Sze Ho Sunny Wong

OBJECTIVES: The aim of this study was to analyze the value of performing laboratory tests, taking cultures, and imaging, a diagnostic approach for febrile seizures (FSs) still routinely performed despite the American Academy of Pediatrics recommendations not to. Another aim of this study was to identify the most common sources of fever in patients with FSs and to determine whether the occurrence of FSs correlates with the seasons of the year. METHODS: This is a retrospective study that included all patients diagnosed with simple or complex FSs who were seen in the emergency room or inpatient unit from January 2004 to December 2009. RESULTS: Of the 219 patients included in the study, 135 (61.4%) cases had the etiology of the FS diagnosed. Upper respiratory tract infection, otitis media, urinary infection, and pneumonia were the most common diagnoses attributed to the fever. Leukocytosis was present in 48 (24%) of 219, and neutrophilia in 199 (91%) of 219 cases. Low bicarbonate levels were common among every age group. Only 1 blood culture was positive for Salmonella. The incidence of FS was higher during the winter (49.3% of the cases), and it closely paralleled the seasonal variation of viral infections. CONCLUSIONS: Even though laboratory tests, taking cultures, and imaging are performed in daily practice when approaching FSs, the association of FSs with serious infectious disease is rare and usually overestimated. The diagnostic approach should be individualized to each case and correlated with available data like that shown in this study. Parents should be educated with the knowledge that the occurrence of FSs tends to be higher in winter.

Community-acquired methicillin-resistant Staphylococcus aureus has become a well-established pathogen with alarming rates during the last decade. The current situation of this bacteria in pediatric infections is very limited and motivated us to conduct this study. This is a retrospective and analytical study including patients less than 18 years of age with the diagnosis of skin or soft tissue infections in 2008 and 2009 meeting the criteria of Community-acquired infection. A prevalence of 41.9% among skin and soft tissue infections was found. Inducible resistance to clindamycin was detected in 1.3% of the strains and the infection shows a seasonal predilection for summer (P=0.003); 57.8% of the cases required hospitalization with a mean stay of 3.3±2.5 days. The susceptibility to clindamycin and co-trimoxazole is 88 and 97% respectively. The resistance to erythromycin has reached 92%. The main diagnoses at presentation was gluteal abscess plus cellulitis (34.2%).The prevalence of CA-MRSA is trending up and seems to become a large burden for the health system in our community. Clindamycin is still an excellent option in the community setting since inducible clindamycin resistance is extremely low in this community. Co-trimoxazole should be kept as a reserved drug to avoid the rapid resurgence resistance in the community.

Kidney transplant recipients have increased risk of cancers when compared with the general population. Hepatocellular carcinoma (HCC) is extremely important in Asia where hepatitis B virus (HBV) infection is endemic. The aim is to study the epidemiological and clinical aspects of all de novo HCC in our kidney transplant recipients. Moreover, various preventive strategies which may help to optimize the outcome will also be discussed. A retrospective review of all patients who developed HCC after kidney transplantation between May 1972 and December 2011 in Hong Kong, based on the data from Hong Kong Renal Registry. After a follow-up period of 40,246 person-years, 20 patients (males 15: females 5) developed HCC. The annual incidence was 49.7/100,000 persons per year. Among them, 16 were HBV carriers, 2 were hepatitis C (HCV) carriers and 2 had HBV and HCV co-infection. Presence of HBV infection was associated with 78-fold higher risk for HCC development. Majority (85%) were asymptomatic when HCC was diagnosed by ultrasound or alpha-fetoprotein surveillance. All patients diagnosed by surveillance received active treatment while 2/3 of symptomatic patients could only receive symptomatic care and died rapidly. In conclusion, HBV infection is the major etiological factor for HCC development in kidney transplant recipients in HBV endemic areas. Regular HCC surveillance appeared to be able to detect early stage cancers which are amenable to treatment and offer the best hope of cure.