The family physician has the monumental task of deciding if a pediatric patient can be treated as an outpatient or needs to be referred to the hospital for further acute care. Some common conditions that may be discharged without referral include the stable child with a minor head injury and balanitis. Others may be complicated by decompensated gastroenteritis or serious bacterial infections such as unstable pneumonia and urinary tract infection in the very young. The younger the child, the more subtle the signs and symptoms are. There is also a higher incidence of congenital conditions like pyloric stenosis in the very young that are unique in this population group. This article summarises such conditions with helpful hints on recognition of abnormal vital signs, and seeks to act as a guide to assist the family physician who may face these patients in his daily practice.

The family physician has the monumental task of deciding if a pediatric patient can be treated as an outpatient or needs to be referred to the hospital for further acute care. Some common conditions that may be discharged without referral include the stable child with a minor head injury and balanitis. Others may be complicated by decompensated gastroenteritis or serious bacterial infections such as unstable pneumonia and urinary tract infection in the very young. The younger the child, the more subtle the signs and symptoms are. There is also a higher incidence of congenital conditions like pyloric stenosis in the very young that are unique in this population group. This article summarises such conditions with helpful hints on recognition of abnormal vital signs, and seeks to act as a guide to assist the family physician who may face these patients in his daily practice.

Aims: The aim of this study was to investigate the genetic relatedness of the most prevalent Candida bloodstream infection (BSI) species in in a Malaysian population via Randomly Amplified Polymorphic DNA-Polymerase Chain Reaction (RAPD-PCR) fingerprinting. Methodology and results: The genomic DNA of 43 Candida BSI blood culture samples obtained from Universiti Malaya Medical Centre (UMMC) was isolated, after which species identification was carried out using PCR with ITS-1 and ITS-4 pan-fungal primers in conjunction with CHROMagar™ Candida. The predominant Candida species in the BSI samples is Candida albicans (14 out of 43 isolates). RAPD-PCR on these 14 C. albicans clinical isolates was performed using PST as the arbitrary primer. Data analysis using MEGA found an overall non-relatedness of these 14 clinical isolates [average similarity coefficient (SAB) value 0.733±0.172]. Following in-depth analysis, five of the 14 isolates were observed to be identical (SAB values of 1.00 each), four isolates had SAB values of 0.80-0.99, indicating that they are highly similar, but are non-identical, while five isolates are unrelated (SAB lower than 0.80). This suggests that microevolution might have occurred and that these clinical isolates may possibly belong to different strains. Conclusion, significance and impact of study: A fair degree of genetic heterogeneity was found among the 14 C. albicans isolates from UMMC. To our knowledge, this is the first report on the genetic profiles of C. albicans bloodstream infection isolates from Malaysia, warranting further studies in the possible evolutionary trends within this Candida species in Malaysia. Keywords: Randomly Amplified Polymorphic DNA PCR (RAPD-PCR), Candida albicans, Candida bloodstream infections, Genetic relatedness, DNA fingerprinting
Candida albicans

Trauma is a major cause of death, and haemorrhage represents an important target for improving outcomes after severe injury. Volume replacement with crystalloids in resuscitation might become harmful in large amounts because of coagulopathy. A fine balance must be achieved between haemodynamic and haemostatic resuscitation. Permissive hypotension refers to permitting some degree of hypotension in such adult patients in an attempt to attain this fine balance. For patients who require a significant volume of blood product resuscitation, the term 'massive transfusion protocol' (MTP) is used. There is very little data on transfusion protocols for paediatric trauma patients, and children respond to hypovolemic shock in a different physiological manner compared to adults. Hence, concepts such as permissive hypotension may not be appropriate when treating children involved in major trauma. We recently embarked on a plan to streamline the management of blood transfusion in massive bleeding during paediatric trauma, to reduce the logistical problems associated with the transport of blood products from the blood bank to the patient. From this, we evolved a MTP for paediatric major trauma. Nonetheless, further studies will be needed to see if there is indeed improved outcome after MTP in paediatric major trauma as current evidence is extrapolated from adult studies.
Adult ; Blood Coagulation Disorders ; complications ; therapy ; Child ; Clinical Protocols ; Evidence-Based Medicine ; Fluid Therapy ; standards ; Humans ; Injury Severity Score ; Resuscitation ; methods ; Wounds and Injuries ; complications ; therapy

After-Hours Care ; Attitude of Health Personnel ; Attitude to Health ; Child ; Cross-Sectional Studies ; Emergency Service, Hospital ; utilization ; Humans ; Medical Overuse ; Parents ; Pediatrics ; Primary Health Care ; Singapore ; Surveys and Questionnaires

INTRODUCTIONToy-related injuries, a common reason for emergency department visits in the paediatric population, constitute a significant health burden in Singapore. Although government regulations imposed on toys and childcare-related items are in place, parents and caregivers still play a pivotal role in ensuring toy safety in children. We hypothesised that deficiencies in knowledge surrounding toy safety issues exist in our adult population.

METHODSWe conducted a cross-sectional questionnaire study at KK Women's and Children's Hospital, Singapore, to examine the current attitudes, knowledge and practices of the local population regarding toy safety. Hypothetical questions on toy selection were included in the questionnaire to assess respondents' ability to identify appropriate toys and discern potentially dangerous toys for a specified age group.

RESULTSThe scores of the 93 respondents showed that they were less able to identify appropriate toys for children in the 1-2 years (66.7%; 95% confidence interval [CI] 61.4%-72.0%) and 2-3 years age groups (69.9%; 95% CI 65.5%-74.3%) than for children in the 0-1 year (82.8%; 95% CI 79.9%-85.7%) and 3-5 years age groups (85.2%; 95% CI 81.2%-89.2%). Our survey also identified key areas for improvement (e.g. educational efforts and government regulation) in current practices in order to attain a higher level of toy safety.

CONCLUSIONOur study highlights the current knowledge deficit in toy safety issues and the need for improvements in regulation, education and surveillance in order to minimise the risk of toy-related injuries in children.

Adult ; Age Factors ; Child ; Child Welfare ; Child, Preschool ; Confidence Intervals ; Consumer Product Safety ; Cross-Sectional Studies ; Female ; Humans ; Incidence ; Needs Assessment ; Play and Playthings ; injuries ; Singapore ; Surveys and Questionnaires ; Wounds and Injuries ; etiology ; physiopathology

INTRODUCTION: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. METHODS: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). RESULTS: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020. CONCLUSION Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.
Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Disease Outbreaks ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Patient Acceptance of Health Care/statistics & numerical data* ; Patient Admission/trends* ; Pediatrics ; Retrospective Studies ; Severe Acute Respiratory Syndrome/epidemiology* ; Singapore/epidemiology*

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Attention Deficit Disorder with Hyperactivity ; diagnosis ; drug therapy ; therapy ; Caregivers ; Child ; Evidence-Based Medicine ; Humans ; Methylphenidate ; therapeutic use ; Parents ; Psychiatry ; methods ; standards ; Singapore ; Societies, Medical

Aedes ; Animals ; Female ; Humans ; Microcephaly ; epidemiology ; Pregnancy ; Pregnancy Complications, Infectious ; epidemiology ; therapy ; Public Health ; Zika Virus ; Zika Virus Infection ; epidemiology ; therapy ; transmission

Healthcare delivery is moving towards a more personalised and patient-centric approach. There is now an appropriate emphasis on providing value in our healthcare system. Patient-reported outcome measures (PROMs) assess our patients' perceptions of the status of their health and quality of life, measured over a period of time. PROM is an integral component of a value-driven and value-based healthcare system and is key if we want to practise value-based medicine. In paediatrics and child health, PROMs, if implemented well with appropriate measurement tools that are regularly updated and validated in a self-learning healthcare ecosystem, will help to enhance personalised healthcare delivery and collectively improve the health of the community at large. This review covers the role of PROMs in paediatrics, as well as their role in value-based medicine.
Humans ; Child ; Quality of Life ; Ecosystem ; Delivery of Health Care ; Patient Reported Outcome Measures ; Pediatrics