In the last issue, our experts shared their insights on zoonotic infections like monkeypox, immunotherapy for cancer while shedding light on the journey to becoming a clinician-scientist.

And in this issue, they are back, taking on another round of your questions relating to health and medical education, including: blood sugar spikes, chicken pox and other infectious diseases in adults and the road ahead in a neurosurgeon residency.

While this may be the last issue for 2022, experts from our Signature Research Programmes and Research Centres as well as our clinical specialists and faculty from the Academic Clinical Programmes and our academic medicine partner, SingHealth, remain ready to share their insights, experiences and advice to your burning questions. We welcome all questions and will focus on those that intrigue and where our experts can provide the most meaningful insights and answers.

Have a question? Send it in and it may be answered in the next issue of MEDICUS!


How long is the residency for a neurosurgeon?

How long is the residency for a neurosurgeon?

Lujayn Elbatsh

Neurosurgery is currently a National Integrated Residency Programme that is administered by SingHealth. The total length of the programme is six years with an option of doing an extra year under the Clinician-Scientist Programme (total of seven years). The first two years are a general surgery programme with compulsory rotations to different medical and surgical specialties. The last four years are spent fully working in neurosurgery with rotations to the main campus of the National Neuroscience Institute at the Singapore General and Tan Tock Seng Hospitals as well as to the National University Health System’s neurosurgery department. 

The programme’s strength lies in the diverse clinical cases and subspecialty focus across both adult and paediatric conditions. Neurosurgery is at a frontier of medicine, integrating the latest technological advancements with basic neuroscience research. The programme aims to nurture neurosurgeons into clinician-leaders, clinician-educators and clinician-scientists

Clinical Associate Professor Jai Prashanth Rao
Duke-NUS Neuroscience Academic Clinical Programme Programme
Director of Singapore Integrated Programme for Neurosurgery

Why are blood sugar spikes harmful?

Why are blood sugar spikes harmful? And how can they be controlled?


Spikes or fluctuations in blood sugar, or glucose, levels are also known as glycaemic variability. In individuals with diabetes mellitus, high glycaemic variability is associated with an increased risk of hypoglycaemia—a condition where blood sugar levels are too low—as well as  diabetic complications and end-organ damage. In individuals who have yet to be diagnosed with diabetes mellitus, high glycaemic variability may be a sign of pre-diabetes.

Adopting healthier lifestyle measures is the first step in reducing spikes in blood glucose levels. It is important to instil dietary measures to reduce carbohydrate intake, especially refined carbohydrates and sweetened beverages.  

The “My Healthy Plate” guide from the Health Promotion Board (HPB) recommends a quarter plate of wholegrains (such as brown rice and wholemeal bread), a quarter plate of proteins, and half a plate of fruit and vegetables for a healthier meal.

Secondly, regular exercise is also important as this helps to reduce insulin resistance which keeps blood glucose levels in check. As a guide, HPB recommends a total of 150 minutes of moderate intensity, or 75 minutes of vigorous intensity physical activity a week. Working towards a healthy body mass index (18 – 23 kg/m2) is also important for individuals who are overweight.

As for individuals who have been diagnosed with diabetes mellitus, they may need to be started on medications and/or insulin to control blood glucose spikes and to reduce glycaemic variability. Compliance to medications and insulin as well as regular monitoring of blood glucose levels are important to ensure that glycaemic targets are met. Going for regular follow-ups with their managing physicians is also essential.

Dr Sarah Tan Ying Tse
Associate Consultant in Endocrinology
Singapore General Hospital

Why do adults seem to suffer from a more severe form of chicken pox or HFMD when they get infected?

Why do adults seem to suffer from a more severe form of chicken pox or HFMD when they get infected?


The probable answer to this question lies in how our immunity changes and develops as we age. After birth, our immunity develops rapidly, receiving signals and triggers from infections, vaccinations and allergens from the environment we interact with or the food we eat. The mix of stimulants helps build our immunity as we grow, fighting off infections or ensuring they are only mild illnesses, for example, a child with hand foot and mouth disease, HFMD, or chickenpox.

It is common to describe disease severity as being worse at the ‘extremes of age’, meaning that symptoms and signs of an infectious disease are often worse in infants and the elderly. The concept of immune ageing or ‘immunosenescence’ is when our immunity ‘ages’ and is less responsive, which becomes clinically apparent in people aged 60 years and older.

However, a systematic analysis published in Nature shows that disease severity is high during infancy but becomes less severe during early childhood until a child is around 10 years of age. Disease severity then rises again through adolescence and into adulthood. This shows that our immunity to diseases is low after birth but rapidly strengthens in early childhood before slowly tapering through our lives. This new evidence could provide some clues as to why adults seem to suffer from infectious diseases more severely than children.

The human immunological response remains a complex mystery but with ongoing studies that look at how our bodies respond to pathogens and factors such as changes in lifestyle and environmental triggers, we are a step closer to understanding our bodies and hopefully with this knowledge, we are able to design better healthcare interventions like vaccines or medicines.

Dr Khoo Yoong Khean
Scientific Officer, Duke-NUS Centre for Outbreak Preparedness

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