Adolescent Eating Disorder in Primary Care - A Case Study

@#Anorexia Nervosa is one of the eating disorders, as classified in the Diagnostic and Statistical Manual, the fifth edition. It is characterised by a pathological fear of weight gain associated with an overwhelming drive for thinness. Patients do present to primary care with vague, non-specific complaints. A heightened degree of suspicion is required for the diagnosis, as patients tend to hide symptoms and are often in denial. We present a case in an 11-year-old girl brought by her mother to the polyclinic with a history of restrictive eating and excessive exercise for three weeks. This case provided a learning opportunity on the assessment and management of an eating disorder, as well as the adverse effects of undernutrition.

Enterovirus infections in Singaporean children: an assessment of neurological manifestations and clinical outcomes

<p><b>INTRODUCTION</b>Enterovirus infections in childhood can be associated with significant neurological morbidity. This study aimed to describe the prevalence and range of neurological manifestations, determine the clinical characteristics and assess differences in clinical outcomes for Singaporean children diagnosed with enterovirus infections.</p><p><b>METHODS</b>In this single-centre, case-control study, clinical data was collected retrospectively from patients admitted to National University Hospital, Singapore, from August 2007 to October 2011 and diagnosed with enterovirus infection, based on the enterovirus polymerase chain reaction test, or cultures from throat and rectal swabs or cerebrospinal fluid samples. The occurrence of neurological manifestations was reviewed and clinical outcomes were assessed.</p><p><b>RESULTS</b>A total of 48 patients (age range: six days-17.8 years) were included in the study. Neurological manifestations were seen in 75.0% of patients, 63.9% of whom presented with aseptic meningitis. Other neurological manifestations included encephalitis, acute cerebellitis, transverse myelitis and autonomic dysfunction. The incidence of neurological manifestations was significantly higher in patients aged > 1 year as compared to younger patients (p = 0.043). In patients without neurological manifestations, a significantly higher proportion presented with hand, foot and mouth disease and poor feeding. Long-term neurological sequelae were seen in 16.7% of patients with neurological manifestations.</p><p><b>CONCLUSION</b>A wide spectrum of neurological manifestations resulting in a relatively low incidence of long-term neurological sequelae was observed in our study of Singaporean children with enterovirus infections. As some of these neurological morbidities were severe, careful evaluation of children with neurological involvement is therefore necessary.</p>