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This study investigates how peer influence, school attachment, and substance abuse are related to sexual behavior, with particular interest in exploring the relationship between substance abuse and sexual misconduct, while using a stratified random sample of adolescents in Macau. Mediation analyses were employed. The results show that substance abuse, apart from susceptibility to peer influence and school attachment/commitment, was significantly related to sexual misconduct. Substance abuse was the best predictor of sexual misconduct, and it significantly mediated the relationship between susceptibility to peer influence, as well as school attachment and sexual misconduct. This reflects that the use of substances, including drugs, alcohol, and cigarettes, can be viewed as a catalyst for triggering engagement in sexual misconduct. The implications of this study involve taking measures to reduce the rate of substance abuse as a way of decreasing sexual misconduct in adolescents. Future research directions in exploring the relationship between adolescent substance abuse and risky sexual behavior are discussed.

This study examined the psychometric properties of the Chinese Post-Traumatic Growth Inventory among Hong Kong chronic disease patients. Using a cross-sectional design and multistage stratification sampling, 265 chronic disease patients were recruited from a selection of non-governmental organizations and patient self-help groups across Hong Kong. The Chinese Post-Traumatic Growth Inventory total scale and subscales showed satisfactory internal consistency, reliability and concurrent validity. The factor structure of the Chinese Post-Traumatic Growth Inventory fit well with a higher-order intrapersonal factor (self, spiritual and life orientation) and a first-order interpersonal factor. The Chinese Post-Traumatic Growth Inventory was predictive of hope and positive coping but negatively predictive of anxiety. The five Chinese Post-Traumatic Growth Inventory subscales can help practitioners identify meaningful health outcomes for Chinese chronic disease patients.

With bullying in schools high on policy makers’ agendas, researchers are looking for effective strategies to tackle its disruptive effects. The present study sets out to address this issue. First, the prevalence of bullying is examined in Hong Kong High Schools, and second, the effectiveness of a Restorative Whole-school Approach (RWsA) in reducing bullying is examined in a quasi-experimental design. The RWsA emphasizes the setting up of restorative goals, clear instructions, team building, and good relationships among students, parents, and teachers. Over the course of 2 years, and across four schools, the effectiveness of this program was observed by comparing an intervention group with a partial intervention group (which did not receive the full treatment) and a control group (which received no treatment whatsoever). The group that received the RWsA treatment exhibited a significant reduction of bullying, higher empathic attitudes, and higher self-esteem in comparison to the partial intervention and the control group.

Transcription activator-like effector nucleases (TALENs) have been proven to be effective for gene specific targeting across species. Here we describe the validated protocol for TALEN assembly as well as methods for generating gene knockout animals of Xenopus and zebrafish. This protocol covers selection of TALEN targeting sites, TALEN assembly with a modified Golden Gate method, injection of TALEN mRNAs into Xenopus and zebrafish embryos as well as the detection of somatic and germ-line transmitted mutations. Finally, the establishment of knockout Xenopus and zebrafish lines is also described. This protocol will facilitate broader applications of TALENs in developmental biology.

Proteases have been shown to modulate pain signaling in the spinal cord and may contribute to the development of chronic postsurgical pain. By using peripheral inflammation in rats as a chronic pain model, the authors identified the deregulation of proteases and their inhibitors as a hallmark of chronic pain development using a genome-wide screening approach.A microarray analysis was performed and identified spinal cathepsin G (CTSG) as the most up-regulated gene in rats with persistent hyperalgesia after intraplantar injection of complete Freund's adjuvant (n = 4). Further experiments were performed to elucidate the mechanisms of CTSG-induced hyperalgesia by intrathecally applying specific CTSG inhibitor (n = 10). The authors also evaluated the association between CTSG gene polymorphisms and the risk of chronic postsurgical pain in 1,152 surgical patients.CTSG blockade reduced heat hyperalgesia, accompanied by a reduction in neutrophil infiltration and interleukin 1β levels in the dorsal horns. In the gene association study, 246 patients (21.4%) reported chronic postsurgical pain at 12-month follow-up. Patients with AA genotypes at polymorphisms rs2070697 (AA-15.3%, GA-24.1%, and GG-22.3%) or rs2236742 (AA-6.4%, GA-20.4%, and GG-22.6%) in the CTSG gene had lower risk for chronic postsurgical pain compared with wild-types. The adjusted odds ratios were 0.67 (95% CI, 0.26 to 0.99) and 0.34 (95% CI, 0.21 to 0.98), respectively.This study demonstrated that CTSG is a pronociceptive mediator in both animal model and human study. CTSG represents a new target for pain control and a potential marker to predict patients who are prone to develop chronic pain after surgery.

The authors used the Twenty Statements Test in 2 studies to investigate gender and country differences in the spontaneous self-descriptions of 811 college students from Hong Kong, India, Nepal, Nigeria, and Zimbabwe and 136 secondary school students from Taiwan and Hong Kong. The authors performed statistical analysis and found no significant gender differences in the percentage of responses classified as belonging to the idiocentric self in either study. However, the authors found significant Country effects in both studies for responses classified as representing the idiocentric self and some aspects of the collective self, and the authors found significant Country x Gender effects involving all 4 categories of the idiocentric self and the collective self for the college students. These findings raise questions about the generalizability of Western findings that males are more likely to espouse an independent conception of self than females. However, as the authors predicted, females were more likely to use small group self-descriptions than their male peers.

Pertussis vaccination of infants has dramatically reduced disease, complications and deaths in infancy and early childhood. But there is still a major public health challenge — to deal with the morbidity and economic burden of illness in older children, adolescents and adults. Furthermore, it is these groups that form a major source of infection for non-immunised and partially immunised infants who are at high risk of severe complications. Adult-type acellular pertussis vaccine confers safe and effective protection against pertussis. There are several strategies to consider for immunising older individuals. Universal vaccination of all age groups would be the best available strategy for protecting individuals. It would also reduce the potential for transmitting the disease to other susceptibles, particularly infants. However, such a policy may be difficult both logistically and economically at this time. More easily achievable as a first step would be a strategy of universal adolescent booster vaccination combined with a programme targeted at adults most likely to have contact with very young babies including healthcare and childcare workers, parents and close family contacts. There is also potential for offering vaccination to adults (and their carers and close contacts) whose medical conditions or advanced age may place them at increased risk of more severe pertussis disease. Specific details of immunisation programmes must be made on a country by country basis depending on local circumstances.

Nitrous oxide inactivates methionine synthase and may lead to DNA damage and wound infection. By using single-cell gel electrophoresis (comet assay), the authors determined the effect of nitrous oxide on DNA damage in circulating leukocytes.In this double-blind, randomized controlled trial, 91 patients undergoing major colorectal surgery were randomized to receive 70% nitrous oxide (n = 31) or nitrous oxide-free anesthesia using 30 (n = 30) or 80% (n = 30) oxygen. Venous blood was collected before and 24 h after surgery. The primary outcome was extent of DNA damage, quantified as the percentage of DNA staining intensity in the comet tail using digital fluorescence microscopy. Incidence of postoperative wound infection was also recorded.Nitrous oxide exposure was associated with a two-fold increase in the percentage of DNA intensity in tail (P = 0.0003), but not in the 30 (P = 0.181) or 80% oxygen groups (P = 0.419). There was a positive correlation between the duration of nitrous oxide exposure and extent of DNA damage, r = 0.33, P = 0.029. However, no correlation was observed in nitrous oxide-free patients. The proportions of postoperative wound infection, using the Centers for Disease Control and Prevention criteria, were 19.4% (6 of 31) in the 70% nitrous oxide group and 6.7% (2 of 30) in both the 30 and 80% oxygen groups, P = 0.21. An increase in DNA damage was associated with a higher risk of wound infection, adjusted odds ratio (95% CIs): 1.19 (1.07-1.34), P = 0.003.Nitrous oxide increased DNA damage compared with nitrous oxide-free anesthesia and was associated with postoperative wound infection.

Insulin-like growth factors (Igfs) are implicated in a wide variety of physiological roles in teleost gonadal development and reproduction. In the present study, igf3 mRNA expression in the tilapia ovary was found to be higher than in the testis from 5 to 40 days after hatching (dah) but was lower than that in testis from 50 to 70 dah. Consistently, Igf3 protein signal was detected in the somatic cells of XX and XY gonads from 10 dah until adulthood by immunohistochemistry, using a specific Igf3 polyclonal antibody. Incubation of ovarian and testicular cells in primary culture with recombinant Igf3 significantly increased nr5a1, foxl2, dmrt1, cyp19a1a, cyp11a1, cyp11b2, hsd3b2 , and cyp17a1 expression in a time- and dose-dependent manner. Promoter analysis using luciferase assays in HEK293 cells revealed that igf3 promoter activity was directly activated by Nr5a1 (Sf1) and further enhanced by Foxl2, Nr0b1a (Dax1), and Nr0b1b (Dax2) but repressed by Dmrt1 and estrogen receptor (Esr1, Esr2a, or Esr2b) along with 17beta-estradiol treatment. In addition, igf3 promoter activity was increased slightly by forskolin treatment alone but synergistically up-regulated by transfection with nr5a1. These in vitro results correlated well with the expression profile of igf3 during early gonad differentiation. Our results indicated that igf3 is involved in fish gonad steroidogenesis because of its ability to regulate the expression of foxl2, dmrt1, and nr5a1 and steroidogenic enzymes. The expression of igf3 is in turn regulated by transcription factors Foxl2, Dmrt1, and Nr5a1, as well as by 17beta-estradiol treatment.

The gonad-specific expression of a recently discovered Igf subtype (Igf3) in teleost has indicated the important role of this novel Igf in the reproductive functions of fish. In the present study using zebrafish as the model organism, we have further examined the gene expression patterns and the physiological role of Igf3 in the ovary. The igf3 gene in zebrafish was found to be alternatively spliced into two transcripts, with transcript variant 1 exclusively expressed in the gonads, and transcript variant 2 only expressed during early development. Using specific antibodies developed for zebrafish Igf3, both the Igf3 prepropeptide and the mature peptide forms of Igf3 were found to be predominantly expressed in the zebrafish ovary. Real-time PCR and in situ hybridization revealed that igf3 mRNA is relatively low in the early follicles, but is significantly increased after the mid-vitellogenic stage (midstage III), and is high in the full-grown follicles. In the full-grown follicles, igf3 mRNA was detected mainly in the somatic follicular cells with a low level of expression in the oocytes. Igf3 immunoreactivity was confined to the follicular cells only. The expression of igf3 was significantly up-regulated in both ovarian fragments and isolated follicles upon treatment with human chorionic gonadotropin in dose- and time-dependent manners. Treatment with 8-bromoadenosine 3',5'-cyclic monophosphate or 3-isobutyl-1-methylxanthine also up-regulated the expression of igf3 in full-grown follicles. Incubation of follicles with recombinant zebrafish Igf3 significantly enhanced oocyte maturation in time-, dose-, and stage-dependent manners. The actions of Igf3 could be blocked by cycloheximide, but not by actinomycin D. Taken together, these results support an important role of Igf3 in the ovarian functions of zebrafish, especially in oocyte maturation.

Psoriasis is a skin disease associated with hyperproliferation and aberrant differentiation of keratinocytes. Our previous studies have identified the root of Rubia cordifolia L. as a potent antiproliferative and apoptogenic agent in cultured HaCaT cells (IC(50) 1.4 microg/ml). In the present study, ethanolic extract of Radix Rubiae was fractioned sequentially with hexane, ethyl acetate (EA), n-butanol and water. EA fraction was found to possess most potent antiproliferative action on HaCaT cells (IC(50) 0.9 microg/ml). Mechanistic study revealed that EA fraction induced apoptosis on HaCaT cells, as it was capable of inducing apoptotic morphological changes. Annexin V-PI staining assay also demonstrated that EA fraction significantly augmented HaCaT apoptosis. In addition, EA fraction decreased mitochondrial membrane potential in a concentration- and time-dependent manner. The standardized EA fraction was formulated into topical gel and its keratinocyte-modulating action was tested on mouse tail model. EA fraction dose-dependently increased the number and thickness of granular layer and epidermal thickness on mouse tail skin, indicative of the keratinocyte differentiation-inducing activity. Taking the in vitro and in vivo findings together, the present preclinical study confirms that EA fraction is a promising antipsoriatic agent warranting further development for psoriasis treatment.

To investigate the antioxidant and cytotoxic properties of five diarylheptanoids (1-5) isolated from the rhizomes of Zingiber officinale.Various models such as scavenging superoxide anions and 1,1-diphenyl-2- picrylhydrazyl (DPPH) radicals, inhibiting lipid peroxidation, as well as protecting of rat pheochromocytoma (PC12) cells induced by hydrogen peroxide (H2O2) were employed to assay the antioxidative effects of the diarylheptanoids. The cytotoxicities of compounds 1-5 were measured with MTT assays.The test compounds (1-5) showed promising DPPH inhibitory activities, and compound 5 exhibited the strongest DPPH scavenging activity with an IC50 value of (22.6+/-2.4) micromol x L(-1). Compounds 1, 3 and 4 showed potential anti-peroxidative effects with inhibitory rates of (66.3+/-15.4)%, (68.7+/-15.8)% and (72.2+/-10.6)%, respectively, at 100 microg x mL(-1). It could be observed that compounds 1, 3 and 4 demonstrated significant neuroprotective activities in a dose-dependent manner. Moreover, compound 3 exhibited certain cytotoxicities against human chronic myelogenous leukemia cells (K562) and its adriamycin-resistant cells (K562/ADR) with IC50 values of (34.9+/-0.6), (50.6+/-23.5) micromol x L(-1), respectively.In vitro results demonstrated that five diarylheptanoids (1-5) isolated from the roots of Z. officinale were capable of scavenging radicals, inhibiting lipid peroxidation and protecting PC12 cells against the insult by H2O2. Additionally, compound 3 could inhibit the growth of K562 and K562/ADR cells.

We set out to determine the prevalence of obstructive sleep apnea syndrome (OSAS) among obese Singapore school children and identify risk factors for OSAS. This study was designed as a prospective study in three phases. Parents completed a questionnaire with regards to sleep and daytime symptoms in Phase 1. Children suspected to have OSAS based on the questionnaire and all with a percent ideal body weight (IBW)/=180 were called for clinic visits in Phase 2. All whose percent IBW/=180 and those in whom the physicians strongly suspected OSAS were subjected to a polysomnogram in phase 3. The children were recruited from the School Health Nutritional Clinic for obese children. The investigations were carried out at Tan Tock Seng Hospital. In all, 3,671 children were screened with the questionnaire. Of these, 146 were selected to undergo polysomnography. Twenty-six had abnormal sleep studies with apnea/hypoxia indices (AHIs)5/hr. The significant clinical feature which correlated with OSAS was sleep sitting up (P = 0.005). The risk is higher in morbidly obese (IBW/=180), with a prevalence of 13.3% (8/60), than in less obese children (IBW180). One in eight (12.5%) of these children was asymptomatic and would have been missed based on the questionnaire. Presence of adenotonsillar hypertrophy led to increased risk of OSAS. The prevalence of OSAS was 0.7% (26/3,671) among the obese schoolchildren in Singapore, which is similar to the prevalence reported by others. Using discriminant analysis, the estimated prevalence increased to 5.7%. In the morbidly obese (IBW/=180), the prevalence rate is higher at 13.3%.

This is a study of complicated varicella zoster infection in paediatric patients.To find out the number of patients with such complications, the types of complications and their outcome.This involved a retrospective review of the case records of 8 patients who presented to our unit over a 12-month period (Jan-Dec 96). All patients were previously well without any underlying immunodeficiency. Varicella zoster (VZ) infection was confirmed by VZ immunofluorescence from vesicular fluid.CMS complications accounted for 6 of the 8 cases. Of these, 3 presented with encephalitis, 2 with cerebella ataxia and 1 with aseptic meningitis and cerebella ataxia. Of the non-CNS cases, 1 presented with glomerulonephritis with superimposed staphylococcus infection of skin ulcers; the other had disseminated VZ infection with haemorrhagic vesicles, hepatitis, ileus with mesenteric adenitis and disseminated intravascular coagulation.The patient with disseminated VZ infection and multiple organ involvement died 5 days after a stormy course. One patient with encephalitis who had status epilepticus for 2 hours had behavioural problems and poor memory. The remaining 6 patients had no sequelae.VZ infection usually a minor illness, can result in serious life-threatening complications in previously healthy patients.

Progressive tissue iron deposition from multiple blood transfusions is common in beta-thalassaemia and pulmonary iron deposition may result in parenchymal damage. The objectives of this study were to: 1) determine the predominant pulmonary dysfunction in patients with thalassaemia major; and 2) demonstrate that parenchymal disease, if present, is at the level of the alveolocapillary membrane. Fourteen thalassaemia major patients (13 nonsmokers) receiving regular blood transfusion and without any history of chronic respiratory disease were recruited. Pulmonary function tests and echocardiography were performed before the scheduled transfusions. Three patients with the most restricted lung function were selected for high resolution computerized tomography (CT) of the lungs. One patient had an obstructive pattern with a forced expiratory volume in one second as percentage of forced vital capacity (FEV1/FVC) of 71%. Four patients demonstrated a restrictive pattern, as defined by total lung capacity (TLC) less than 80% predicted with normal FEV1/FVC%. Twelve patients had pulmonary transfer factors for carbon monoxide (TL,CO) below 80% pred, even after correction for the anaemia, indicating parenchymal disease. Eight of these 12 patients had alveolocapillary membrane defect, as demonstrated by a gas transfer factor of the pulmonary membrane (Tm) less than 80% pred. Mean resting arterial oxygen saturation was 95 +/- 2 (range 92-98) %. Eleven patients had oxygen desaturation of 5% or more during exercise on a bicycle ergometer, consistent with interstitial lung disease. There was no clinical or echocardiographic evidence of heart failure. Percentage predicted TLC was inversely correlated with age (r = -0.547; p = 0.043). Both percentage predicted TLC and TL,CO were not correlated with iron burden or desferoxamine ratio. High resolution CT in the three selected patients showed no evidence of pulmonary fibrosis. We conclude that thalassaemia major patients have a predominant restrictive lung dysfunction with pulmonary parenchymal disease and alveolocapillary membrane block. The restrictive and interstitial lung disease could not be accounted for by iron loading or pulmonary fibrosis in our patients.

ECG abnormalities suggestive of carditis were encountered in 20 of 25 patients (80%) with Kawasaki Disease. The commonest abnormalities were raised S-T segments (11 patients), increased Q/R ratio (11 patients) and prolonged corrected Q-T interval (7 patients). Six patients had coronary artery dilatation and all resolved on subsequent 2-D Echocardiography. These six patients all had ECG changes of carditis. Such changes were present in 74% of patients with normal coronary arteries. The differences were not significant. A similar comparison between the two groups using the modified Asai scoring system failed to show the usefulness of this scoring system in predicting the risk of coronary artery involvement in our patients.

Acute respiratory infections are common childhood illnesses. Most are mild and self-limiting. Five percent are lower respiratory tract diseases and are potentially serious. A prospective study was conducted to ascertain the etiology of community-acquired severe lower respiratory tract infections (LRTI) in hospital based patients. Mycoplasma was the most frequently identified agent (33%). This was followed by viruses (28%) and bacteria (15%). Twenty-four percent of children had no identified causative agent.

The clinical features and haematologic indices of 100 young infants aged 3 months and below, admitted with suspected bacterial infections, were analysed. Fever, lethargy, hepatomegaly, poor feeding and irritability were the commonest features for suspecting a bacterial infection in these infants. However, the features significantly associated with bacterial infections were respiratory distress and cyanosis. Of the haematologic indices commonly associated with bacterial infections, only C-reactive protein and erythrocyte sedimentation rate were significantly predictive compared to leukocyte counts, absolute neutrophil counts and nitro-blue tetrazolium tests. When used in combination, a raised C-reactive protein with erythrocyte sedimentation rate, a raised erythrocyte sedimentation rate with abnormal leukocyte counts and a raised C-reactive protein with abnormal leukocyte counts were significantly associated with bacterial infections.

One hundred and eleven children with Mycoplasma pneumonia infection were studied. Their mean age was 6.2 +/- 3.1 years. The two commonest symptoms were cough (98%) and fever (95%). Only 23% of children had cough of greater than one week's duration. Ninety one per cent had positive chest signs. Radiological abnormalities were seen in 95% of chest x-ray. Complications included dermatological (10%), pleural effusion (5%), neurological disorder (3%), septicaemia (1%), bronchiectasis (1%). Two children with Down's Syndrome died. A rare case of Mycoplasma bronchitis with Reye's Syndrome was observed.

Over one year period, 240 children with severe lower respiratory infection was admitted to a general paediatric department. The mortality was 1.6%. Apart from pleural effusions and skin exanthems, several major complications were noted. These were septicaemia (1), apnoea (2), encephalopathy (3), meningitis (1), Stevens Johnson Syndrome (1), bronchiectasis (1) and lung abscess (1).

Acute viral bronchiolitis is one of the most common causes of paediatric respiratory disease, especially in the first year of life. Young infants and those with pre-existent cardiorespiratory problems are at an increased risk of acute respiratory failure necessitating mechanical ventilation. A prospective study was carried out from November 1988 to October 1989, to analyse the clinical features, aetiology and outcome of patients with severe bronchiolitis. 52 (29.9%) out of 174 cases of acute bronchiolitis admitted were found to be severe. A virus aetiology was identified in 75% of the cases, respiratory syncytial virus (RSV) being the commonest agent. 88.5% of the patients were less than 1 year of age, with a male preponderance of 1.4:1. There was a higher incidence in the Malay ethic group. Despite the viral aetiology, 88.2% were treated with a course of antibiotics. There was one death, and 2 patients had apnea requiring mechanical ventilation.

Urinary borates calculated as boric acid were found to span 0 to 54 microgramme per ml urine for both Singaporean adults (population size: 507) and children (population size: 162). The normal dietary boron intake could account for the urinary boric acid levels observed. Of the hundred and fifty-three children who suffered from gastroenteritis in Singapore over the period from Jan to May 1989, two were found to have urinary boric acid exceeding 54 micrograms per ml urine. One of them was said to have consumed fish balls, bean curds and noodles prior to the onset of illness. These food items were among those likely to have added borates. Unfortunately, the dietary intake prior to the onset of illness of the other child was not recorded. Of the hundred and twelve adults affected by gastroenteritis in Dec 1988 in the Tiong Bahru area, one was found to have boric acid level of 117 micrograms per ml urine, indicative of added borates in the diet. The present study showed that borates related gastroenteritis incidents in Singapore over the time-period of our study at least, were few and far in between. With the on-going surveillance for the presence of added borates in both locally manufactured and imported food and the continued tight control over the importation and sale of borates, future incidents are likely to be minimal.

Margosa Oil is an extract of the seed of the Neem tree and is widely used as a traditional medicine by Indians in India, Sri Lanka, Burma, Thailand, Malaysia and Indonesia. Used mainly for external applications, it is often administered orally to neonates and infants regularly in small amounts. Margosa Oil causes toxic encephalopathy particularly in infants and young children. The usual features are vomiting, drowsiness, tachypnea and recurrent generalised seizures. Leucocytosis and metabolic acidosis are significant laboratory findings. Management is aimed primarily towards the control of convulsions although supportive management is equally important. Prognosis is usually good but fatalities and neurological deficits have been reported. We report here two infants with Margosa Oil poisoning presenting with encephalopathy.

We present 4 neonates with enteroviral meningitis. The cerebrospinal fluid findings were variable and posed a diagnostic problem. Immediate outcome was excellent and 3 of the 4 infants were normal at follow-up at 6 months of age. However long-term follow-up will be necessary to to determine any long-term sequelae.

Percutaneous balloon pulmonary valvuloplasty was performed in ten children aged 4 months to 9 years (mean age = 3.9 years). Their weights ranged from 5.6 to 38 kg (mean = 16.1 kg). Seven had typical pulmonary valve stenosis, two had pulmonary atresia and previous surgical valvotomy and one had dysplastic pulmonary valve. In patients with typical pulmonary valve stenosis, significant reductions in the right ventricular systolic pressure and pulmonary systolic pressure gradients were observed immediately after balloon dilatation. Follow-up evaluation by Doppler echocardiography at six months to two years showed further reduction in pulmonary gradients in five, and in the other two, the gradients remained low. Reduction in right ventricular pressure was less in patients with pulmonary atresia and previous surgical valvotomy and patients with dysplastic pulmonary valve. Balloon pulmonary valvuloplasty is a safe and effective procedure for the relief of typical pulmonary valve stenosis. In patients with pulmonary atresia and previous surgical valvotomy, balloon valvuloplasty can be an effective palliation for decompressing the right ventricle and improving pulmonary blood flow.

From May 1988 to January 1989, we performed balloon atrial septostomy under Two Dimensional Echocardiographic visualisation on 8 patients at the bedside in the intensive care unit, in the Singapore General Hospital. Their ages ranged from 3 to 45 days (median = 7 days). Their weights ranged from 1.6 to 4.0 kg (mean +/- 2sd = 3.2 + 1.6). Five patients had transposition of the great arteries, 1 had tricuspid atresia and 2 with pulmonary atresia/stenosis. There were no complications related to the procedure. The advantage of Two Dimensional Echocardiographic imaging compared to fluoroscopy are 1) excellent visualisation of cardiac structures, 2) it can be performed safely at the bedside without transporting patient to the cardiac catheter laboratory, 3) Immediate detection of cardiac complications and 4) no radiation exposure. Balloon atrial septostomy done using Two Dimensional Echocardiographic visualisation is acceptable and safe. It is the method of choice in our department.

Between February 1986 to November 1986, 335 cases of febrile convulsion were admitted to the paediatric ward, Tan Tock Seng Hospital. The study revealed 87 cases (26%) were complex febrile convulsion and 73 cases (21.8%) were recurrent febrile convulsion. 51 patients with complex febrile convulsion and 32 patients with recurrent febrile seizures were put on long term phenobarbitone. The number of patients with recurrent and complex convulsion was big. The role of anticonvulsant prophylaxis is reviewed and its efficacy discussed.

The aim of this prospective survey was to study the clinical profile, the incidence among the various age groups, the bacteriology, sequelae and mortality in patients, with bacterial meningitis. Patients included in the study were 36 cases of bacterial meningitis admitted to the Paediatric Unit, Tan Tock Seng Hospital, Singapore, between the period January 1984 to December 1987. Of the total number of patients, 36% were in the neonatal age group. Positive bacterial cultures were obtained in 45% of cases in both the cerebrospinal fluid and blood. The incidence of neurological sequelae was about 10%. 14% of the patients died and the majority of deaths were patients in the neonatal age group. Among the patients studied, was one who had recurrent episodes of bacterial meningitis.

Autoimmune hemolytic anemia (AHA) is uncommon in childhood. A female child presented with severe and chronic clinical course. She was refractory to steroid and the response to splenectomy was poor. She showed excellent remission of hematological condition with Danazol. Danazol may be the drug of choice for refractory autoimmune hemolytic anemia.

This retrospective study of 132 patients less than 12 years of age with Appendectomy done for Acute Appendicitis showed histological confirmation in 106 patients (80.3%) and a "negative appendix" rate of 19.7%. The appendix was perforated in 31 patients (23.5%). In those patients with confirmed Acute Appendicitis, males predominate (1.7 males: 1 female) and the peak incidence was in those 9 years of age or more. Abdominal pain was present in all patients except a 13 month old infant. Abdominal tenderness was also elicited in all patients except one. Fever was present in 83 patients (78.3%), vomiting in 82 patients (77.4%) and diarrhoea in 19 patients (17.9%). There were 2 deaths in this review, giving a mortality rate of 1.9%. Postoperative complications include wound infection (13.2%), pelvic abscess (0.9%), ileus (0.9%) and adhesion obstruction (0.9%).

287 patients with Acute Gastroenteritis were studied. Rotavirus accounted for 29.7% and bacterial aetiology for 9.3% of the cases. In the early infant age group (0-6 months), bacterial aetiology (28.8%) was commoner than Rotavirus aetiology (7.7%). In the older age groups, Rotavirus was more common than bacteria as a cause for Gastroenteritis.