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Background: Epidermolysis bullosa simplex (EBS) belongs to a group of inherited, mechanobullous disorders; one subtype is EBS Dowling—Meara (EBS-DM), which is the focus of this article. EBS-DM is characterized by painful skin blistering from minor friction, which evolves into chronic wounds. Objective: We describe the holistic nursing care of a child with EBS-DM in a tertiary outpatient dermatology clinic in Singapore. Methods: This case study highlights the clinical history, signs and symptoms, pathophysiology, nursing management, and patient education of a child with EBS-DM. Conclusion: The management of EBS-DM poses challenges in the absence of a definite cure. Patients with EBS-DM need individualized care, according to the severity of their disease. A multidisciplinary team approach of providing holistic care helps to maximize the health, outcome, and quality of life for these patients. [ABSTRACT FROM AUTHOR]

Objective:To determine if watching a children's program onaportablevideoplayerreducesanxietylevels inpreschool children before cryotherapy for cutaneous viral warts. Design: Nonblinded before-after trial. Setting: General dermatology clinic. Participants: Consecutive patients aged 2 to 6 years who underwent cryotherapy for cutaneous viral warts. Intervention: Patients were shown a children's program on a portable video player before cryotherapy. Main Outcome Measure: Mean score difference on the modified Yale Preoperative Anxiety Scale between children treated during the 10 weeks before vs the 10 weeks after the intervention was implemented. Results: Ninety-nine cryotherapy sessions performed among 35 children were evaluated. Fifteen children underwent cryotherapy during the preintervention phase only, and 13 children underwent cryotherapy during the intervention phase only. The mean modified Yale Preoperative Anxiety Scale scores were 58.4 during the preintervention phase and 37.7 during the intervention phase (P=.005). The percentages of children with a high anxiety score (⩾30) were 100% (15 of 15) during the preintervention phase and 38% (5 of 13) during the intervention phase (P<.001). Another 7 children underwent cryotherapy during both the preintervention and intervention phases. Their mean modified Yale Preoperative Anxiety Scale scores were 53.7 during the preintervention phase and 42.0 during the intervention phase (P=.03). The percentages of children with a high anxiety score were 86% (6 of 7) during the intervention phase and 43% (3 of 7) during the intervention phase (P=.25). In both groups, the time spent coaxing and treating children decreased after the intervention, but the differences were not statistically significant. Conclusion: The use of a portable video player significantly reduced preprocedural anxiety levels in preschool children undergoing cryotherapy for cutaneous viral warts. [ABSTRACT FROM AUTHOR]

Thalassemia can lead to severe transfusion-dependent anemia, and it is the most common genetic disorder in Malaysia. This paper aims to determine the prevalence of thalassemia in the Kadazandusuns, the largest indigenous group in Sabah, East Malaysia. α- and β-thalassemia were confirmed in 33.6% and 12.8%, of the individuals studied respectively. The high prevalence of α- and β-thalassemia in the Kadazandusuns indicates that thalassemia screening, genetic counseling, and prenatal diagnosis should be included as part of their healthcare system. This preliminary paper serves as a baseline for further investigations into the health and genetic defects of the major indigenous population in Sabah, East Malaysia. [ABSTRACT FROM AUTHOR]

Background: The interaction of the non-deletional α+-thalassaemia mutations Haemoglobin Constant Spring and Haemoglobin Quong Sze with the Southeast Asian double α-globin gene deletion results in non-deletional Haemoglobin H disease. Accurate detection of non-deletional Haemoglobin H disease, which is associated with severe phenotypes, is necessary as these mutations have been confirmed in the Malaysian population. Methods: DNA from two families with Haemoglobin H disease was extracted from EDTA-anticoagulated whole blood and subjected to molecular analysis for a-thalassaemia. A duplex polymerase chain reaction was used to detect the Southeast Asian a-globin gene deletion. Polymerase chain reaction-restriction fragment length polymorphism analysis was then carried out to determine the presence of Haemoglobin Constant Spring and Haemoglobin Quong Sze. A combine- amplification refractory mutation system protocol was optimised and implemented for the rapid and specific molecular characterisation of Haemoglobin Constant Spring and Haemoglobin Quong Sze in a single polymerase chain reaction. Results and Conclusions: The combine- amplification refractory mutation system for Haemoglobin Constant Spring and Haemoglobin Quong Sze, together with the duplex polymerase chain reaction, provides accurate pre- and postnatal diagnosis of non-deletional Haemoglobin H disease and allows detailed genotype analyses using minimal quantities of DNA. [ABSTRACT FROM AUTHOR]

Aim: Interactions between different determinants of α-thalassemia raises considerable problems, particularly during pregnancies where antenatal diagnosis is necessary. This study aims to determine the different types of deletional α-thalassemia and Hemoglobin Constant Spring (HbCS), and their frequency in Malays, Chinese and Indians in Malaysia. Methods: DNA from 650 pregnant women from the Antenatal Clinic of the University of Malaya Medical Center in Kuala Lumpur, Malaysia who showed mean cell volume ≤89 fL and/or mean cell hemoglobin ≤28 pg were analyzed for the double α-globin gene South-East Asian deletion (--SEA), the -α3.7 and -α4.2 single α-globin gene deletions and HbCS. Results: One hundred and three (15.8%) of the pregnant women were confirmed as α-thalassemia carriers: 25 (3.8%) were α-thalassemia-1 carriers with the --SEA/αα genotype, 64 (9.8%) were heterozygous for the -α3.7 rightward deletion (-α3.7/αα), four (0.6%) were heterozygous for the -α4.2 leftward deletion (-α4.2/αα), nine (1.4%) were heterozygous for HbCS (αCSα/αα) and one (0.2%) was compound heterozygous with the -α3.7/αCSα genotype. The double α-globin gene --SEA deletion was significantly higher in the Chinese (15%) compared to the Malays (2.5%) and not detected in the Indians studied. The -α3.7 deletion was distributed equally in the three races. HbCS and -α4.2 was observed only in the Malays. Conclusion: The data obtained gives a better understanding of the interactions of the different α-thalassemia determinants in the different ethnic groups, thus enabling more rapid and specific confirmation of α-thalassemia in affected pregnancies where antenatal diagnosis is necessary. [ABSTRACT FROM AUTHOR]

Molecular characterization of the compound heterozygous condition--[supG]γ([supA]γδΒ)[supo]/Β-thalassemia--in four families showing mild Β-thalassemia intermedia was carried out using DNA amplification techniques. Using the Amplification Refractory Mutation System (ARMS) to confirm the Β-mutations and DNA amplification to detect the 100-kb Chinese-specific [supG]γ([supA]γδΒ)[supo]-deletion, two families were confirmed to possess [supG]γ([supA]γδΒ)[supo]/&Beta-thalassemia with the IVSII No. 654 Β[sup+]-allele. In the third family, the [supG]γ([supA]γδΒ)[supo]-deletion was confirmed in the father and the mother was a Β-thalassemia carrier with the cd 41-42 Β[supo]-allele. Their affected child with [supG]γ([supA]γδΒ)[supo]/Β-thalassemia was found to be transfusion dependent. The same [supG]γ([supA]γδΒ)[supo]-deletion and Β-thalassemia (cd 41-42) was also confirmed in a fourth family. In addition, the mother was also diagnosed with Hb H disease (genotype-α[sup3.7]/[sup-SEA]). Both the children were found to possess [supG]γ([supA]γδΒ)[supo]/Β-thalassemia but they were not transfusion dependent and this could be due to co-inheritance of α-thalassemia-2 (genotype-α[sup3.7]/αα) in the children together with their compound heterozygous condition. [ABSTRACT FROM AUTHOR]

Dystrophinopathy is the commonest form of muscular dystrophy and comprises clinically recognized forms, Duchenne dystrophy and Becker dystrophy. Mutations in the dystrophin gene which consist of large gene deletions (65%), duplications (5%) and point mutations (30%) are responsible for reducing the amount of functional dystrophin protein in skeletal muscle fibres leading to fibre destruction and disease. The aims of this study are to investigate the detection rate, types and distribution of large gene deletions in Malaysian dystrophinopathy patients using the multiplex polymerase chain reaction (MPCR). MPCR of 18 "hot-spot deletion" regions along the dystrophin gene was performed on DNA from 48 muscle biopsy-confirmed cases of dystrophinopathy. A positive detection rate of 58% (28/48) was observed, where 84% (16/19) Indian, 35% (6/17) Chinese and 50% (6/12) Malay ethnic groups showed deletions in their dystrophin genes. The Malaysian Indians appear to have a higher prevalence for large gene deletions compared to the Chinese and Malays. Further analyses of 42 confirmed positive cases (present 28 plus previous 14 cases) by MPCR showed the majority of deletions were in the mid-distal region of the dystrophin gene (81% in exons 45-60). The MPCR is a specific and sensitive method for confirmation of gene deletions responsible for dystrophinopathy. [ABSTRACT FROM AUTHOR]