This paper reported two cases of congenital neuroblastoma of adrenal medulla origin. Of which one from a newly born baby with extensive metastasis besides a primary tumor lived only to 66 days. The other was found primarily in the adrenal medulla of a two-year old child with metastasis in multiple organs and in skull. In connection with these cases, the pathogenic character as well as histogenesis and causes of this tumor were analyzed and discussed.

Convincing evidence suggests that females and males are different in regard to susceptibility to both infectious and non-infectious diseases. Sex and gender influences the severity and outcome of several infectious diseases, including leptospirosis, tuberculosis, listeriosis, Q fever, avian influenza and SARS.

AIM: To assess the affect of ketamine and xylazine (ketamine/xylazine) to the transient lens opacity in mice.METHODS: Kimba mice (n=10) and wild-type mice (wt, n=8) were sedated with intraperitoneal injection of ketamine (60mg/kg for mice) and xylazine (10mg/kg) at 4, 8, 12 and 16 weeks old respectively. Pupils were dilated with tropicamide 25g/L alone to allow imaging lens status and retina using Spectralis HRA+OCT. RESULTS: All Kimba mice and wt presented extreme proptosis, suppression of the eye-blink reflex, corneal surface drying and lens opacities which occurred as early as 21±6 minutes after giving anesthesia and the lens opacities lasted up to 150±24 minutes.CONCLUSION: Ketamine/xylazine can cause transient lens opacity that may be related with the drugs side-effect.

Background: In the course of managing preterm labour, increasing trends of total white cell count raises concern for the obstetrician, suggesting a possible underlying infectious aetiology. Although mild leukocytosis is expected in pregnancy, the patterns of increment after corticosteroid administration are not well described beyond animal models and in a small number of human studies. Methods: Seventy-three consecutive patients who required antenatal corticosteroids for either preterm labour or prelabour caesarean section were recruited and given a standard course of 12mg dexamethasone phosphate, twelve hours apart. Venous blood samples were taken before administration, at six hours and 36 hours after the first dose of dexamethasone. Results: The total white count trend was 10.31±2.62 at baseline, 11.44±3.05 at six hours and 12.20±3.49 at 36 hours. Neutrophil-lymphocyte ratio was 3.60±1.31, 8.73±3.63 and 3.24±1.49 respectively, reflecting relative neutrophilia and lymphopenia which normalised by 36 hours. Conclusion: In contrast to previous studies, we found only a slight increment in total white cell count of about 10%. The marginal changes described in our study would not normally raise any clinical concern, although vigilance should be exercised if higher levels were observed.
Leukocytosis ; Pregnancy

BACKGROUND:The study aimed to determine the frequency of enoxaparin dosing errors for patients who had a measured emergency department (ED) weight compared to those who did not have a measured ED weight, and to determine if demographic variables (e.g., weight, height, age, English-speaking, race) impact the likelihood of receiving an inappropriate dose. METHODS:This is a retrospective, electronic chart review of patients who received a dose of enoxaparin in the ED between January 1, 2008 and July 1, 2013. We identified all patients >18 years who received a dose of enoxaparin while in the ED, were admitted, and had at least one inpatient weight within the first four days of hospitalization. Patients were excluded if they received enoxaparin for prophylaxis or a dose of more than 1.25 mg/kg. RESULTS:A total of 1,944 patients were included. Patients were more likely to experience an error if they did not have a measured ED weight. Over-doses of >10 mg were more likely to occur in patients without a measured ED weight. Patients with no documented ED weight or with a staff-estimated ED weight were more likely to experience a dosing error than those with a patient-stated weight. Patients were more likely to experience an error if their first inpatient weight was more than 96 kg, they were more than 175-cm tall, or were English speaking. CONCLUSION:Dosing errors are more likely to occur when patients are not weighed in the ED. Modifications to current workflows to incorporate weighing those patients who receive weight-dosed medications may be warranted.

In medicine, it is the physician's obligation to promote and protect the patient's interest. In obstetrics, the ethical principles of beneficence and autonomy provide the fundamental framework which guides the management of all pregnant patients. As there is the need for consideration of the fetus, autonomy can become a complex issue giving rise to what is sometimes called "maternal-fetal conflict." In this paper, we aim to discuss some scenarios we encounter in our day-to-day obstetric practice such as pre-eclampsia, fetal growth restriction and labour induction when the best interests of the mother and fetus may be conflicted. We hope to illustrate that logical consideration for maternal and fetal best interests is only possible when there is adequate knowledge to support clinical practice. Certainly, with the rapid availability of newer knowledge and technology, it is the duty of the physician to be educated continuously so as to protect the patient from harm.
Beneficence ; Clinical Competence ; Conflict (Psychology) ; Ethics, Medical ; Female ; Fetal Growth Retardation ; Fetus ; Health Knowledge, Attitudes, Practice ; Humans ; Maternal Welfare ; Maternal-Fetal Relations ; Obstetrics ; ethics ; methods ; Patient Care ; ethics ; Patient Rights ; Personal Autonomy ; Physician-Patient Relations ; ethics ; Pregnancy ; Pregnancy Complications ; Prenatal Diagnosis

INTRODUCTIONInfluenza A H1N1 (2009) pandemic has affected countries worldwide including Singapore. Data on obstetric outcomes of women with H1N1 (2009) in pregnancy are lacking.

MATERIALS AND METHODSThis was an observational study analysing the obstetric outcomes of pregnant women with influenza A H1N1 (2009) infection who had delivered at a viable gestation (24 weeks or more) in our centre.

RESULTSBetween 23 June 2009 and 30 September 2009, 235 pregnant women were diagnosed with influenza A H1N1 (2009) at our centre, with 42 having delivered and comprising the study cohort. Median age was 27.5 years (range, 16 to 42). Multiparous women comprised 59.5% (25/42) whilst 40.5% (17/42) were primiparous. In terms of ethnicity, 61.9% were Malays, 26.2% Chinese, 4.8% Indians and 7.1% Others. All women received oseltamivir. All had shown recovery from the acute influenza infection. There were no respiratory complications. Twenty-nine women (69.0%) delivered at term. Twenty-fi ve women (59.5%) had spontaneous labour whilst 15 (35.7%) had labour induction. Two women (4.8%) did not labour. Thirty-six women (85.7%) had vaginal delivery, of whom 3 were instrumental deliveries. Apgar scores of greater than 8 at 1 min and 5 min were documented in babies of 95.2% (40/42) women, respectively. Thirty-two women (76.2%) delivered babies with birthweights greater than 2500 g. Compared with historical data from 2008, the H1N1 cohort had comparable mean birthweight and average gestational age at delivery of 38 weeks.

CONCLUSIONOur study suggested that obstetric outcomes were not adversely affected by influenza A H1N1 (2009) infection.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Apgar Score ; Birth Weight ; Female ; Gestational Age ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; drug therapy ; epidemiology ; Obstetrics and Gynecology Department, Hospital ; Oseltamivir ; therapeutic use ; Outcome Assessment (Health Care) ; Pregnancy ; Pregnancy Complications ; Singapore ; Young Adult

In the study, we used oil palm residues (empty fruit bunch, EFB) as raw material to produce cellulosic ethanol by pretreatment, enzymatic hydrolysis and fermentation. Firstly, the pretreatment of EFB with alkali, alkali/hydrogen peroxide and the effects on the components and enzymatic hydrolysis of cellulose were studied. The results show that dilute alkali was the suitable pretreatment method and the conditions were first to soak the substrate with 1% sodium hydroxide with a solid-liquid ratio of 1:10 at 40 degrees C for 24 h, and then subjected to 121 degrees C for 30 min. Under the conditions, EFB solid recovery was 74.09%, and glucan, xylan and lignin content were 44.08%, 25.74% and 13.89%, respectively. After separated with alkali solution, the pretreated EFB was washed and hydrolyzed for 72 h with 5% substrate concentration and 30 FPU/g dry mass (DM) enzyme loading, and the conversion of glucan and xylan reached 84.44% and 89.28%, respectively. We further investigated the effects of substrate concentration and enzyme loading on enzymatic hydrolysis and ethanol batch simultaneous saccharification and fermentation (SSF). The results show that when enzyme loading was 30 FPU/g DM and substrate concentration was increased from 5% to 25%, ethanol concentration were 9.76 g/L and 35.25 g/L after 72 h fermentation with Saccharomyces cerevisiae (inoculum size 5%, V/V), which was 79.09% and 56.96% of ethanol theory yield.
Alkalies ; chemistry ; Biofuels ; Ethanol ; metabolism ; Fermentation ; Lignin ; chemistry ; Palm Oil ; Plant Oils