SARS-CoV-2 viral RNA load dynamics in the nasopharynx of infected children.

It is important to understand the temporal trend of the paediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load to estimate the transmission potential of children in schools and communities. We determined the differences in SARS-CoV-2 viral load dynamics between nasopharyngeal samples of infected asymptomatic and symptomatic children. Serial cycle threshold values of SARS-CoV-2 from the nasopharynx of a cohort of infected children were collected for analysis. Among 17 infected children, 10 (58.8%) were symptomatic. Symptomatic children, when compared to asymptomatic children, had higher viral loads (mean cycle threshold on day 7 of illness 28.6 vs. 36.7, P = 0.02). Peak SARS-CoV-2 viral loads occurred around day 2 of illness in infected children. Although we were unable to directly demonstrate infectivity, the detection of significant amount of virus in the upper airway of asymptomatic children suggest that they have the potential to shed and transmit SARS-CoV-2. Our study highlights the importance of contact tracing and screening for SARS-CoV-2 in children with epidemiological risk factors regardless of their symptom status, in order to improve containment of the virus in the community, including educational settings.

Invasive paediatric Elizabethkingia meningoseptica infections are best treated with a combination of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or fluoroquinolone.

OBJECTIVES: Elizabethkingia meningoseptica is a multi-drug-resistant organism that is associated with high mortality and morbidity in newborn and immunocompromised patients. This study aimed to identify the best antimicrobial therapy for treating this infection. METHODS: A retrospective descriptive study was conducted from 2010 to 2017 in a tertiary paediatric hospital in Singapore. Paediatric patients aged 0 to 18 years old with a positive culture for E. meningoseptica from any sterile site were identified from the hospital laboratory database. The data collected included clinical characteristics, antimicrobial susceptibility and treatment, and clinical outcomes. RESULTS: Thirteen cases were identified in this study. Combination therapy with piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluoroquinolone resulted in a cure rate of 81.8  %. The mortality rate was 15.4  % and neurological morbidity in patients with bacteraemia and meningitis remained high (75 %). CONCLUSIONS: Treatment with combination therapy of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluroquinolone was effective in this study, with low mortality rates being observed.

[Analysis and discussion of risk factors related to dental implant failure].

The implant prosthesis has been extensively used in clinic recently, and implant failure is appearing. Many factors may cause the failure, and they work together generally. This paper summarizes and analyzes the failure cases related to implant treatment and relevant risk factors of oral implants in Department of Implantation, School of Stomatology, The Fourth Military Medical University during the past six years, in order to improve the success rate of implant prosthesis and provide guidance for clinical application.

Validity of EuroQOL-5D, time trade-off, and standard gamble for age-related macular degeneration in the Singapore population.

BACKGROUND/AIMS: Utility values of age-related macular degeneration (AMD) in Asian patients are unknown. This study aims to assess utility values and construct validity of the EuroQOL-5D (EQ-5D), time trade-off (TTO), and standard gamble (SG) instruments in the Singapore multi-ethnic AMD population. METHODS: Cross-sectional, two-centre, institution-based study. Visual acuity (VA), clinical AMD severity, and utility scores on the EQ-5D, TTO, and SG were obtained from 338 AMD patients. VA was analysed in terms of the better-seeing eye (BEVA), worse-seeing eye (WEVA), and weighted average of both eyes (WVA). We evaluated SG on the perfect health-death (SG(death)) and binocular perfect vision-binocular blindness (SG(blindness)) scales. Construct validity was determined by testing a priorihypotheses relating the EQ-5D, TTO, and SG utility scores to VA and clinical AMD severity. RESULTS: The mean utilities on the EQ-5D, TTO, SG(death), and SG(blindness) were 0.89, 0.81, 0.86, and 0.90, respectively. EQ-5D scores correlated weakly with BEVA, WEVA, and WVA (Pearson's correlation coefficients -0.291, -0.247, and -0.305 respectively, P<0.001 for all). SG(death) and SG(blindness) demonstrated no correlation with BEVA, WEVA, or WVA (Pearson's correlation coefficients, range -0.06 to -0.125). TTO showed weak association only with WEVA and WVA (correlation coefficients -0.237, -0.228, P<0.0001), but not with BEVA (correlation coefficient -0.161). Clinical AMD severity correlated with EQ-5D and SG(death), but not with TTO and SG(blindness) (P=0.004, 0.002, 0.235, and 0.069, respectively). CONCLUSIONS: AMD has a negative impact on utilities, although utility scores were high compared with Western cohorts. EQ-5D, TTO, and SG showed suboptimal construct validity, suggesting that health status utilities may not be sufficiently robust for cost-utility analyses in this population.

Neonatal hepatic abscess in preterm infants:a rare entity?

INTRODUCTION AND OBJECTIVE: Neonatal pyogenic hepatic abscess in preterm infants is a rare entity. We present 6 cases of neonatal liver abscesses diagnosed in our hospital as well as an approach that will facilitate the early diagnosis and management of neonatal pyogenic liver abscess based on our case series and review of the literature. MATERIALS AND METHODS: Retrospective review of case records of all 6 patients diagnosed with neonatal liver abscess from January 2000 to December 2002 in KK Women's and Children's Hospital, Singapore. RESULTS: All neonates were premature with gestational ages between 24 and 34 weeks. Persistence of positive blood culture despite appropriate antibiotic treatment in 67% of the cases prompted use of hepatobiliary ultrasounds to detect liver abscess. Surgical drainage of liver abscess was performed in 33% of the cases, with the remainder treated conservatively with appropriate intravenous antibiotics. Half of the infants recovered with resolution of their liver abscess on serial hepatobiliary ultrasound. The other half died of fulminant sepsis. CONCLUSIONS: Neonatal pyogenic liver abscess, though rare, is associated with good outcome if diagnosed promptly and appropriate treatment instituted. In a preterm infant with sepsis, a high index of suspicion is required if there is persistence of positive blood culture despite appropriate antibiotic treatment, and hepatobiliary ultrasound should be done to detect and monitor neonatal liver abscess.

Temporal variations in myopia progression in Singaporean children within an academic year.

PURPOSE: Excessive nearwork is believed to be associated with myopia development and progression. To investigate this further, we studied refractive error changes and their correlation with nearwork in a cohort of grade school children in Singapore. METHODS: Cycloplegic autorefraction was performed 5 times over 10 months on 168 children aged 7, 9, and 12 years who were further divided into myopic and nonmyopic subgroups based in their initial refractive errors. Information about nearwork was obtained through diaries filled out over 24 h at the commencement of the study. RESULTS: Myopia progression was high (overall mean: -0.87 D per year) and largely linear throughout the year, but significantly higher rates were seen after the final school examinations in 7-year-old myopes and nonmyopes. Overall, myopic groups exhibited higher progression rates than nonmyopic groups, although 33.6% of subjects from the latter groups had become myopic by the end of the study. Nearwork scores derived from the diaries were generally not well correlated with overall myopia progression. CONCLUSIONS: The tendency for myopia progression rates to increase after the final school examinations in 7-year-olds is interpreted as a delayed effect of the intense nearwork associated with preparing for them. The timing of nearwork-diary data collection at the beginning of the study could be responsible for the poor correlation between these data and overall myopia progression rates.

A cross-sectional survey of physical activity among middle aged women in Singapore.

OBJECTIVES: To assess the extent to which middle-aged women in Singapore engage in physical activity of a level which would result in long-term health benefits, and to determine the factors associated with this. METHODS: We conducted a cross-sectional survey of women aged between 35 and 60 years residing in Marine Terrace. A standardised questionnaire incorporating a modified Seven-Day Recall Questionnaire was used to record the level and type of physical activity engaged in over the past week. Demographic information and factors promoting or discouraging sports and exercise were also elicited. The total energy expenditure for household, occupational and sports activities of moderate intensity and above was calculated using metabolic equivalents (METs) in kcal/kg/week. RESULTS: Of the 341 respondents, 50.7% reported engaging in at least moderate activity for 30 minutes or more every day during the past week, thus fulfilling the WHO recommendations on physical activity. Housework contributed significantly to the energy expenditure on these activities among our target population. After adjusting for age, body mass index and educational level, we found that housewives without domestic help were most likely to fulfill the WHO recommendations. Housewives or working women with domestic help were the two groups at highest risk of low physical activity. A lack of time was the reason most commonly cited for not engaging in sports or exercise. CONCLUSION: Studies assessing physical activity in relation to disease risk among women should include domestic work in addition to the traditional leisure-time activities. There is a scope for further efforts to improve the level of activity in this population, which could be facilitated by the support of health professionals, employers and family members.

Retinoblastoma in Singapore: 1976 to 1995.

There were at least 56 local and 42 foreign patients seen in Singapore between 1976 and 1995 inclusively. The local incidence rate is 1 in 15789 live-births, and there appears to be no predilection for sex and race. Ninety-eight per cent presented before the age of five with the average age at diagnosis being 18 months. Bilateral cases were diagnosed earlier than unilateral cases. At least 17% are hereditary, with only 2 of these with positive family histories. Of the 41 patients studied for presenting complaints, 82.9% had leukocoria, 19.5% had strabismus and 12.2% had decreased visual acuity. The main mode of treatment was enucleation alone in unilateral disease; in bilateral cases, the main mode was enucleation of the more badly affected eye together with radiotherapy and cryotherapy of the fellow eye. Ninety per cent of all patients who underwent treatment have had enucleation done. Four patients defaulted treatment--with counselling of the parents of these patients, this number could be reduced or at least kept low. Patients with early diagnosis and treatment are more likely to survive. Eight of the 56 patients died. However, with better treatment modalities, the prognosis for both life and vision have, in recent years, improved significantly.

Structure-related properties of the mutagenic lesion 6-O-methylguanine in DNA.

Chemical probing of the structures of a few very similar 30 base-pair duplexes containing a 6-O-methylguanine (meG) residue at the 16th position reveals that the modified base simultaneously perturbs the helical structure in two ways; it preferentially unstacks the 3' neighbouring base residue (thymine in this study) on the same strand and it unstacks the pyrimidine to which it is base-paired. Depending on its neighbouring 5' base residue and the base-pairing pyrimidine, this perturbation can extend to a few base-pairs in both 3' and 5' directions from the abnormal base-pair. These perturbations can be detected by cleavage at the site for the restriction enzyme MaeII. The unstaking of the C in the meG.C and A.C base-pairs may explain the de novo methylation of these helices by the human DNA-(cytosine-5-)methyltransferase. Interestingly, the kinetics of repair of the 6-O-methylguanine-containing dinucleotides by the cloned human methylguanine methyltransferase appears to be largely determined by the strength of the stacking interaction between the 6-O-methylguanine and the 5' neighbouring base.

Interaction of oligonucleotides containing 6-O-methylguanine with human DNA (cytosine-5-)-methyltransferase [published erratumm appears in Biochemistry 1992 Aug 4;31(30):7008].

Thirty-base-pair synthetic oligonucleotide duplexes containing a single meG.C (meG = 6-O-methylguanine) or A.C base pair at the 16th position (i.e., 5'-CCCGTTTAAATATACXTATACCCGGGTACC-3', where X = A or meG) were used to study de novo methylation by the purified human DNA (cytosine-5)-methyltransferase isolated from CEM cells. Both duplexes containing meG.C and A.C base pairs show enhanced methyl group acceptor properties. Subsequent introduction of hemimethylated sites at the 15th position of the top strand (the C residue next to the abnormal base pair) and the 7th, 15th (which represents the C residue in the 6meG.C and A.C base pairs), and 27th positions of the bottom strand were used to study the maintenance methylation of the hemimethylated duplexes by the methylase. This revealed striking differences in the rate, amount, and sites of methylation, which are dependent on the position of the hemimethylated site in the duplex. The possible mechanism of action of the methylase is discussed. The data show that 6-O-methylguanine residues in DNA can have other genetic effects apart from their miscoding behavior and that meG.C and A.C base pairs exert different effects in terms of methylation.