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Tanugroho RR, Wee LWY, Koh MJA, Chong JH. Approach to clinically significant vascular anomalies in children. Singapore Med J 2023; 64:714-720. [PMID: 34808707 PMCID: PMC10775298 DOI: 10.11622/smedj.2021209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022]
Abstract
Vascular anomalies consist of tumours or malformations made up of abnormal growth or collections of blood vessels that can result in functional or cosmetic problems. While many vascular anomalies are present at birth, some do not appear until later in life, making diagnosis more challenging. Although many vascular anomalies are benign, some are associated with serious complications and may involve multiple organ systems. This article highlights the important features of clinically significant vascular anomalies to help physicians promptly identify and refer these cases to a specialised multidisciplinary team for evaluation and management. The discussion includes the various presenting complaints of vascular anomalies in children, namely, rapidly growing birthmarks, painful lesions, seizures/neurological manifestations, bleeding diathesis, cardiac/airway abnormalities and part of an overgrowth syndrome.
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Affiliation(s)
| | | | | | - Jin Ho Chong
- Raffles Children’s Centre, Raffles Hospital, Singapore
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2
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Chong JH. Atopic dermatitis in children: when topical steroid treatment "does not work". BMJ 2021; 372:n297. [PMID: 33602868 DOI: 10.1136/bmj.n297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jin Ho Chong
- Raffles Children's Centre, Raffles Hospital, Singapore
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3
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Bao J, Foong YW, Chong JH, Aan Koh MJ. Systemic immunosuppressants for the treatment of atopic dermatitis in a cohort of Asian children. Dermatol Ther 2020; 33:e13981. [DOI: 10.1111/dth.13981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/07/2020] [Accepted: 07/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Jianda Bao
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Yee Wah Foong
- Dermatology Service KK Women's and Children's Hospital Singapore
| | - Jin Ho Chong
- Dermatology Service KK Women's and Children's Hospital Singapore
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4
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Salas‐Walinsundin WM, Wong V, Chong JH, Koh MJ. Steroid phobia in children with atopic dermatitis and their caregivers in Singapore. Dermatol Ther 2020; 33:e13452. [DOI: 10.1111/dth.13452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/28/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Vivian Wong
- Department of Dermatology Warren Alpert Medical School of Brown University Rhode Island Hospital Rhode Island USA
| | - Jin Ho Chong
- Dermatology Service KK Women's and Children's Hospital Singapore Singapore
| | - Mark J.A. Koh
- Dermatology Service KK Women's and Children's Hospital Singapore Singapore
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5
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Abstract
The Rumpel-Leede phenomenon (RLP) is a rare clinical presentation and in some cases shown to be related to serious systemic conditions. In children, it has been described in association with idiopathic thrombocytopenic purpura and Henoch-Schönlein purpura. We present a series of pediatric cases of RLP with mechanical etiologies that had a benign course. We propose minimal investigations for pediatric RLP cases who are systemically well and have a clear suggestive history of a mechanical cause.
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Affiliation(s)
| | - Jin Ho Chong
- Raffles Hospital, Children's Centre, Singapore, Singapore
| | - Priya Bishnoi
- KK Women's and Children's Hospital, Dermatology Service, Singapore, Singapore
| | - Mark J A Koh
- KK Women's and Children's Hospital, Dermatology Service, Singapore, Singapore
| | - Sharon M Y Wong
- KK Women's and Children's Hospital, Dermatology Service, Singapore, Singapore
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6
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Affiliation(s)
- Zi Xean Khoo
- Department of Paediatric Medicine, General Paediatrics Service, KK Women's and Children's Hospital, Singapore
| | - Jin Ho Chong
- Dermatology Service, KK Women's and Children's Hospital, Singapore
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7
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Chong JH, Maxwell M, Smith T, Walker MJ, Crake T, Westwood M, Ghosh AK, Manisty CH. P680The clinical value of CMR in the management of Cardio-Oncology patients - a tertiary centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is increasing awareness of cardiotoxicity arising from cancer treatments. Early diagnosis and treatment is key, to ensure patients receive optimal oncological management. Cardiovascular magnetic resonance (CMR) offers gold standard measurement of cardiac function, alongside tissue characterisation and myocardial perfusion, thereby potentially providing additive value in the context of cardio-oncology.
Purpose
We sought to understand the clinical value of CMR in cardio-oncology at a tertiary cardio-oncology centre.
Methods
We retrospectively reviewed CMR scans requested in cardio-oncology patients at our institution within a ten-month period. We categorised clinical indications and assessed the impact on clinical management using previously-published criteria.
Results
102 CMR studies were requested in 93 cardio-oncology patients (mean age 56 (range 18 to 82), 49% male) between (March to December 2018). 41% of patients had haematological malignancies, 59% solid tumours.
15% of requests were for risk stratification prior to initiation of cancer therapy, 21% for screening for cardio-toxicity in patients currently receiving cardiotoxic agents (3% anthracyclines, 13% HER2 monoclonal antibodies, 4% fluoropyrimidines), 15% for investigation of patients with cardiac complications during cancer treatment, 35% assessment for late effects post cancer treatment, and 14% for cardiac malignancies/ infiltration.
The most common indications for CMR were monitoring of left ventricular ejection fraction (LVEF) in patients where quantification by echocardiography was non-diagnostic or significantly different between imaging studies (39%) and ischaemia assessment including for patients due to receive fluoropyrimidines (26%). Others were aetiology of LV dysfunction/cardiomyopathy (13%) and tissue characterisation (23%), including assessment for cardiac AL amyloid (11 patients), myocarditis (2), cardiac metastases (1), cardiac masses (6), and cardiac iron loading (1).
CMR findings had clinical impact in 61% of patients and assisted in adjudicating a new diagnosis in 29% of patients. 88% of patients were able to continue anthracycline/anti-HER2 therapies based on CMR findings of stable LVEF (93% of whose echocardiograms had suggested reductions). LVEF had reduced significantly in 12% of patients meaning chemotherapy was held/discontinued. 3 patients were recommended to receive non-fluoropyrimidine chemotherapy based on perfusion CMR (pCMR) findings, with one patient permitted to receive capecitabine following normal pCMR.
Conclusion
CMR provides a comprehensive assessment of myocardial structure and function with utility within the context of cardio-oncology for risk stratification pre-chemotherapy, screening for cardiotoxicity during treatment and investigation of cardiac complications of cancer treatment. The additional information derived from CMR generally provides reassurance enabling administration of optimal cancer therapies.
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Affiliation(s)
- J H Chong
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - M Maxwell
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - T Smith
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - M J Walker
- Hatter Cardiovascular Institute, London, United Kingdom
| | - T Crake
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - M Westwood
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - A K Ghosh
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - C H Manisty
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
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8
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Maridet C, Perromat M, Miquel J, Chiaverini C, Bessis D, Lasek A, Piram M, Bursztejn AC, Abasq C, Phan A, Martin L, Bréchat B, Chong JH, Seneschal J, Taïeb A, Boralevi F. Childhood chronic prurigo: Interest in patch tests and delayed-reading skin prick tests to environmental allergens. J Allergy Clin Immunol 2018; 141:797-799.e9. [DOI: 10.1016/j.jaci.2017.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 11/26/2022]
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Affiliation(s)
- Xinyi Chin
- KK Women's and Children's Hospital, Singapore
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10
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Chong JH, Prey S, Mya HT, Delarue A, Labreze C. Can the extent of heart rate reduction predict the clinical response of infantile haemangiomas to propranolol? Br J Dermatol 2018; 178:e196-e197. [PMID: 28886210 DOI: 10.1111/bjd.15966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J H Chong
- Department of Pediatric Medicine, Dermatology Service, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore, 229899.,Department of Pediatric Dermatology, National Centre for Rare Skin Disorders, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France
| | - S Prey
- Department of Pediatric Dermatology, National Centre for Rare Skin Disorders, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France
| | - H T Mya
- Department of Hematology, Singapore General Hospital, Singapore
| | - A Delarue
- Pierre Fabre Dermatologie, Lavaur, France
| | - C Labreze
- Department of Pediatric Dermatology, National Centre for Rare Skin Disorders, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France
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11
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Affiliation(s)
- Hui Min Liew
- Dermatology, KK Women's and Children's Hospital, Singapore
| | - Jin Ho Chong
- Dermatology, KK Women's and Children's Hospital, Singapore
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12
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Chong JH, Mermin D, Marti A, Lafon ME, Dutkiewicz AS, Léauté-Labrèze C, Boralevi F. Red palms associated with adenovirus gastroenteritis. Arch Dis Child 2017; 102:868-869. [PMID: 28082320 DOI: 10.1136/archdischild-2016-312107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 11/04/2022]
Affiliation(s)
- J H Chong
- Pediatric Dermatology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - D Mermin
- Pediatric Dermatology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - A Marti
- Pediatric Dermatology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - M E Lafon
- Department of Virology, Centre Hospitalier Universitaire, Bordeaux, France
| | - A S Dutkiewicz
- Pediatric Dermatology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - C Léauté-Labrèze
- Pediatric Dermatology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - F Boralevi
- Pediatric Dermatology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
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13
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Abstract
Atopic dermatitis (AD) is a common chronic, pruritic skin disease in children. As the incidence of AD increases, especially in high-income countries, paediatricians may see an increasing number of recalcitrant AD cases in their practice. Although these cases are principally managed by paediatric dermatologists, it is important for paediatricians to be aware of the use and side effects of non-topical treatment like phototherapy and systemic agents as well as the evidence for alternative treatment, which caregivers may ask about. This review presents paediatric evidence for the practical use of phototherapy and certain oral immunosuppressants for paediatric AD including doses, duration of use and monitoring of adverse effects. The use of alternative therapy including traditional medicine, probiotics and the role of nutrition are also discussed. Narrow band ultraviolet B phototherapy is effective in recalcitrant paediatric AD. When phototherapy is ineffective or contraindicated, systemic drugs may be administered cautiously with close surveillance of side effects. The use of azathioprine, ciclosporin, methotrexate and mycophenolate mofetil is generally safe in the short term under close monitoring and can be effective alongside compliance to topical treatment. Alternative complementary treatment is not known to be effective. Holistic management including therapeutic patient education is important. Good quality paediatric studies for non-topical AD treatment are needed for definitive guidelines.
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Affiliation(s)
- Jin Ho Chong
- Dermatology service, KK Women's and Children's Hospital, Singapore.,Department of General Paediatrics, KK Women's and Children's Hospital, Singapore
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14
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Koh MJA, Giam YC, Liew HM, Foong AYW, Chong JH, Wong SMY, Tang MBY, Ho MSL, Tan LS, Mason JM, Cork MJ. Comparison of the Simple Patient-Centric Atopic Dermatitis Scoring System PEST with SCORAD in Young Children Using a Ceramide Dominant Therapeutic Moisturizer. Dermatol Ther (Heidelb) 2017; 7:383-393. [PMID: 28616853 PMCID: PMC5574738 DOI: 10.1007/s13555-017-0186-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction Patient eczema severity time (PEST) is a new atopic dermatitis (AD) scoring system based on patients’ own perception of their disease. Conventional scales such as SCORing of atopic dermatitis (SCORAD) reflect the clinician’s observations during the clinic visit. Instead, the PEST score captures eczema severity, relapse and recovery as experienced by the patient or caregiver on a daily basis, promoting patient engagement, compliance with treatment and improved outcomes. This study aims to determine the correlation between carer-assessed PEST and clinician-assessed SCORAD in paediatric AD patients after 12 weeks of treatment using a ceramide-dominant therapeutic moisturizer. Methods Prospective, open-label, observational, multi-centre study in which children with AD aged 6 months to 6 years were treated with a ceramide dominant therapeutic moisturizer twice daily for 12 weeks; 58 children with mild-to-moderate AD were included. Correlation between the 7-day averaged PEST and SCORAD scores for assessment of AD severity was measured within a general linear model. PEST and SCORAD were compared in week 4 and week 12. Results At week 12, a moderate correlation was found between the SCORAD and PEST scores (r = 0.51). The mean change in SCORAD and PEST scores from baseline to week 12 was −11.46 [95% confidence interval (CI) −14.99 to −7.92, p < 0.0001] and −1.33 (95% CI −0.71 to −0.10, p < 0.0001) respectively. PEST demonstrated greater responsiveness to change (33.3% of scale) compared to SCORAD (13.8% of scale). Conclusion The PEST score correlates well with the SCORAD score and may have improved sensitivity when detecting changes in the severity of AD. The ceramide-dominant therapeutic moisturizer used was safe and effective in the management of AD in young children. Funding Hyphens Pharma Pte Ltd. Trial Registration clinicaltrials.gov identifier, NCT02073591.
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Affiliation(s)
- Mark Jean-Ann Koh
- KK Women's and Children's Hospital, Bukit Timah, Singapore, Singapore
| | - Yoke Chin Giam
- National Skin Centre, Mandalay Road, Singapore, Singapore
| | - Hui Min Liew
- KK Women's and Children's Hospital, Bukit Timah, Singapore, Singapore
| | | | - Jin Ho Chong
- KK Women's and Children's Hospital, Bukit Timah, Singapore, Singapore
| | | | | | | | | | - James M Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael J Cork
- Dermatology Research Group, Department of Infection, Immunity and Cardiovascular Disease, Faculty of Medicine, Dentistry and Health, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
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15
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Chong JH, Mermin D, Goussot JF, Taïeb A. Vitiligo co-existing with lichen striatus: more than a coincidence? J Eur Acad Dermatol Venereol 2016; 31:e200-e202. [PMID: 27579541 DOI: 10.1111/jdv.13954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J H Chong
- Department of Pediatric Dermatology, Hôpital Pellegrin-Enfants, Bordeaux, France.,Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - D Mermin
- Department of Pediatric Dermatology, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - J F Goussot
- Department of Pathology, Hôpital Haut-Lévêque, Pessac, France
| | - A Taïeb
- Department of Pediatric Dermatology, Hôpital Pellegrin-Enfants, Bordeaux, France
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Abstract
A 13-year-old boy underwent allogeneic hematopoietic stem cell transplantation (HSCT) for underlying acute lymphoblastic leukemia and achieved neutrophil engraftment 28 days after HSCT. He developed ichthyosis 6 weeks after HSCT and then keratotic follicular papules, palmoplantar keratoderma, and a seborrheic dermatitis-like eruption 18 weeks after HSCT. From skin biopsies he was diagnosed with eczematoid graft-versus host disease (GVHD), which showed spongiosis with scattered necrotic keratinocytes. He responded to oral and topical steroids and an increase in cyclosporine dose. Although uncommon, eczematoid GVHD must be considered in children who have undergone HSCT and then develop an atypical eczematous eruption, especially in the absence of a history of atopy.
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Affiliation(s)
- Jin Ho Chong
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - Khawn Tawng
- Paediatric Haematology / Oncology, KK Women's and Children's Hospital, Singapore
| | - Hui Min Liew
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - Shui Yen Soh
- Paediatric Haematology / Oncology, KK Women's and Children's Hospital, Singapore
| | - Ah Moy Tan
- Paediatric Haematology / Oncology, KK Women's and Children's Hospital, Singapore
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Chong JH, Jamuar SS, Ong C, Thoon KC, Tan ES, Lai A, Aan MKJ, Tan WLW, Foo R, Tan EC, Lau YL, Liew WK. Tricho-hepato-enteric syndrome (THE-S): two cases and review of the literature. Eur J Pediatr 2015; 174:1405-11. [PMID: 25976726 DOI: 10.1007/s00431-015-2563-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/03/2015] [Accepted: 05/06/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED Tricho-hepato-enteric syndrome (THE-S) is characterized by severe infantile diarrhea, failure to thrive, dysmorphism, woolly hair, and immune or hepatic dysfunction. We report two cases of East Asian descent with THE-S who had remained undiagnosed despite extensive investigations but were diagnosed on whole exome sequencing (WES). Both cases presented with chronic diarrhea, failure to thrive, and recurrent infections. Case 1 had posteriorly rotated low set ears, mild retrognathia, and fine curly hypopigmented hair. She was managed with prolonged total parenteral nutrition and intravenous immunoglobulin infusions. Case 2 had sparse coarse brown hair as well as multiple lentigines and café-au-lait macules. She was managed with amino acid-based formula. For both cases, routine investigations were inconclusive. WES in both cases showed biallelic truncating mutations in TTC37 (c.3507T>G;p.Y1169X and c.3601C>T;p.R1201X in case 1 and c.3507T>G;p.Y1169X and c.154G>T;p.E52X in case 2), suggesting a diagnosis of THE-S. CONCLUSION We present novel mutations in the TTC37 gene in two individuals of East Asian descent with the rare THE-S, detected by WES. Future identification of patients with THE-S and establishing genotype-phenotype correlations will aid in counseling the patients and their families. WHAT IS KNOWN • Tricho-Hepato-Enteric syndrome (THE-S) is characterized by severe infantile diarrhea, failure to thrive, dysmorphism, woolly hair, and immune or hepatic dysfunction. • Complex patients with diagnostic dilemmas undergo extensive investigations. What is New: • This is a report of novel mutations in TTC37 in individuals of East Asian descent. • Whole exome sequencing (WES) can be useful in certain complex cases with diagnostic dilemmas.
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Affiliation(s)
- Jin Ho Chong
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Saumya Shekhar Jamuar
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Christina Ong
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Koh Cheng Thoon
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Ee Shien Tan
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Angeline Lai
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore.
| | - Mark Koh Jean Aan
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore.
| | | | - Roger Foo
- Genome Institute of Singapore, Singapore, Singapore.
| | - Ene Choo Tan
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China.
| | - Woei Kang Liew
- Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.
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18
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Chong JH, Liew HM, Koh MJA. A lumbosacral hemangioma with spinal dysraphism. J Pediatr 2015; 166:495. [PMID: 25449217 DOI: 10.1016/j.jpeds.2014.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Jin Ho Chong
- KK Women's and Children's Hospital, Dermatology Service, Singapore
| | - Hui Min Liew
- KK Women's and Children's Hospital, Dermatology Service, Singapore
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Yeo ASH, Chong JH, Tan TH, Ng ASB, Rajadurai VS, Chan YH. Neonatal and Paediatric Extracorporeal Membrane Oxygenation (ECMO) in a Single Asian Tertiary Centre. Ann Acad Med Singap 2014; 43:355-361. [PMID: 25142471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass technique (CPB) which provides life-saving support in patients with refractory cardiorespiratory failure until cardiopulmonary recovery or organ replacement. MATERIALS AND METHODS This is a single centre retrospective study reporting the largest series of paediatric patients in Singapore who received ECMO support over an 11-year period from January 2002 to December 2012. The objective is to describe the characteristics of the patients and to report the survival to hospital discharge, complications during ECMO and other long-term complications. RESULTS Forty-eight patients received ECMO during the study period. ECMO was initiated for myocarditis in majority of the paediatric patients whereas postoperative low cardiac output state was the most common indication in the neonatal population. The overall survival rate to hospital discharge was 45.8%. Survival was highest in the neonates with respiratory failure (75%). Haematological and cardiac complications were most common during ECMO. Age group, gender, duration of ECMO, need for renal replacement therapy, acute neurological complications were not associated with mortality. Those needing inotropic support during ECMO had poorer survival while those with hypertension requiring vasodilator treatment had a higher survival rate. The survival rates for ECMO patients more than doubled from the initial 6 years of 23% to 54% in the last 5 years of the study period. Long-term complications encountered included neurological, respiratory and cardiac problems. CONCLUSION ECMO is a life-saving modality for neonatal and paediatric patients with cardiopulmonary failure from diverse causes. Patients with persistent need for inotropes during ECMO had poorer outcome. Centre experience had an impact on ECMO outcome.
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Affiliation(s)
- Angela S H Yeo
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore
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20
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Chong JH, Chandran S, Agarwal P, Rajadurai VS. Delayed presentation of prolonged hyperinsulinaemic hypoglycaemia in a preterm small-for-gestational age neonate. BMJ Case Rep 2013; 2013:bcr-2013-200920. [PMID: 24351577 DOI: 10.1136/bcr-2013-200920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hyperinsulinaemic hypoglycaemia in small-for-gestational age infants usually presents in the first two postnatal days. We present a preterm, small-for-gestational age infant who had hyperinsulinaemic hypoglycaemia on day 13 of life. A female twin infant weighing 1390 g was born at 32(+6) weeks of gestation. Her glycaemic profile was normal till day 13 of life, after which she was noted to be lethargic and hypoglycaemic and had hyperinsulinism, hypoketonaemia and hypofattyacidaemia, requiring high glucose infusion rate to maintain normoglycaemia, while negative for septic markers and metabolic screen. Initially, there was no response to diazoxide and the genetic studies for ABCC8 and KCNJ11 gene mutations were negative. Delayed response to diazoxide was followed by complete resolution of hypoglycaemia in 5 months. This case highlights the importance of glucose monitoring in small-for-date infants for hypoglycaemia till they achieve full feeds and gain weight. Early recognition and appropriate management of hypoglycaemia in this group of infants have important implications for neurodevelopmental outcome.
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Affiliation(s)
- Jin Ho Chong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
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21
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Abstract
AIM To quantify clinically significant hypersalivation and other adverse events requiring intervention, with and without the use of atropine during ketamine use, using a consensus-based, standardised terminology. METHODS This was a retrospective study based on paediatric patients who received ketamine for procedures done at the children's emergency department from July 2010 to September 2010. Patients who were given atropine were compared with patients who were not given atropine with regard to clinically significant hypersalivation. All other side effects of ketamine (airway, respiratory, cardiovascular, neurological and gastrointestinal side effects) were documented. RESULTS Two out of the 164 (1.2%) patients who received atropine and 1 out of the 119 (0.8%) patients who did not receive atropine had desaturation (odds ratio (OR) 1.5; 95% CI 0.1-16.3). These three patients were all under 5 years old (P = 0.3) and had airway malalignment requiring repositioning. None had hypersalivation requiring intervention. Two out of 164 (1.2%) who received atropine and 3 out of 119 (2.5%) who did not receive atropine had vomiting (OR 0.5; CI 0.1-2.9). One patient who vomited did not receive atropine and was given ondansetron. The others had delayed discharges following a longer period of observation in the unit. CONCLUSIONS There was no clinically significant hypersalivation in children given ketamine sedation, with or without the coadministration of atropine. Ketamine is a relatively safe drug for use in children with few intervention-based side effects.
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Affiliation(s)
- Jin Ho Chong
- Paediatric Emergency Medicine, KK Women's and Children's Hospital, Singapore.
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22
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Abstract
AIMS Previous studies reported an increasing temporal trend of hypospadias and a significant association with poor intrauterine growth. It remains unclear whether the association relates to birth weight, degree of prematurity or intra-uterine growth. The objective was to study the incidence of hypospadias and to examine the association with various risk factors. METHODS A retrospective case-control study was carried out of infants admitted to a neonatal unit from January 1st, 1999 to December 31st, 2005. RESULTS Of 6538 male live births, 27 (0.41%) infants had hypospadias. Incidence increased from 2.85 per thousand in 1999 to 6.89 per thousand in 2005. Hypospadias occurred significantly more frequently in babies born small for gestational age (SGA), in very low birth weight (VLBW) infants, those born preterm and to mothers with preeclampsia (PET). Logistic regression revealed that VLBW (OR 14.12, CI 5.48-36.39), maternal PET (OR 3.90, CI 1.50-10.14) and SGA (OR 3.23, CI 1.25-8.37) as independent risk factors. CONCLUSIONS Hypospadias is associated with VLBW, maternal PET and poor intra-uterine growth, but not with preterm birth. A rising trend in the incidence of hypospadias was noted in our population of Asian babies, suggesting a universal phenomenon.
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Affiliation(s)
- Jin Ho Chong
- Singapore General Hospital, Outram Road, Singapore
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23
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Abstract
We aimed to study the prevalence of refractive conditions in Singapore teenagers. Grade 9 and 10 students (n = 946) aged 15-19 years from two secondary schools in Singapore were recruited. The refractive errors of the students' eyes were measured using non-cycloplegic autorefraction. Sociodemographic data and information on risk factors for myopia (such as reading and writing) were also obtained using an interviewer-administered questionnaire. The prevalence of refractive conditions was found to be: myopia [spherical equivalent (SE) at least -0.50 D] - 73.9%, hyperopia (SE at least +0.50 D) - 1.5%, astigmatism (cylinder at least -0.50 D) - 58.7% and anisometropia (SE difference at least 1.00 D) - 11.2%. After adjusting for age and gender, currently doing more than 20.5 h of reading and writing a week was found to be positively associated with myopia [odds ratio 1.12 (95% CI 1.04-1.20, p = 0.003)], as was reading and writing at a close distance and a better educational stream. The prevalence of myopia (73.9%) in Singapore teenagers is high. Current reading and writing habits, reading at close distances and a better educational stream are possible risk factors for myopia.
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Affiliation(s)
- Timothy P L Quek
- Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, Singapore 117597, Republic of Singapore
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