4.Enteric Fever in a Tertiary Paediatric Hospital: A Retrospective Six-Year Review.
Nur Adila Ahmad HATIB ; Chia Yin CHONG ; Koh Cheng THOON ; Nancy Ws TEE ; Subramania S KRISHNAMOORTHY ; Natalie Wh TAN
Annals of the Academy of Medicine, Singapore 2016;45(7):297-302
INTRODUCTIONEnteric fever is a multisystemic infection which largely affects children. This study aimed to analyse the epidemiology, clinical presentation, treatment and outcome of paediatric enteric fever in Singapore.
MATERIALS AND METHODSA retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records.
RESULTSOf 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries.
CONCLUSIONEnteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.
Adolescent ; Anemia ; epidemiology ; Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; Drinking Water ; Drug Resistance, Multiple, Bacterial ; physiology ; Enterocolitis ; epidemiology ; Female ; Food Contamination ; Health Education ; Hospitals, Pediatric ; Humans ; India ; Indonesia ; Infant ; Malaysia ; Male ; Paratyphoid Fever ; drug therapy ; epidemiology ; microbiology ; Pericardial Effusion ; epidemiology ; Retrospective Studies ; Salmonella paratyphi A ; physiology ; Salmonella typhi ; physiology ; Shock ; epidemiology ; Singapore ; epidemiology ; Tertiary Care Centers ; Travel ; Typhoid Fever ; drug therapy ; epidemiology ; microbiology ; prevention & control ; Typhoid-Paratyphoid Vaccines ; therapeutic use
5.Risk Factors for Complicated Influenza A (H1N1) 2009 Disease in Children.
Chia Yin CHONG ; Natalie Wh TAN ; Anita MENON ; Koh Cheng THOON ; Nancy W S TEE ; Sheng FU
Annals of the Academy of Medicine, Singapore 2013;42(5):232-236
INTRODUCTIONSingapore had its first case of pandemic influenza A (H1N1) 2009 on 26 May 2009. As of 3 August 2009, 440 children with confirmed H1N1were admitted to KK Women's and Children's Hospital (KKH).
MATERIALS AND METHODSThis is a retrospective case control study of children admitted from 26 May 2009 to 19 July 2009 with H1N1infection. Cases and controls were first differentiated by whether they were complicated or non-complicated in nature, and subsequently analysed with regards to possible independent risk factors.
RESULTSWe analysed 143 admitted children; 48 cases and 95 controls (1: 2 ratio). Significant comorbidity was found in 20.3% (n = 29) of patients with the majority having asthma (n = 18, 12.6 %) followed by obesity (n = 7, 4.9%). Binary logistic regression analysis showed risk factors for complicated disease were comorbidity (adjusted OR 6.0, 95% CI, 2.5 to 14.6, P < 0.0001) and age <2 years (adjusted OR 9.8, 95% CI, 2.4 to 40, P = 0.001). Age less than 5 years was not found to be a risk factor.
CONCLUSIONIn the early stages of an evolving influenza epidemic when oseltamivir stocks are low, oseltamivir treatment for influenza can be streamlined and offered to those at highest risk who are under 2 years old or have significant comorbidity to prevent complicated disease.
Adolescent ; Age Factors ; Antiviral Agents ; therapeutic use ; Asthma ; complications ; Bronchitis ; complications ; Case-Control Studies ; Child ; Child, Preschool ; Cohort Studies ; Female ; Fluid Therapy ; Gastritis ; virology ; Gastroenteritis ; virology ; Humans ; Infant ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; complications ; Male ; Obesity ; complications ; Oseltamivir ; therapeutic use ; Pneumonia, Bacterial ; complications ; Retrospective Studies ; Risk Factors ; Seizures ; complications ; Singapore
6.Risk Factors for Severe Adenovirus Infection in Children during an Outbreak in Singapore.
Veena RAJKUMAR ; Cheryl S M CHIANG ; Jia Meng LOW ; Lin CUI ; Raymond T P LIN ; Nancy W S TEE ; Matthias MAIWALD ; Chia Yin CHONG ; Koh Cheng THOON ; Natalie W H TAN
Annals of the Academy of Medicine, Singapore 2015;44(2):50-59
BACKGROUNDHuman adenoviruses (HAdVs) can cause a variety of human illnesses, with associated temporal and geographic changes in disease incidence. We report the emergence of an outbreak of HAdV infections in Singapore, presumably caused by a change of the predominating type to HAdV-7. We examined the clinical features of children admitted with HAdV infection to 1 institution and the risk factors for severe infection.
MATERIALS AND METHODSThis is a retrospective case-control study of all HAdV-infected children admitted during weeks 1 to 19 in 2013, as identified from laboratory records. A descriptive retrospective analysis of epidemiology, clinical data and the outcome of these children was also performed. Patients with severe infections were defined as cases, those with non-severe infections as controls, and the 2 groups were compared to find possible independent risk factors.
RESULTSEighty-five patients with HAdV infection were studied, including 11 (12.9%) cases and 74 (87.1%) controls. Binary logistic regression showed that cases were more likely to be <2 years old (adjusted OR 10.6, 95% CI, 1.8 to 63.2) and to have significant comorbidities (adjusted OR 19.9, 95% CI, 3.4 to 116.1) compared to controls. The predominant type in 2013 was HAdV-7, which differed from 2011 and 2012, when HAdV-3 was more common. There was a trend towards pneumonia being more common in patients infected with HAdV-7 than in patients infected with other types, although this did not reach statistical significance (OR 2.8, 95% CI, 0.9 to 8.7).
CONCLUSIONThe emergence of HAdV-7 in a population where other HAdV types had circulated previously may have caused the outbreak in Singapore, and this was associated with more serious infections in children. Young age (<2 years) and significant comorbidities were associated with more severe HAdV infection.
Adenoviridae Infections ; epidemiology ; virology ; Adenoviruses, Human ; genetics ; pathogenicity ; Adolescent ; Case-Control Studies ; Child ; Child, Preschool ; Comorbidity ; Disease Outbreaks ; Female ; Humans ; Immunocompromised Host ; Infant ; Male ; Retrospective Studies ; Severity of Illness Index ; Singapore ; epidemiology
7.Zika Virus: An Evolving Public Health Threat.
Chee Fu YUNG ; Chia Yin CHONG ; Kee Thai YEO ; Christina LIEW ; Lee Ching NG ; Natalie Wh TAN ; George Sh YEO ; Nancy Ws TEE ; Raymond Tp LIN ; Thiam Chye TAN ; Victor S RAJADURAI ; Jerry Ky CHAN ; Koh Cheng THOON
Annals of the Academy of Medicine, Singapore 2016;45(4):148-151
8.Multimodal prehabilitation before major abdominal surgery: A retrospective study.
Ning Qi PANG ; Stephanie Shengjie HE ; Joel Qi Xuan FOO ; Natalie Hui Ying KOH ; Tin Wei YUEN ; Ming Na LIEW ; John Peter RAMYA ; Yijun LOY ; Glenn Kunnath BONNEY ; Wai Kit CHEONG ; Shridhar Ganpathi IYER ; Ker Kan TAN ; Wan Chin LIM ; Alfred Wei Chieh KOW
Annals of the Academy of Medicine, Singapore 2021;50(12):892-902
INTRODUCTION:
Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme.
METHODS:
Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation.
RESULTS:
There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay (
CONCLUSION
The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.
Humans
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Postoperative Complications/prevention & control*
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Preoperative Care
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Preoperative Exercise
;
Prospective Studies
;
Retrospective Studies
9.Multisystem inflammatory syndrome in children in Singapore.
Karen Donceras NADUA ; Chia Yin CHONG ; Kai Qian KAM ; Yee Hui MOK ; Jonathan Tze Liang CHOO ; Joyce Ching Mei LAM ; Jiahui LI ; Natalie Woon Hui TAN ; Chee Fu YUNG ; Su Wan Bianca CHAN ; Kai Liang TEH ; Lena DAS ; Thaschawee ARKACHAISRI ; Koh Cheng THOON
Annals of the Academy of Medicine, Singapore 2022;51(11):669-676
INTRODUCTION:
Multisystem inflammatory syndrome in children (MIS-C) is a rare inflammatory syndrome with multisystem involvement affecting children exposed to COVID-19. This condition is rarely reported in East Asia and was not detected in Singapore until 2021. We present 12 cases of MIS-C diagnosed in KK Women's and Children's Hospital (KKH) from October 2021 to December 2021.
METHOD:
We conducted an observational study on cases fulfilling the Singapore Ministry of Health criteria for MIS-C from January 2020 to December 2021 in KKH. Medical records were reviewed to obtain information on clinical presentation, disease course, treatment received and outcomes.
RESULTS:
In the 12 cases detected, the median age was 7.50 years (interquartile range 4.00-9.25); 8 were male. All patients had mucocutaneous symptoms similar to Kawasaki disease. Other commonly involved systems were: haematological (coagulopathy 100%, lymphopaenia 91.70% and thrombocytopaenia 75.00%), gastrointestinal (75.00%) and cardiovascular (83.30%). Six patients (50.00%) had shock and were admitted to the intensive care unit. The majority of patients received treatment within 2 days of hospitalisation with intravenous immunoglobulin (IVIg) and steroids. All survived; the majority had normal echocardiograms and no long-term organ sequelae at 6 months post-discharge.
CONCLUSION
MIS-C emerged in Singapore as the incidence of COVID-19 in the community increased in 2021. The clinical presentation of our patients is similar to earlier reports, with some significant differences from Kawasaki disease. Multidisciplinary management, timely diagnosis, and early initiation of treatment with IVIg and steroids likely contributed to comparatively good outcomes. Our cases highlight the need for continued awareness of MIS-C among physicians, and surveillance of its incidence, short- and long-term outcomes.
Child
;
Humans
;
Female
;
Male
;
COVID-19/epidemiology*
;
Mucocutaneous Lymph Node Syndrome
;
Immunoglobulins, Intravenous/therapeutic use*
;
Aftercare
;
Singapore/epidemiology*
;
Patient Discharge
10.Angiotensin receptor-neprilysin inhibitor improves New York Heart Association class and N-terminal-pro B-type natriuretic peptide levels: initial experience in a Singapore single-centre cohort.
Natalie KOH ; Vera Jin-Ling GOH ; Chee Kiang TEOH ; Jin Shing HON ; Louis Loon Yee TEO ; Choon Pin LIM ; David SIM
Singapore medical journal 2021;62(7):359-361