Introduction: β-Thalassemia is genetic disorder which clinically presents as anaemia due to decreased production of beta-chains of haemoglobin molecule. Literature on oro-facial manifestations, oral health status is sparse and inconclusive in the β-thalassemia major patients (TM). Methods: This cross-sectional study was done to assess oro-facial manifestations of β-Thalassemia. 31 TM patients in the age group of 6-18 years were clinically examined and oro-facial manifestations were recorded. Oral health status including oral hygiene status, dental caries, gingival status of these TM children was compared with 42 healthy children. The mean values were compared using Student’s t-test. Treatment needs of both the groups were recorded using WHO oral health assessment form. Results: Lip incompetence (38.75%) and maxillary protrusion (19.35%) were most common oro-facial manifestations of Thalassemia major. Mean OHI-S score for TM and healthy children were comparable 1.73 ± 1.10 and 1.36 ±1.17 respectively (p=.178) but mean GI score for TM was higher than healthy children, 1.42±.39 and .94±.51 respectively (p<.05). Mean DMFT scores for TM and healthy children were 1.5±1.8 and 1.2±2.1 respectively (p=.578). Treatment needs was relatively higher among TM children with 58% of these children requiring one surface filling. Conclusion: Lip incompetence followed by maxillary protrusion were most common oro-facial manifestations of Thalassemia major. There is no significant association between oral hygiene and dental caries with Thalassemia major. However, thalassemia major is associated with gingivitis. Treatment requirement was relatively higher among TM children with one surface filling being the commonest need.

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.

Summary Dilated pore of Winer is a benign adnexal tumour of follicular differentiation. It has typical clinical feature of asymptomatic, solitary enlarged pore with a keratin plug. Dermoscopy offers further assistance in diagnosis. In this case on dermoscopy, well defined lamellated central blackish area arranged in concentric circles, surrounded by a bluish grey halo was seen with a rim of hyperpigmentation.
Dermoscopy

Background: As the number of patients getting tattooed is increasing, so is the number of patients seeking removal of tattoos. The primary objective of this study was to assess the reasons as to why patients got tattoos and also seek tattoo removal. The secondary objective was to study the demographics and the knowledge they had regarding tattoo removal. Methods: A cross sectional study was done among 250 consecutive patients who attended the Dermatology centre seeking tattoo removal. A questionnaire was used to fill in the details. Results: 167 males and 83 females were included in the study. Majority of patients were in the age group of 21 to 30 years (43.8%) followed by 31-40 years (26.7%). 56.6% of patients had got tattoos in the third decade and 35.1% in the second decade. 52.6% of those seeking tattoo removal had got their tattoos from amateur artists, village fairs or roadside tattoo shops. 45.8% did not have a specific reason for getting a tattoo and were decorative tattoos. 34.7% had names of their beloved or family members. 29.5% were seeking removal for professional reasons and 23.1% due to changes in relationship status. Conclusion Patients seek tattoo removal mainly for professional reasons, changes in personal relationships when they have name tattoo and due to complications. Most of the patients were in the third decade of life. It is important to educate school going children ang youngsters regarding the permanent nature of tattoo and its complications.
Tattooing ; Laser Therapy

Summary Trichorrhexis nodosa (TN) is a hair shaft disorder characterized by fragile hair with nodes on the hair shaft. Here we report a case of aquired localised trichorrhexis nodosa and describe the importance of noninvasive tools like trichoscopy and light microscopy in the diagnosis of an isolated TN.
Hair Diseases--diagnosis

Nocardia species are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia species occur as a result of local trauma and contamination of the wound. Clinically, it may manifest as an acute infection (abscesses or cellulitis), mycetoma, or sporotrichoid infection. Herein we report a rare case of cutaneous nocardiosis following surgery mimicking a hypertrophic scar.

The widespread use of microsurgery in numerous surgical fields has increased the need for basic microsurgical training outside of the operating room. The traditional start of microsurgical training has been in undertaking a 5-day basic microsurgery course. In an era characterised by financial constraints in academic and healthcare institutions as well as increasing emphasis on patient safety, there has been a shift in microsurgery training to simulation environments. This paper reviews the stepwise framework of microsurgical skill acquisition providing a cost analysis of basic microsurgery courses in order to aid planning and dissemination of microsurgical training worldwide.
Costs and Cost Analysis* ; Delivery of Health Care ; Education ; Microsurgery* ; Mortuary Practice ; Operating Rooms ; Patient Safety

Microsurgery training in Singapore began in 1980 with the opening of the Experimental Surgical Unit. Since then, the unit has continued to grow and have held microsurgical training courses biannually. The road to becoming a full-fledged reconstructive surgeon requires the mastering of both microvascular as well as flap raising techniques and requires time, patience and good training facilities. In Singapore, over the past 2 decades, we have had the opportunity to develop good training facilities and to refine our surgical education programmes in reconstructive microsurgery. In this article, we share our experience with training in reconstructive microsurgery.
Education ; Microsurgery* ; Singapore*