We report the case of an infant who was found dead in the toilet of a nursery. Examination of the scene revealed an element of neglect in the care of the child. Postmortem showed evidence of drowning. Her blood sample showed a toxicologic evidence of alcohol exposure.
*Accidents ; *Child Abuse ; Drowning/*etiology ; Nurseries/legislation & jurisprudence ; Singapore

Clonal disorders of LGL may either be CD3+ CD56- or CD3- CD56+ phenotype and these have been designated as T-cell leukaemia (T-LGL) or natural killer cell (NK)-LGL leukaemia respectively. Clonality is usually demonstrated by clonal rearrangement of T-cell receptor gene rearrangement or identified by flowcytometry analysis. Most patients with T-LGL will have an indolent course. In this report we described an aggressiveness of disease in a patient with clonal CD3+ LGL leukaemia whose cells also co-expressed CD56 diagnosed by flowcytometry. The patient responded well to interrupt ALL standard risk protocol however succumbed to her disease while waiting for upfront stem cell transplant. This case highlights on both the classical laboratory findings of rare entity of disease as well as a review of the literature pertaining particularly on its management.

A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.

A 42-year-old Malay gentleman presented with progressive painless blurring of vision on his left eye associated with ocular ache, redness and increasing proptosis. Examination revealed presence of relative afferent papillary defect with visual acuity of counting finger, and 6/6 on the right eye. Extraocular muscle movement of the left eye was restricted to ten percent in all directions. Computed tomography (CT) and magnetic resonance imaging (MRI) showed enhancing mass occupying the left orbital apex. Diagnosis of optic nerve sheath meningioma was made, and patient subsequently went for radiotherapy. His symptoms subsided completely, until he presented with similar visual complains, and fullness of the upper lid two years later. A repeated MRI showed enlargement of superior and lateral recti muscles with extension to lacrimal gland region. Biopsy of the lacrimal gland revealed inflammatory cells consistent of inflammatory pseudotumor. High dose systemic steroid was instituted, followed by slow tapering of oral steroid. His symptoms completely resolved, and latest visual acuity was 6/9, with no recurrence, to date.

Plasma cell leukaemia (PCL) is a rare form of malignant plasma cell dyscrasia. It can occur as a primary form without prior evidence of multiple myeloma or as a secondary form which is a terminal event in multiple myeloma. It is characterised by a proliferation of plasma cells in blood and the bone marrow. The outcome of plasma cell leukemia is poor with conventional therapy. Here we illustrate a case of primary plasma cell leukemia complicated by para plegia. The patient initially responded to combination chemotherapy but succumbed to the disease two months after presentation

Haemoglobinopathies presenting with erythrocytosis is relatively rare. The clinicians might mistakenly diagnose such patients with other causes of erythrocytosis such as myeloproliferative neoplasm, etc instead of haemoglobinopathies. Here, we described two cases of haemoglobin variant, namely Haemoglobin Johnstown (Hb Johnstown) and Haemoglobin Bethesda (Hb Besthesda) that were detected following various futile investigations for persistent erythrocytosis. For both cases, the two main screening methods used were capillary electrophoresis (CE) and high performance liquid chromatography (HPLC). Approximately 30% of the high affinity haemoglobin (Hb) are not detected by electrophoresis method, however, in some cases, a variant Hb peak can be seen in chromatography method. Thus, a high index of suspicion of such diagnosis is utmost important as to not to miss the definitive diagnostic test by DNA analysis.