Asthma admission among children in Hong Kong during the first year of the COVID-19 pandemic.

BACKGROUND: Multiple nonpharmaceutical interventions (NPIs) had been introduced in Hong Kong during coronavirus disease 2019 (COVID-19) pandemic. The impact on asthma admission, which was closely related to viral infection, was of concern. OBJECTIVE: The study aimed to identify the impact of NPIs on pediatric asthma admissions and their association with respiratory viruses. METHODS: We conducted a retrospective observational study to compare the difference in pediatric asthma hospital admission rates between pre-COVID-19 and COVID-19 periods. Information on demographics, nasopharyngeal specimen results, ventilatory support, intensive care admission, hospital stay duration, asthma control therapy, and previous admission episodes was collected. Weather parameters including temperature, rainfall, humidity, and air quality data that was reflected by the air quality health index were recorded. RESULTS: A total of 1808 pediatric asthma admissions were recorded during the pre-COVID-19 period while there were 62 admissions during COVID-19 period, among which 54 admissions from the pre-COVID-19 period and 4 admissions from COVID-19 period were excluded. Weekly pediatric asthma admissions per total pediatric admissions during COVID-19 was one-third of that during the pre-COVID-19 period (0.3% vs. 0.9%, p < 0.001). During COVID-19 period, a significantly lower percentage of respiratory virus isolates was noted (58.6% vs. 72.6%, p = 0.019). Poisson regression analysis showed that the COVID-19 period (odds ratio [OR] = 0.202, 95% confidence interval  [CI, 0.16-0.26]; p ≤ 0.001), summer vacation period (OR = 0.512, 95% CI [0.43-0.62]; p ≤ 0.001), and humidity (OR = 0.99, 95% CI [0.98-1.00]; p = 0.004) were independent protective factors for asthma admission. CONCLUSIONS: There was a significant reduction in pediatric asthma hospitalizations and respiratory virus isolates in the first year of COVID-19 pandemic in Hong Kong with the implementation of NPIs. Rhinovirus remained the key respiratory virus isolate. Incorporation of appropriate NPIs in long run could reduce virus infection-related pediatric asthma admission.

Mental health & maltreatment risk of children with special educational needs during COVID-19.

BACKGROUND: Children with special educational needs (SEN) are more vulnerable during the COVID-19 pandemic with risk of poor mental wellbeing and child maltreatment. OBJECTIVE: To examine the impact of COVID-19 on the mental health of children with SEN and their maltreatment risk. PARTICIPANTS AND SETTING: 417 children with SEN studying at special schools and 25,427 children with typical development (TD) studying at mainstream schools completed an online survey in April 2020 in Hong Kong during school closures due to COVID-19. METHOD: Emotional/behavioural difficulties, quality of life and parental stress of children with SEN were compared with typically developed children using mixed effect model. Linear regression analyses were performed to explore factors associated with child emotional/behavioural difficulties and parental stress during the pandemic. Chi-square test was performed to detect the differences in maltreatment risk before and during COVID-19. RESULTS: Children with SEN had significantly poorer overall quality of life (68.05 vs 80.65, p < 0.01). 23.5% of children had at least one episode of severe physical assault and 1.9% experienced very severe physical assault during COVID-19. Rates of physical assault increased significantly (59.8% vs. 71.2% p < 0.001) while children with mental disorders had increased risk of severe physical assault comparing to those without mental disorders (RR = 1.58, ꭓ2 = 5.19 p = 0.023). CONCLUSION: Children with SEN had poorer mental health than typically developed children during the COVID-19 pandemic. Maltreatment risk for children with SEN is higher in comparison to pre-COVID-19 era. Surveillance of child maltreatment, continuity of medical and rehabilitation care to support children with SEN are essential during a disease pandemic.

Infected pancreatic pseudocyst following severe dengue infection.

Severe dengue infection is life threatening as it can result in fatal complications such as intractable bleeding from coagulopathy, multiorgan failure from shock and haemophagocytic syndrome. There have been case reports of atypical manifestation of severe dengue infection such as pancreatitis, Guillian-Barre's syndrome, perforated viscus and myocarditis. However, to our knowledge, pancreatic pseudocyst from dengue-related pancreatitis has never been reported in the literature. We hereby report a case of infected pancreatic pseudocyst in a patient with persistent pyrexia, abdominal pain and raised inflammatory markers 10 weeks from the onset of severe dengue infection. Endoscopic ultrasound (EUS) guided transluminal drainage of the infected pancreatic pseudocyst with lumen-apposing metallic stent (LAMS) was performed with good clinical and radiological outcome.

Resistant hypertension during antituberculosis treatment: how is rifampicin implicated?

A 67-year-old mental institute resident was treated for smear-positive pulmonary tuberculosis. His background history included chronic essential hypertension which was well-controlled with amlodipine 10mg daily. However, his blood pressure became suboptimal one week into antitubercular treatment, necessitating escalation of antihypertensive therapy up to six medications. Following completion of antitubercular treatment, his blood pressure improved markedly. The number of antihypertensives was able to be reduced to only two after a month. We postulate that rifampicin has attenuated the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 but the failure to control the blood pressure even with medications unrelated to cytochrome P450 pathways raises the spectre of an additional interaction.

Immuno-oncology for surgeons.

Cancer has traditionally been treated with surgery, cytotoxic chemotherapy and/or radiotherapy. The focus of treatment has been the mutated neoplastic cell. Critical advances in genomic and molecular techniques herald the potential for personalized treatments. Incremental breakthroughs in immunology have translated to a step-change in care by providing a mechanistic understanding of the immune system and how it may be mobilized to target cancer cells. As a result, clinical trials of immune-modifying agents have increased at an exponential rate and are revolutionizing cancer care. It is increasingly likely that the surgical oncologist will find themself caring for patients who have had immuno-oncology therapies as part of their neoadjuvant or adjuvant treatment. This review provides an update on immuno-oncology for the surgeon, covering the mechanisms of action of the agents in use. Emerging and surgically relevant toxicities are discussed, and available data on combining and sequencing cancer surgery with immuno-oncology treatments are summarized.

El paradigma del tratamiento del cáncer está evolucionando rápidamente. Tradicionalmente, el cáncer se ha tratado con cirugía, quimioterapia citotóxica y/o radioterapia, pero el foco de atención de su tratamiento se ha polarizado en las mutaciones que dan lugar a la célula neoplásica. Los progresos fundamentales en las técnicas genómicas y moleculares han precedido a los tratamientos personalizados y fármacos dirigidos a dianas terapéuticas, pero los resultados de ensayos clínicos con dichos fármacos han sido en general decepcionantes. En los últimos años, los avances rigurosos y progresivos en inmunología se han traducido en un cambio sustancial en el tratamiento al proporcionar una comprensión mecanicista de cómo interviene el sistema inmune y cómo puede movilizarse mejor para atacar a las células cancerosas. Como resultado, las indicaciones y ensayos clínicos con fármacos modificadores del sistema inmune han aumentado a un ritmo exponencial y están revolucionando el tratamiento del cáncer. Por consiguiente, cada vez es más probable que los cirujanos oncólogos se encuentren tratando pacientes que recibirán terapias inmunooncológicas (immuno-oncology, IO) como parte de los tratamientos neoadyuvantes o adyuvantes. Esta revisión describe y proporciona una guía concisa y exhaustiva de la IO, abarcando los mecanismos de acción de los fármacos en uso. Se discuten las nuevas toxicidades con relevancia para la cirugía y se resumen los datos disponibles sobre la combinación y secuencia de la cirugía oncológica con los tratamientos IO.

Correction to: In utero exposure to gestational diabetes and adiposity: does breastfeeding make a difference?

In the original version of this article, the Publisher incorrectly listed the affiliation of the author, G.M. Leung. The correct affiliation for this author should be: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.

Observation of Anomalous Meissner Screening in Cu/Nb and Cu/Nb/Co Thin Films.

We have observed the spatial distribution of magnetic flux in Nb, Cu/Nb, and Cu/Nb/Co thin films using muon-spin rotation. In an isolated 50-nm-thick Nb film, we find a weak flux expulsion (Meissner effect) which becomes significantly enhanced when adding an adjacent 40 nm layer of Cu. The added Cu layer exhibits a Meissner effect (due to induced superconducting pairs) and is at least as effective as the Nb to expel flux. These results are confirmed by theoretical calculations using the quasiclassical Green's function formalism. An unexpected further significant enhancement of the flux expulsion is observed when adding a thin (2.4 nm) ferromagnetic Co layer to the bottom side of the Nb. This observed cooperation between superconductivity and ferromagnetism, by an unknown mechanism, forms a key ingredient for developing superconducting spintronics.

In utero exposure to gestational diabetes and adiposity: does breastfeeding make a difference?

BACKGROUND/OBJECTIVES: Short-term breastfeeding from mothers with gestational diabetes (GDM) may programme metabolism and increase offspring diabetes risk. We examined the association of in utero GDM exposure with adiposity from infancy to adolescence, and whether any association was modified by breastfeeding during early infancy. METHODS: In the prospective Chinese birth cohort "Children of 1997" (n = 7342, 88% follow-up rate), generalised estimate equations with multiple imputation were used to assess associations of in utero GDM exposure with age- and sex-specific body mass index (BMI) z-score during infancy (3 and 9 months), childhood (2- < 8 years) and adolescence (8-16 years), adjusted for sex, parity, maternal age, birth place, preeclampisa, smoking, and family socio-economic position. We also tested whether the associations differed by mode of infant feeding (always formula-fed, mixed, always breastfed) during the first three months of life. RESULTS: In utero GDM exposure (7.5%) was associated with a lower BMI z-score during infancy (-0.13, 95% confidence interval (CI) -0.22, -0.05) but higher BMI z-scores during childhood (0.14, 95% CI 0.03, 0.25) and adolescence (0.25 95% CI 0.11, 0.38). Breastfeeding for the first three months did not modify the association of in utero GDM status with subsequent BMI (all p values for interaction >0.4). CONCLUSIONS: In utero GDM exposure was associated with greater adiposity during childhood and adolescence. Breastfeeding in early infancy from mothers with GDM was not associated with greater adiposity in children and thus should still be encouraged.

Okur-Chung neurodevelopmental syndrome: Eight additional cases with implications on phenotype and genotype expansion.

Okur-Chung syndrome is a neurodevelopmental condition attributed to germline CSNK2A1 pathogenic missense variants. We present 8 unreported subjects with the above syndrome, who have recognizable dysmorphism, varying degrees of developmental delay and multisystem involvement. Together with 6 previously reported cases, we present a case series of 7 female and 7 male subjects, highlighting the recognizable facial features of the syndrome (microcephaly, hypertelorism, epicanthic fold, ptosis, arched eyebrows, low set ears, ear fold abnormality, broad nasal bridge and round face) as well as frequently occurring clinical features including neurodevelopmental delay (93%), gastrointestinal (57%), musculoskeletal (57%) and immunological (43%) abnormalities. The variants reported in this study are evolutionary conserved and absent in the normal population. We observed that the CSNK2A1 gene is relatively intolerant to missense genetic changes, and most variants are within the protein kinase domain. All except 1 variant reported in this cohort are spatially located on the binding pocket of the holoenzyme. We further provide key recommendations on the management of Okur-Chung syndrome. To conclude, this is the second case series on Okur-Chung syndrome, and an in-depth review of the phenotypic features and genomic findings of the condition with suggestions on clinical management.

Gate-opening upon CO2 adsorption on a metal-organic framework that mimics a natural stimuli-response system.

A dynamic metal-organic framework that consists of d-champhorate-based homochiral protuberant-grid-type networks can successively participate in gate-opening and closing processes for many cycles, which were triggered by the stimuli of the adsorption and desorption of CO2 to highly and specifically recognize CO2 over N2 and H2 with a high CO2 uptake of 90 mg g-1 under 35 bar at 298 K. It is highly thermally stable and the structure remains intact at least for ten reversible gate-opening and -closing processes. Thus, it is a potential candidate for industrial CO2 capture and facile release.

Perforated gastric ulcer in severe dengue infection: A case report.

Abdominal pain is one of the common presentations in severe dengue infection. We report a rare case of perforated gastric ulcer in a young man diagnosed with severe dengue infection and the challenges we faced in managing this patient. Perforated gastric ulcer need to be considered if there are signs of peritonitis and persistent abdominal pain that does not conform to the natural history of dengue. Proper imaging and early surgical intervention in perforated gastric ulcer is vital in preventing further complication and reducing the risk of mortality.

Infection associated haemophagocytic syndrome in severe dengue infection - a case series in a district hospital.

Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder resulting from uncontrolled hyperinflammatory response. There had been increase in cases of one of the secondary form of HLH, i.e., infectionassociated haemophagocytic syndrome (IAHS) in severe dengue in recent years. However, the condition remains under diagnosed due to lack of awareness compounded by the lack of validated diagnostic criteria. Severe hepatitis with prolonged cytopenias, severe hyperferritinemia, hypofibrinogenemia and persistent fever were evident in all four cases reported. All the subjects survived with supportive care and adjuvant steroid therapy. Prospective controlled studies are needed to develop diagnostic criteria and management protocol for IAHS in severe dengue.

Supplement of autologous ooplasm into porcine somatic cell nuclear transfer embryos does not alter embryo development.

Somatic cell nuclear transfer (SCNT) is considered as the technique in which a somatic cell is introduced into an enucleated oocyte to make a cloned animal. However, it is unavoidable to lose a small amount of the ooplasm during enucleation step during SCNT procedure. The present study was aimed to uncover whether the supplement of autologous ooplasm could ameliorate the oocyte competence so as to improve low efficiency of embryo development in porcine SCNT. Autologous ooplasm-transferred (AOT) embryos were generated by the supplementation with autologous ooplasm into SCNT embryos. They were comparatively evaluated with respect to embryo developmental potential, the number of apoptotic body formation and gene expression including embryonic lineage differentiation, apoptosis, epigenetics and mitochondrial activity in comparison with parthenogenetic, in vitro-fertilized (IVF) and SCNT embryos. Although AOT embryos showed perfect fusion of autologous donor ooplasm with recipient SCNT embryos, the supplement of autologous ooplasm could not ameliorate embryo developmental potential in regard to the rate of blastocyst formation, total cell number and the number of apoptotic body. Furthermore, overall gene expression of AOT embryos was presented with no significant alterations in comparison with that of SCNT embryos. Taken together, the results of AOT demonstrated inability to make relevant values improved from the level of SCNT embryos to their IVF counterparts.

Multidetector-row computed tomography (MDCT) findings of adnexal torsion: An analysis of 116 patients.

PURPOSE: The purpose of this study was to identify differences in multidetector-row computed tomography (MDCT) findings of adnexal torsion (AT) according to the anatomical subtypes and identify MDCT findings that may predict conservative treatment. MATERIALS AND METHODS: A total of 295 consecutive women with pelvic pain who underwent preoperative MDCT and subsequent surgery less than 24 h after admission were included in this retrospective study. Among them, 116 women (mean age: 33.9 years; range: 3-80 years) with histopathologically confirmed AT after surgery were included in the final analysis. RESULTS: On histopathological examination, an underlying ovarian mass was found in 98 women (98/116, 84.5%). In the group without ovarian mass (n=18), massive edema (12/18, 66.7% vs. 16/98, 16.3%; P<0.001) was frequently found. However, in the group with ovarian mass (n=98), twisted tube or pedicle (5/18, 27.8% vs. 55/98, 56.1%; P=0.027) and concentric or eccentric wall thickening (5/18, 27.8% vs. 82/98, 83.7%; P<0.001) demonstrated a statistically significant higher incidence. Based on the surgical and pathological results, the 116 women were classified into three subtypes including ovary-tubal (89/116, 77%), ovary only (22/116, 19%) and tubal only subtype (5/116, 4%). In the ovary-tubal subtype, tubal thickening (88/89, 98.9% vs. 11/22, 50.0%; P<0.001), twisted tube or pedicle (57/89, 64.0% vs. 3/22, 13.6%; P<0.001) and remaining tubal enhancement (52/89, 58.4% vs. 7/22, 31.8%; P=0.025) were more frequently observed than in the ovary only subtype. There was no significant difference between the relative frequency of imaging findings in the cystectomy group and adnexectomy group of the ovary-tubal type. CONCLUSIONS: Knowledge of common and characteristic MDCT findings of AT according to the anatomical subtypes is important to make accurate diagnosis and avoid delayed treatment.

Extraperitoneal ascending appendicitis: Usefulness of the split interfascial plane sign on MDCT.

PURPOSE: To retrospectively evaluate the multidetector computed tomography (MDCT) findings of extraperitoneal ascending appendicitis. MATERIALS AND METHODS: The MDCT examinations of 10 patients with extraperitoneal ascending appendicitis confirmed by laparoscopic surgery were retrospectively analyzed. Preoperative MDCT examinations were obtained after intravenous administration of iodinated contrast material in all patients. Transverse and coronal reformatted MDCT images were reviewed in consensus by two radiologists. The presence of the extraperitoneal triangle sign, the split interfascial plane sign, and the other classical findings of appendicitis were evaluated. RESULTS: Luminal dilatation, wall enhancement of the inflamed appendix, and fat infiltration were present in 10/10 patients (100%). The perforation of the inflamed appendix with abscess formation was present in 4/10 patients (40%). The split interfascial plane sign was present in 7/10 patients (70%), and parts of inflamed appendix or periappendiceal abscess were located behind the right extraperitoneal triangle in 8/10 patients (80%). CONCLUSION: The split interfascial plane sign and the presence of an appendiceal tip or periappendiceal abscess located in the right extraperitoneal triangle are highly suggestive of extraperitoneal ascending appendicitis on MDCT.

Multidetector-row computed tomography (MDCT) features of small bowel obstruction (SBO) caused by Meckel's diverticulum.

OBJECTIVES: To report the multidetector-row computed tomography (MDCT) findings of small bowel obstruction (SBO) caused by Meckel's diverticulum. MATERIALS AND METHODS: Ten patients (9 men and 1 woman; age range, 2-44 years; median age, 21years) with surgical proven Meckel's diverticulum who presented SBO on the preoperative MDCT were included in the study. RESULTS: On MDCT, all patients presented with SBO, either high-grade (n=6) or low-grade obstruction (n=4). Meckel's diverticulum was identified in five patients (n=5, 50%) on preoperative MDCT. In the five patients in whom a diverticulum was not seen on preoperative MDCT, MDCT showed a transition site on ileum with dilated proximal loops (n=3), pneumoperitoneum (n=1), jejuno-jejunal intussusception (n=1). Transition zone was located near midline in four patients (4/5, 80%). CONCLUSION: The diagnosis of Meckel's diverticulum complicated SBO can be made with certainty when the diverticulum is visualized on preoperative MDCT. However, the preoperative diagnosis is difficult if the Meckel's diverticulum is not noted on the MDCT. When the obstructive processes are visualized in the lower abdomen or pelvis, particularly near the midline, one should keep in mind that SBO may be caused by Meckel's diverticulum without prior surgical history.