Teng Sung Shin, Joyce Lam Ching Mei, 20180903000000
Bleeding disorders in children can be divided into acquired and congenital conditions, with the acquired being far more common than the congenital. Clinical bleeding manifestations can vary in severity. Identifying the root cause early is crucial to control and halt bleeding as well as to prevent the risk of future bleeding in a vulnerable age group. This can be achieved by a thorough and salient history, physical evaluation, and appropriate investigations. This review will describe the common causes of bleeding disorders in children and will suggest an approach to the workup and diagnosis of such disorders.
Thrombocytopenia, defined as a platelet count of less than 150,000/microL, is clinically suspected when there is a history of increased bruising or bleeding, or when there is petechiae noted which is often referred to as a “rash”. Thrombocytopenia is usually asymptomatic until platelet counts fall below 50,000/microL, and may also be detected incidentally in a full blood count (FBC) during routine evaluation of an asymptomatic patient or during investigations performed for other reasons.1
Genetic diseases cause great physical effect to newborns and psychological impact to parents. Recessive genetic diseases can hit asymptomatic carrier couples with detrimental impact because very often they are not aware of their carrier status. Recessive genetic disease affects at least 30 in every 1,000 children, ranging from very mild to severe phenotype.1-2 Common examples of recessive genetic diseases include thalassaemia, spinal muscular atrophy, congenital adrenal hyperplasia, cystic ﬁbrosis, among others.
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic
HBV infection is probably the most common maternal infection encountered
in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of
the endemic areas, immunisation against HBV was first provided in 1983
to infants born to mothers who were screened positive for hepatitis B
surface antigen (HBsAg). Immunisation became widespread since November
1988, but HBsAg-positive mothers are still encountered frequently.1
This review article outlines the prevalence of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG), definition of NVP and HG, aetiology, risk factors, complications of HG, recommended investigations, primary care management, hospital and ambulatory daycare, therapeutic management of HG supported by good clinical evidence, discharge planning, and importance of the multidisciplinary team to provide high quality care in patients with NVP and HG.
Uterine arteriovenous malformation (AVM) is an abnormal connection between arteries and veins within the uterus. Although AVM can be congenital or acquired, this article focuses on the diagnosis and management of acquired AVMs identified following early pregnancy complications. AVMs may develop as a result of damage to the uterine tissue following spontaneous miscarriage, pregnancy termination, dilatation and curettage, caesarean scar pregnancy, or gestational trophoblastic disease.1 The incorporation of necrotic villi in the venous sinuses of scar tissue is thought to cause acquired AVM.2
Uterine arteriovenous malformation (AVM) is an abnormal connection
between arteries and veins within the uterus. Although AVM can be
congenital or acquired, this article focuses on the diagnosis and
management of acquired AVMs identified following early pregnancy
complications. AVMs may develop as a result of damage to the uterine
tissue following spontaneous miscarriage, pregnancy termination,
dilatation and curettage, caesarean scar pregnancy, or gestational
trophoblastic disease.1 The incorporation of necrotic villi in the venous sinuses of scar tissue is thought to cause acquired AVM.2
Advances in antenatal, perinatal, and neonatal care lead to increased survival of preterm infants. As survival rates continued to increase, so did the angst of “intact survival,” or survival without disabilities. A recent meta-analysis revealed that at school-age, cognitive scores of former very low birth weight (VLBW) infants are approximately 10 points lower than those of matched control children1 due to difficulties with attention, behaviour, visual-motor integration, and language performance.2-3
Patients with mild hypertension who are at low risk for cardiovascular disease (CVD) do not appear to derive mortality or CVD benefit from antihypertensive treatments, raising questions on the need for treatment in this population, according to a recent study from England.
A personalized computerized neurofeedback intervention for training attention and memory shows potential in cognitive training for healthy elderly men, who improved in cognitive performance after the training, although no significant improvements were seen in the overall study population.
Higher exposure to ticagrelor following myocardial infarction does not appear to contribute to an increased risk of intracranial haemorrhage, which is associated with age and prior cardiovascular morbidities, according to a study.