1982, baseline epidemiological characteristics and incidence trends of primary liver cancer were described. This will facilitate the interpretation of future trends, especially in the light of new interventions such as hepatitis B immunisation. The primary liver cancer incidence is four times higher in males than in females, with the incidence peaked in the seventh decade. The incidence rate was higher in the Chinese than in Malays and Indians and marginally higher among foreign born than Singapore born Chinese. A general declining trend in liver cancer incidence was especially notable in the local born Chinese. Misclassification of metastatic carcinomas in the earlier years of cancer registration may have contributed to the initial higher incidence. Definitive decrease in incidence as a result of hepatitis immunisation will only be seen in another two to three decades.
Fulltext Thrombotic thrombocytopenic purpura after ChAdOx1 nCoV-19 vaccine

Lee HP, Selvaratnam V, Rajasuriar JS

BMJ Case Rep, 2021 Oct 08;14(10).
PMID: 34625443 DOI: 10.1136/bcr-2021-246049

A 50-year-old Indian woman presented with acute dysphasia, left upper limb numbness and thrombocytopenia 12 days after receiving the ChAdOx1 nCoV-19 vaccine (AstraZeneca/Vaxzevria). MRI of the brain was unremarkable. Microangiopathic haemolytic anaemia with thrombocytopenia was noted on her peripheral blood film. A diagnosis of thrombotic thrombocytopenic purpura (TTP) was confirmed through the findings of absent ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity and markedly raised titre of ADAMTS13 autoantibodies. Prompt treatment with plasma exchange, adjunctive steroids and rituximab was commenced. A remission of TTP was achieved and she was discharged 3 weeks after admission. While other immune-mediated conditions have been documented after receipt of the vaccine, this report highlights the first case of immune-mediated TTP diagnosed after administration of the ChAdOx1 nCoV-19 vaccine.
Fulltext Non-Hodgkin's lymphoma in an Asian population: 1968-1992 time trends and ethnic differences in Singapore

Seow A, Lee J, Sng I, Fong CM, Lee HP

Cancer, 1996 May 1;77(9):1899-904.
PMID: 8646691

BACKGROUND: Non-Hodgkin's lymphoma has increased in incidence in many countries, particularly in the West. Advances in diagnostic methods and the understanding of the disease over time pose a challenge to the interpretation of these trends. The aim of this study was to determine if the disease has increased in Singapore, a newly industrialized Asian country, and to examine the possible factors that may account for any observed changes.
METHODS: Data from the population-based Singapore Cancer Registry for the period 1968 to 1992 were reviewed to determine time trends based on sex and ethnic group. The Poisson regression model was fitted to the cross-tabulated data to obtain the adjusted incidence density ratios.
RESULTS: A total of 1988 cases of non-Hodgkin's lymphoma were included in the analysis. There was an overall increase in incidence among both Chinese and Malaysians. However, the rate of increase was greater in females (age-standardized rate from 1.8 per 100,000 in 1968-1972 to 4.5 per 100,000 in 1988-1992) than in males (3.2 per 100,000 to 5.9 per 100,000 in the same time periods). Between ethnic groups, Malay females were at higher overall risk compared with their Chinese counterparts (incidence density ratio 1.32; 95% confidence interval, 1.08-1.61). Although a substantial proportion of patients diagnosed with Hodgkin's disease between 1968 and 1972 were reclassified on review, using present criteria, as having non-Hodgkin's lymphoma, it is unlikely that this, and other recent changes in histologic interpretation, could have accounted for an increase of this magnitude.
CONCLUSIONS: Non-Hodgkin's lymphoma has increased in incidence among the Chinese and Malay populations in Singapore. The pattern of increase differs from that of the common cancer sites, and suggests the need to look for environmental and genetic factors that have not yet been elucidated.
Breast cancer in Singapore: trends in incidence 1968-1992

Seow A, Duffy SW, McGee MA, Lee J, Lee HP

Int J Epidemiol, 1996 Feb;25(1):40-5.
PMID: 8666502

BACKGROUND: Breast cancer is the most commonly occurring cancer among women in Singapore, a country which has experienced significant changes in lifestyle over the past three decades. The increase in incidence of the disease is a matter of some concern.
METHODS: Data from the population-based Singapore Cancer Registry for 1968-1992 were used to determine time trends, inter-ethnic differences and the contributions of age, period and cohort effects to the incidence of the disease.
RESULTS: Our results revealed an average annual increase of 3.6% over the 25-year period for all women, form 20.2 per 100,000 women in the period 1968-1972 to 38.8 per 100,000 in 1988-1992. There was a statistically significant difference between the three major ethnic groups, the rate of increase being highest in Malays (4.4%) and lowest in Indians (1.4%). The overall increase was attributable to a strong cohort effect that remained significant when adjusted for time period for Chinese women and for all ethnic groups combined. The risk was observed to increase in successive birth cohorts from the 1890s to 1960s.
CONCLUSIONS: Our results suggest that breast cancer incidence rates are likely to continue to increase more sharply in the future as women born after the mid-20th century reach the high-risk age groups. They also suggest the pattern by which important aetiological factors for the disease in our population have exerted their effects, and provide support for the role of demographic and lifestyle changes as possible risk factors.
Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren

Daruwalla JS, Balasubramaniam P, Chay SO, Rajan U, Lee HP

J Bone Joint Surg Br, 1985 Mar;67(2):182-4.
PMID: 3980521

Routine examination for spinal deformity as part of a school health screening programme was introduced in Singapore in 1981. The three different ethnic groups included in the study provided figures for the prevalence of idiopathic scoliosis in an Asian population. A three-tier system of examination was used and a total of 110744 children in three age groups were studied. In those aged 6 to 7 years the prevalence was 0.12%. The prevalence in those aged 11 to 12 years was 1.7% for girls and 0.4% for boys, a ratio of 3.2 to 1. In girls aged 16 to 17 years the prevalence was 3.1%. In the latter two age groups there was a significantly higher prevalence in Chinese girls as compared with Malay and Indian girls. The optimal age for school screening seemed to be 11 to 12 years, but repeated examinations may be worthwhile.
Doses to patients in routine X-ray examinations in Malaysia

Ng KH, Rassiah P, Wang HB, Hambali AS, Muthuvellu P, Lee HP

Br J Radiol, 1998 Jun;71(846):654-60.
PMID: 9849390

A collaborative national survey initiated by the University of Malaya and the Ministry of Health was conducted from 1993 to 1995 to establish baseline patient dose data for seven common types (12 projections) of X-ray examinations in Malaysia. A total of 12 randomly selected public hospitals and 867 patients were included in this survey. The entrance surface doses (ESD) received by the patients were measured using thermoluminescent dosemeters (TLDs) attached to the patient's skin. Histograms are presented showing wide, positively skewed distributions of measured entrance surface doses for each examination. Mean, median, first and third quartile values of ESD and median effective dose are reported. Survey results are generally comparable with those reported in the UK, USA and by the International Atomic Energy Agency (IAEA). The results also provide information on dose level for a lower weight population (mean weight 60 kg) compared with the international reference dose values based on a 70 kg standard. The findings support the importance of the on-going national quality assurance programme to ensure doses are kept to a level consistent with optimum image quality. The data will also be useful for the formulation of national guidance levels as recommended by the IAEA. Furthermore, this study provides patient dosimetry information on healthcare level II countries.
How sexually permissive are Singaporeans?

Kok LP, Heng BH, Ong YW, Ho ML, Lee HP

Ann Acad Med Singap, 1995 Sep;24(5):679-84.
PMID: 8579309

This paper presents data on two surveys done in 1989 and 1992 that indicated the attitudes of Singaporeans to sexuality. Both surveys revealed that Singaporeans have sexually conservative attitudes and those who have a lower education, are single, above the age of 40, are Malays/Muslims hold more conservative views.
Fulltext Ministry of health clinical practice guidelines: cancer screening

Lee HP, Chew CT, Consigliere DT, Heng D, Huang DT, Khoo J, et al.

Singapore Med J, 2010 Feb;51(2):170-3; quiz 174-5.
PMID: 20358158

The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with key recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on cancer screening, for the information of readers of the Singapore Medical Journal. 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/mohcorp/publications.aspx?id=24018). 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.
Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study

Chang CT, Chan HK, Cheah WK, Tan MP, Ch'ng ASH, Thiam CN, et al.

J Pharm Policy Pract, 2023 Oct 19;16(1):122.
PMID: 37858273 DOI: 10.1186/s40545-023-00630-4

INTRODUCTION: Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source.
AIM: To develop a list of medications to facilitate appropriate prescribing among older adults.
METHODS: A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians.
RESULTS: The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains.
CONCLUSIONS: The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.

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