Congenital arhinia is one of the rare craniofacial malformation that may cause severe respiratory distress at birth due to upper airway obstruction. Our patient, whose abnormalities were only detected after delivery in our centre, is the first reported case of congenital arhinia in Malaysia. Contrary to popular belief that neonates are obligate nasal breather, our patient adapted well to breathing through mouth before an elective tracheostomy was performed on day four of life.
Nose

A 5-year-old girl presented with three brief episodes of afebrile seizure within 24 hours. There was no significant past medical history but she had symptoms of acute gastroenteritis for the past 2 days. She was mildly dehydrated with no neurological signs. Serum electrolytes and blood sugar were normal and cerebrospinal fluid examination was negative for meningoencephalitis. Contrast-enhanced CT Brain showed no evidence of intracranial lesion, haemorrhage or meningeal enhancement. Only stool investigation was positive for Rotavirus. The conclusion of Benign Afebrile Convulsion with gastroenteritis (CwG) was established after excluding other serious causes of afebrile seizure in children.

We report a case of benign transient hyperphosphatasaemia (BTH) which was noted incidentally when the patient was admitted for acute tonsillitis. Blood result showed alkaline phosphatase (ALP) at admission was markedly elevated with value of 2481 U/L [normal range 34 – 104 U/L]. He had no history or physical findings to suggest liver or bone disease. Various blood and radiographic investigations were performed to determine the cause but results were normal. He was followed-up with repeat blood test and the alkaline phosphatase normalised after 42 days.

We describe here an infant girl with ductal dependent complex cyanotic heart disease, who required prostaglandin infusion for a total of five months prior to Blalock-Taussig shunt procedure. Her alkaline phosphatase activity was raised after seven weeks being on prostaglandin and only dropped to the normal range seven days after discontinuing prostaglandin infusion. During our review at five months old, her limbs were grossly swollen and radiographic examination showed dense periosteal reaction in the long bones. Based on the clinical findings and investigations, she was diagnosed to have cortical hyperostosis, which is an uncommon side effect of prostaglandin. She underwent right Blalock-Taussig Shunt procedure successfully with no major complications. Unfortunately, she succumbed to infection two months after surgery.

Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory.
Ambulatory Care/methods* ; COVID-19/prevention & control* ; Home Care Services ; Hospitalization ; Humans ; Infection Control/methods* ; Pandemics ; Peritoneal Dialysis/methods* ; Self Care/methods* ; Singapore/epidemiology*