Swee Chye Quek

• National University of Singapore

Infection prevention and control (IPC) programs form the basis of minimizing spread of pathogens in the healthcare setting and beyond. The COVID-19 pandemic amplified the demand for IPC. However, the environmental impact of IPC practices has yet to be addressed and attempts to quantify its climate implications have been sparse. We performed a scopi...

Introduction Myopericarditis is a rare but serious coronavirus disease 2019 (COVID-19) vaccine-related adverse event primarily affecting adolescents. Given recent approvals for childhood vaccination, we performed a meta-analysis investigating myopericarditis following messenger ribonucleic acid COVID-19 vaccination in children aged <19 years, focus...

Diabetes mellitus (DM) is the third most common chronic condition associated with frequent hospital readmissions. Predictors of the number of readmissions within 1 year among patients with DM are less often studied compared with those of 30-day readmission. This study aims to identify predictors of number of readmissions within 1 year amongst adult...

Context: Healthcare workers all over the world were prioritized for vaccination against COVID-19 in view of the high-risk nature of their job scopes when vaccines were first available in late 2020. Vaccine hesitancy was an important problem to tackle in order to achieve a high vaccination rate, especially for vaccines that were developed using mRN...

Objective: The primary objective is to develop a prediction model of 30-day hospital readmission amongst adults with diabetes mellitus (DM) whose index admission was DM-related. The secondary aims are to: internally and externally validate the prediction model; and compare its performance with two existing models. Research design and setting: Da...

Introduction: Analysis of risk factors can pave the way for reducing unscheduled hospital readmissions and improve resource utilisation. Methods: This was a concurrent nested, mixed method study. Factors associated with patients readmitted within 30 days between 2011 and 2015 at the National University Hospital, Singapore (N=104,496) were examin...

Introduction: Vaccination remains a key strategy to living endemically with COVID-19. The Pfizer-BioNTech COVID-19 vaccine was first granted interim authorisation for use in Singapore in December 2020. With overseas studies published about the safety and side effect profiles of mRNA COVID-19 vaccines focusing mainly on non-Asian populations, we de...

Singapore’s hospitals had prepared operations to receive patients (potentially) infected with SARS-CoV-2, planning various scenarios and levels of surge with a policy of isolating all confirmed cases as inpatients. The National University Hospital, adopted a whole of hospital approach to COVID-19 with three primary goals: zero hospital-acquired COV...

Adult patients with diabetes mellitus (DM) represent one-fifth of all 30-day unplanned hospital readmissions but some may be preventable through continuity of care with better DM self-management. We aim to synthesize evidence concerning the association between 30-day unplanned hospital readmission and patient-related factors, insurance status, trea...

Background: On January 30, COVID-19 was declared a Public Health Emergency of International Concern-a week after Singapore's first imported case and 5 days before local transmission. The National University Hospital (NUH) is Singapore's third largest hospital with 1200 beds, heavy clinical workloads, and major roles in research and teaching. Main...

Aim We aimed to assess the utility of four published risk‐scoring methods in predicting intravenous immunoglobulins (IVIG) non‐responsiveness in Kawasaki disease (KD) patients from Singapore and develop a new predictive model. Methods We reviewed the medical records of 215 KD children. The performance of existing scoring methods in identifying non...

Right ventricle to pulmonary artery (RV-PA) conduits have been used for the surgical repair of congenital heart defects. These conduits frequently become stenosed or develop insufficiency with time, necessitating reoperations. Percutanous pulmonary valve implantation (PPVI) can delay the need for repeated surgeries in patients with congenital heart...

Purpose: The purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension. Methods: This was a prospective cross-sectional study of pregnant and postnatal women aged between 18-35 years with no co...

With the increase in long-term survival of post-transplant children, there is a paradigm shift in the emphasis of post-transplant care. We describe de novo cardiovascular abnormalities, which occurred in otherwise asymptomatic paediatric liver transplant recipients, who received liver allografts between 1991 and 2014 at the National University Hosp...

Background: While transcatheter device closure of ventricular septal defects (VSDs) is gaining popularity, concerns remain about adverse events; particularly heart block in peri-membranous VSDs (pmVSDs). The aim of this study is to ascertain outcomes of transcatheter device closure of pmVSDs through a meta-analysis of current literature. Methods:...

Coronary arteritis in Kawasaki disease can lead to serious complications such myocardial infarction and sudden death. The identification of coronary manifestations with a method that is minimally invasive and of low radiation exposure is therefore important in paediatric patients with Kawasaki disease. Coronary CT angiography can be an attractive a...

Precancerous cervical lesions precede the development of invasive cervical cancer by 10–20 years, making cervical cancer preventable if these lesions are detected and effectively treated. Treatment has evolved in the last few decades and now includes ablative options that can be performed in lower-resource settings where surgical excision is not fe...

It is unclear whether all children with Kawasaki disease (KD) have increased later cardiovascular risk. The retinal microvasculature reflects changes in the microcirculation and is associated with traditional cardiovascular risk factors and events. The aim of this study was to investigate retinal microvascular parameters in two populations of patie...

Background Genome-wide association study (GWAS) has reported that rs6903956 within the first intron of androgen-dependent tissue factor pathway inhibitor (TFPI) regulating protein (ADTRP) gene is associated with coronary artery disease (CAD) risk in the Chinese population. Although ADTRP is believed to be involved in the upregulation of TFPI, the u...

The aim of this study was to investigate whether there is a reduction in radiation dose and improvement in image quality of pediatric cardiac computed tomography scans performed using the high-pitch spiral technique on a new third-generation dual-source 2 × 192-slice scanner (group B) compared with scans performed using the sequential technique on...

Background/objectives: The treatment of native coarctation of aorta (CoA) has evolved since surgery performed in 1944, followed by transcatheter balloon angioplasty and recently, widely adopted stent implantation. Despite good results demonstrated with stent implantation, a systematic review and meta-analysis (SRMA) looking at the efficacy and saf...

We report the case of a 23-year-old man who developed constrictive pericarditis within four months after pulmonary valve replacement and repair of partial anomalous pulmonary venous connection. He had previously undergone repair of tetralogy of Fallot in infancy. After an unsuccessful trial of medical management for persistent right heart failure,...

Background: The incidence rate of falls at 1.3 falls/1000 patient-days at a tertiary hospital in 2004 was found to be high when benchmarked against other hospitals' fall rates in Singapore. This marked the starting point of a journey of reducing fall incidence by successfully combining evidence-based healthcare measures with quality-improvement st...

Background: It is estimated that 1%-2% of women develop cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) annually worldwide. The prevalence among women living with HIV is higher, at 10%. If left untreated, CIN 2-3 can progress to cervical cancer. WHO has previously published guidelines for strategies to screen and treat precancerous cervical...

The incidence of hypertension (HT) is rising in children and adolescents, with a prevalence quoted at 1-5%. Diagnosing hypertension is challenging, in part because blood pressure (BP) measurement is not routinely performed in children, and also because there are technical difficulties (unco-operative/moving/agitated child, appropriate cuff size etc...

Introduction: Fractal based analysis of vascular branching complexity is known to have a prognostic role in cardiovascular risk prediction and suboptimal Fractal Dimensions of retinal vessels has been shown to correlate with coronary mortality. We hypothesize that Kawasaki disease permanently alters the fractal pattern of the retinal vasculature re...

Objectives: Although first-line treatment for Kawasaki Disease (KD) is IVIG, some children may not respond, requiring repeat IVIG or another second-line therapy. It is important to predict non-responders for timely management decisions in this group of patients. The objective of our study was to assess the predictive value of the currently availabl...

Levocardia (left-sided cardiac apex) with abdominal situs inversus is extremely rare. This is also known as isolated levocardia and is almost always associated with severe forms of congenital heart defects with poor prognosis. We report isolated levocardia in a 13-year-old symptomatic male patient. The purpose of this paper is to outline the imagin...

Transcatheter device closure of the secundum atrial septal defect (ASD) in children prevents atrial arrhythmias in older age. However, the benefits of favourable atrial electrocardiographic markers in these children remain elusive. We aimed to review the electrocardiographic markers of atrial activity in a longitudinal fashion. We retrospectively r...

Introduction: Coarctation of the aorta (CoA) accounts for 5%-8% of all congenital heart defects. If left untreated, most patients with significant CoA will have varying degrees of morbidity (e.g. hypertension, stroke, collateral formation and ventricular hypertrophy), possibly even mortality. Traditionally, treatment for this condition is surgical...

Advances in interventional techniques now allow for transcatheter treatment of some ventricular septal defects (VSD), although there remain concerns about adverse events. We performed a systematic review to look at outcomes and complications associated with transcatheter closure of VSD. A PubMed search for series in English on device closure of VSD...

This international consensus statement is the collaborative effort of three medical societies representing electrophysiology in North America, Europe, and Asian-Pacific area: the Heart Rhythm Society (HRS), the European Heart Rhythm Association (EHRA), and the Asia Pacific Heart Rhythm Society. The objective of the consensus document is to provide cl...

Short-axis cine gradient echo images showing the deep cleft at the anterior mitral valve leaflet directed toward the left ventricular outflow tract.

Aim: Atrioventricular septal defect (AVSD) is widely accepted as the most common type of congenital heart defect in trisomy 21. Most of these studies, however, were conducted in Caucasian communities. The few Asian studies that had been conducted on this subject yielded different results. In the largest study of its kind in Asia, we described the...

Isolated cleft mitral valve (ICMV) is a rare entity not known to be related to pulmonary atresia with ventricular septal defect (PA-VSD). This report describes the use of cardiovascular magnetic resonance (CMR) imaging to diagnose ICMV in a patient with repaired PA-VSD who presented with incidental severe mitral regurgitation (MR) on follow-up echo...

Background Delayed access to specialist care for emergency patients is associated with increased risk of morbidity and mortality, and increased patient anxiety. Objectives (1) To provide timelier access to inpatient and urgent outpatient specialist care for emergency patients. (2) To influence multiple stakeholders to modify their traditional pract...

In 2008, cervical cancer was responsible for 275000 deaths, of which approximately 88% occurred in low- and middle-income countries. In 2009, the World Health Organization (WHO) committed to updating recommendations for use of cryotherapy for cervical intraepithelial neoplasia (CIN). We followed the WHO Handbook for Guidelines Development to develo...

Kawasaki disease (KD) is a multisystem inflammatory vasculitis of childhood, with widespread T-helper cell type 1 immune activation. We hypothesize that children who suffered from KD will have a lower risk of developing allergic diseases. This was a cross-sectional study, recruiting children with a history of KD, together with well sibling controls...

With advances in interventional catheterisation, transcatheter device closure of atrial septal defect (ASD) is now a feasible option to open heart surgery, especially in patients with isolated ASD. We aim to compare the outcomes, benefits and costs between device closure versus standard open-heart surgery for ASD in Singapore. This is a comparative...

The device closure of atrial septal defects has evolved over the years. In the early days of transcatheter occlusion, balloon sizing was used to choose an appropriate sized device. We postulate that balloon sizing does not value-add to the procedure and is unnecessary. Patients who had balloon sizing, with (Group 1, n = 38) or without (Group 2, n =...

We devised a new technique for interventional closure of atrial septal defect (ASD) using the Amplatzer Septal Occluder (ASO), and validated this by comparing it with a cohort using the conventional method. Transcatheter closure of ASD is a widely accepted modality of treatment. Although the outcome is good, there are occasional technical difficult...

We report a 4-month-old boy with seizure, a 1-day history of fever, and a generalized maculopapular rash on the trunk and limbs. In very young children, acute chikungunya infection can mimic Kawasaki disease, and its prompt diagnosis, particularly in an endemic area like Singapore, may avoid the administration of costly and unnecessary intravenous...

Birth parameters have been hypothesized to have an influence on IQ. However, studies within the range of normal birth size have been sparse. With this study we examined the associations between birth length, birth weight, head circumference, and gestational age within the normal birth size range in relation to childhood IQ in Asian children. A coho...

IntroductionRationale Behind TreatmentColposcopic and Pathologic Characteristics of CIN Lesion: a Prerequisite to TreatmentColposcopically Directed BiopsyWhich Lesions to TreatPrerequisites for TreatmentMethods of TreatmentExcision Techniques for Treating CINManagement of Extension of the Abnormal (Atypical) Transformation ZoneFollow-up After Treat...

IntroductionEpidemiology and PathogenesisNatural History of VIN: the Rationale for Treatment?PathologyClinical PresentationBiopsy of the VulvaClinical Appearances of VINVIN Affecting the Pilosebaceous UnitEarly Invasive Carcinoma of the VulvaLichen Sclerosus (LS)Paget's Disease (Non-Squamous Intraepithelial Neoplasia)Vulvar Lesions Masquerading as...

IntroductionTissue Basis for ColposcopyThe Colposcopic ExaminationNew Developments in Colposcopy

IntroductionCytological ClassificationsCytological ReportingClinical ReferralCytodiagnosis of Cervical Glandular Intraepithelial Neoplasia/Adencarcinoma-in-Situ, (AIS)Cytologic Features of AdenocarcinomaScreening for Cervical CancerImprovements to Cervical ScreeningSampling TechniquesCytologic InterpretationAdjunctive TestsProblems in Cytologic Scr...

IntroductionCervical Epithelium: Natural HistoryCervical Epithelium: TopographyCervical Epithelium: Colposcopic AppearancesSquamous Metaplastic EpitheliumColposcopy of the Adolescent CervixCervical Epithelium During Pregnancy and PuerperiumThe Effect of Vaginal Delivery on the Cervical EpitheliumThe Cervical Epithelium During the MenopauseThe Oral...

IntroductionNatural History of VAINEtiologyClinical PresentationVAIN Following HysterectomyBiopsy of the VAIN LesionPathology of VAIN: Is it a Precancerous Lesion?Vaginal Precancer and Cancer: Part of the Lower Genital Tract Neoplastic SyndromeTreatment of VAIN

IntroductionCharacteristics of Human PapillomavirusesManifestations of Genital HPV InfectionPrevalence of Genital HPV InfectionsTransmission of Genital HPV InfectionsRisk Factors for Genital HPV InfectionsHPV and Cancer PrecursorsHPV Infections and the Risk for Cervical CancerNatural HistoryMolecular Pathways of HPV OncogenesisThe Role of Oncogenic...

EpidemiologyEtiologyAssociation with Other Genital Intraepithelial Neoplastic DiseasesExaminationPresentationLesions Masquerading as Intraepithelial NeoplasiaAnal Canal InvolvementTreatment

IntroductionTrichomonas VaginalisCandidiasisHerpes Genitalis InfectionHPV InfectionCervical Deciduosis in PregnancyPolypoid Lesions of the Cervix

Developmental AnatomyDevelopmental Anomalies Caused by DES

IntroductionWhich Cytologic Abnormalities Need Further Investigation?Colposcopy: the Initial Clinical ExaminationThe Rationale for the Use of Colposcopy in the Diagnosis of Cervical PrecancerColposcopic Appearance of the Abnormal (Atypical) Cervical EpitheliumThe Classification of Colposcopically Abnormal (Atypical) Cervical EpitheliumColposcopic E...

Half TitleDedicationTitleCopyrightContentsPreface to the Second EditionPreface to the First EditionAcknowledgements

This is a case report of an unusual association of cor triatriatum and partial atrioventricular septal defect in a child.

We describe a case of variant angina and acute inferior myocardial infarction in a previously well 6-year-old boy with a strong family history of ischemic heart disease.

Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. Many patients are identified through the presence of dysmorphic features and associated cardiac abnormalities. Klinefelter syndrome (KS) is associated with gynaecomastia, small testes, azoospermia and eleva...

Factor VII (FVII) is an independent risk factor for coronary artery disease. Three polymorphisms of the factor VII gene (F7) were studied in a group of healthy newborns comprising 561 Chinese, 398 Malays and 226 Asian Indians from Singapore. The allele frequencies of 3 polymorphisms (R353Q, Promoter 0/10bp Del/Ins and Intron 7) in the FVII gene wer...