Publications by authors named "Alexander K C Leung"

250 Publications

Respiratory syncytial virus is the most common causatives of viral bronchiolitis in young children: An updated Review.

Curr Pediatr Rev 2022 Aug 10. Epub 2022 Aug 10.

Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong.

Background: Viral bronchiolitis is a common condition and a leading cause of hospitalization in young children.

Objective: This article provides readers with an update on the evaluation, diagnosis, and treatment of viral bronchiolitis, primarily due to RSV Methods: A PubMed search was conducted in December 2021 in Clinical Queries using the key terms "acute bronchiolitis" OR "respiratory syncytial virus infection". The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to children and English literature. The information retrieved from the above search was used in the compilation of this article.

Results: Respiratory syncytial virus (RSV) bronchiolitis is the most common viral bronchiolitis in young children. Other viruses such as human rhinovirus and coronavirus could be etiological agents. Diagnosis is based on clinical manifestation. Viral testing is useful only for cohort and quarantine purposes. Cochrane evidence-based reviews have been performed on most treatment modalities for RSV and various viral bronchiolitis. Treatment for viral bronchiolitis is mainly symptomatic support. Beta-agonists are frequently used despite the lack of evidence that they reduce hospital admissions or length of stay. Nebulized racemic epinephrine, hypertonic saline and corticosteroids are generally not effective. Passive immunoprophylaxis with a monoclonal antibody against RSV, when given intramuscularly and monthly during winter, is effective in preventing severe RSV bronchiolitis in high-risk children who are born prematurely and in children under 2 years with chronic lung disease or hemodynamically significant congenital heart disease. Vaccines for RSV bronchiolitis are being developed. Children with viral bronchiolitis in early life are at increased risk of developing asthma later in childhood Conclusions: Viral bronchiolitis is common. No current pharmacologic treatment or novel therapy has been proven to improve outcomes comparing to supportive treatment. Viral bronchiolitis in early life predisposes asthma development later in childhood.
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http://dx.doi.org/10.2174/1573396318666220810161945DOI Listing
August 2022

Childhood Obesity: An Updated Review.

Curr Pediatr Rev 2022 Aug 1. Epub 2022 Aug 1.

Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong.

Background: Childhood obesity is an important and serious public health problem worldwide.

Objective: This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

Methods: A PubMed search was conducted in May 2021 in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

Results: Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

Conclusion: Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss followed by rapid re-accumulation of the lost weight after termination of therapy. As such, preventive activity is the key to solve the problem of childhood obesity. Childhood obesity can be prevented by promoting healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to become involved in school and community programs that improve nutritional status and physical activity in their children.
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http://dx.doi.org/10.2174/1573396318666220801093225DOI Listing
August 2022

Asymptomatic linear erythematous plaques following the lines of Blaschko on the cheek.

Paediatr Child Health 2022 Jun 21;27(3):136-137. Epub 2022 Mar 21.

Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.

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http://dx.doi.org/10.1093/pch/pxab113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9191916PMC
June 2022

Successful Treatment of Drug-Resistant Seizures Secondary to Ring 20 Mosaicism with Perampanel as an Add-On Antiepileptic Drug.

Case Rep Pediatr 2022 26;2022:7414628. Epub 2022 May 26.

Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.

We report a girl with drug-resistant seizures, progressive behavioral changes, and cognitive decline. Investigations showed abnormal EEG with frequent high-voltage bifrontotemporal sharp and slow waves, especially during sleep. Seizures were difficult to control, despite the usage of various antiepileptic drugs. Perampanel as an add-on antiepileptic drug appeared efficacious. Due to the recognizable pattern of seizures and EEG findings, a karyotype study was performed which revealed 46 chromosomes with a ring 20 chromosome mosaicism. Ring 20 chromosome is associated with drug-resistant refractory seizures, cognitive decline, and behavioral problems. This case highlights the difficulty and challenge faced in managing drug-resistant refractory seizures associated with ring 20 chromosome. While ring 20 chromosome is often underdiagnosed, one should have a high index of awareness and suspicion of such rare epilepsy syndrome, so that an early diagnosis can be made.
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http://dx.doi.org/10.1155/2022/7414628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9162848PMC
May 2022

Paediatrics: how to manage pediculosis capitis.

Drugs Context 2022 14;11. Epub 2022 Mar 14.

Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong.

Background: Pediculosis capitis is a common human parasitic infestation in childhood. This article aims to provide a narrative updated review on the management of pediculosis capitis.

Methods: A PubMed search was performed with Clinical Queries using the key terms "pediculosis capitis" OR "head lice" OR "head louse". The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews published within the past 10 years. The search was restricted to articles published in English literature. The information retrieved from the search was used in the compilation of the present article.

Results: Topical permethrin and pyrethrin formulated with piperonyl butoxide are the pediculicides of choice in areas where resistance to these products is low. When resistance to these products is suspected based on local levels of resistance or when treatment with these products fails despite their correct use, and reinfestation does not seem to be responsible, other topical treatment options include malathion, benzyl alcohol, dimethicone, spinosad and ivermectin. Wet combing should be considered for children younger than 2 years. Oral ivermectin and trimethoprim/sulfamethoxazole should be reserved for patients who do not respond to appropriate topical pediculicides.

Conclusion: Many topical pediculicides are effective for the treatment of pediculosis capitis. The use of some of these pediculicides is limited for safety reasons, especially in children younger than 2 years. Resistance to pediculicides, especially those with a neurotoxic mode of action, is another concern which may limit the use of some of these pediculicides. New products should be evaluated for effectiveness and safety. Wet combing is time-consuming and should not be used as the sole intervention in the general population.
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http://dx.doi.org/10.7573/dic.2021-11-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8932250PMC
March 2022

Childhood pertussis is still here: An Asian city's perspectives.

Pediatr Pulmonol 2022 04 31;57(4):796-799. Epub 2022 Jan 31.

Department of Paediatrics, Hong Kong Sanatorium & Hospital, Hong Kong.

Introduction: Pertussis, or whooping cough, is a highly contagious respiratory infection that is caused by the bacterium Bordetella pertussis. It is one of the most common causes of death in childhood. It is also a frequent cause of chronic cough in children, adolescents, and adults.

Methods: Global and Hong Kong perspectives of childhood pertussis were described.

Results: Hong Kong has prided herself in the city's childhood immunization program. There appear to be no major outbreaks of pertussis since the 1960s. Nevertheless, pediatricians may see isolated cases of pertussis or pertussis-like cases from time to time. Occasionally, infants are severely affected with apneas and managed with ventilator supports in the PICU. Outbreaks of the notifiable disease continue to occur despite a reasonable surveillance system and vaccination program in Hong Kong. Vaccination of mothers, adolescents, and adults are efficacious methods to further reduce the risks of pertussis. Macrolides remain efficacious antibiotics especially used early during the infectious phase. Infants with pertussis may require intensive care support and morbidity is high.

Conclusions: Physicians should be reminded from time to time that outbreaks of pertussis still exist in Hong Kong and in many cities globally.
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http://dx.doi.org/10.1002/ppul.25839DOI Listing
April 2022

Successful Treatment of Rhabdomyolysis-Associated Acute Kidney Injury with Haemoadsorption and Continuous Renal Replacement Therapy.

Case Rep Pediatr 2021 4;2021:2148024. Epub 2021 Oct 4.

Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, AB T2M 0H5, Canada.

We report two children with rhabdomyolysis-associated acute kidney injury who were successfully treated with a haemoadsorption column CytoSorb® in addition to continuous renal replacement therapy (CRRT). A 14-year-old girl with multiorgan failure requiring extracorporeal membrane oxygenation developed rhabdomyolysis due to reperfusion injury. Her creatine kinase (CK) and lactate levels continued to escalate despite high-dose CRRT. A haemoadsorption column was therefore added post-CRRT filter, which brought down the CK level from 264,500 IU/L to 97,436 IU/L after 8 hours of therapy. Another 4-year-old boy with epilepsy and cerebral palsy who was admitted for gastroenteritis with dehydration developed acute kidney injury and rhabdomyolysis with a peak CK level of 946,060 IU/L. He was initially treated with CRRT for 40 hours, which reduced his CK level to 147,580 IU/L. Two sessions of haemoadsorption were then performed in addition to the CRRT, which further lowered his CK level to 32,306 IU/L in 48 hours. Both patients demonstrated enhanced reduction of CK levels when the haemoadsorption column was used in addition to the CRRT, and no specific complication related to the haemoadsorption therapy was reported. Our cases showed that haemoadsorption can be considered as an adjunctive therapy for children with severe rhabdomyolysis-associated acute kidney injury.
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http://dx.doi.org/10.1155/2021/2148024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8505097PMC
October 2021

Quality of Life for Children with Allergic Skin Diseases.

Curr Pediatr Rev 2022 ;18(3):191-196

Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada.

Allergic skin diseases are highly prevalent among children. Patients with allergic skin diseases experience sociopsychological and quality-of-life (QoL) burdens in excess of those in the general population. Children and their caregivers are especially vulnerable to the burden of many of the common allergic skin diseases. In the past few decades, researchers have developed a number of disease-specific scores and indices for the measurement of QoL for childhood skin diseases. Most of the research in this area has focused on atopic eczema and urticaria and less so on allergic contact dermatitis. We provide an overview of QoL and its assessment for these dermatologic conditions.
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http://dx.doi.org/10.2174/1573396317666210901124211DOI Listing
June 2022

Tubular Dysfunction and Ruptured Ureter in a Child with Menkes Syndrome.

Case Rep Pediatr 2021 17;2021:4398456. Epub 2021 Aug 17.

Department of Surgery, The Hong Kong Children's Hospital, Kowloon, Hong Kong.

Children with Menkes disease may develop various urological and renal problems that evolve as the disease progresses. A 4-year-old boy with Menkes disease had multiple bladder diverticula and a history of recurrent urinary tract infection caused by urea-splitting organisms. The child developed urosepsis and right pyelonephritis. Subsequent investigations revealed multiple right renal stones and a ruptured right ureter. The child also developed hypokalemia, hypophosphatemia, and normal anion gap metabolic acidosis that required electrolyte and potassium citrate supplement. Further assessment revealed renal tubular dysfunction. Our case suggests that regular imaging surveillance, monitoring of renal function and electrolyte profile, and tubular function assessment should be considered in children with Menkes disease.
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http://dx.doi.org/10.1155/2021/4398456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387186PMC
August 2021

Vaccination: a question of social responsibility.

J Prev Med Hyg 2021 Mar 29;62(1):E46-E47. Epub 2021 Apr 29.

Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.

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http://dx.doi.org/10.15167/2421-4248/jpmh2021.62.1.1736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283621PMC
March 2021

Atopic Dermatitis: Conventional and Integrative Medicine.

Curr Pediatr Rev 2022 ;18(2):84-96

Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada.

Although Western medicine and ideas about atopic dermatitis (AD) have become popular in many Asian countries, local beliefs about the disease and its treatment often prevail. The multi- racial background of these countries as well as the influence of the diverse religions (such as Taoism and Ramadan) in these regions often lead to diverse belief systems about the causes of AD (such as the Chi concept, also known as the balance of yin and yang) and the types of treatment (e.g. herbal remedies, topical versus concoctions, and decoctions). In addition, many of the cultural practices are preserved among the Southeast Asian minorities residing in the United Kingdom and North America. Eastern treatments typically take a holistic approach to AD and emphasize the psychosomatic component of the disorder. This overview provides a summary of the difference between conventional, complementary, alternative, and integrative medicine in terms of epidemiology, aetiology, therapy, and prognosis in children with AD. There are a number of similarities in genetic and environmental factors in epidemiology and aetiology; however, differences exist in terms of the concept of management. Complementary and alternative medicine, traditional Chinese medicine, and integrative medicine usage are not only prevalent among the Asian population but are also becoming more popular and accepted in Western societies.
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http://dx.doi.org/10.2174/1573396317666210716152325DOI Listing
June 2022

Successful Treatment of Recalcitrant Granuloma Gluteale Infantum with Topical Tacrolimus 0.03% Ointment.

Case Rep Pediatr 2021 7;2021:9994067. Epub 2021 Jun 7.

Department of Dermatology and Skin Sciences, University of British Columbia and Consultant Pediatric Dermatologist the BC Children's Hospital, Vancouver, British Columbia V6H 3V4, Canada.

Granuloma gluteale infantum is a rare complication of irritant contact dermatitis. For the treatment of granuloma gluteale infantum, the diaper area should be kept clean and dry and the source of skin irritation should be removed or mitigated. For those infants who fail to respond to the conservative management, the use of topical calcineurin inhibitors should be considered. We report the successful treatment of a 12-month-old infant with recalcitrant granuloma gluteale infantum with the use of topical tacrolimus 0.03% ointment. To our knowledge, this is the second case reporting the use of topical calcineurin inhibitors in the treatment of recalcitrant granuloma gluteale infantum.
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http://dx.doi.org/10.1155/2021/9994067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203409PMC
June 2021

Infections in the Paediatric Intensive Care Unit: Illustrated Cases.

Case Rep Pediatr 2021 4;2021:6661932. Epub 2021 Jun 4.

Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong.

is known to be one of the most common gram-positive microorganisms and an important pathogen associated with sepsis and toxic shock. We present four anonymized consecutive cases in a paediatric intensive care unit (PICU) to illustrate the different clinical manifestations of staphylococcal infections, including local infection versus systemic infection, toxic shock versus septic shock, and osteomyelitis. Eczema, short gut syndrome, and scald injury may be associated. Haematologic and coagulopathic abnormalities may be present. Prompt diagnosis and use of appropriate antimicrobial treatments is essential to reducing mortality and morbidity associated with staphylococcal infections.
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http://dx.doi.org/10.1155/2021/6661932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195667PMC
June 2021

Epidermolysis Bullosa: Pediatric Perspectives.

Curr Pediatr Rev 2022 ;18(3):182-190

Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada.

Epidermolysis bullosa (EB) is a group of rare congenital genetic conditions that result in painful blistering of the skin and mucous membranes, which occur with minor trauma or friction. There are many types and subtypes of EB that need to be distinguished, as the management and prognosis of each can vary significantly. We aim to perform an up-to-date literature review on congenital EB for healthcare providers in pediatrics. We performed a review of existing literature in the English language on EB via PubMed Clinical Queries, using key words such as "epidermolysis bullosa", "congenital" and "children". We reviewed EB based on the following subheadings: epidemiology, diagnosis, therapy, prognosis, and clinical prediction guidelines. EB is due to mutation in a number of genes, some types are autosomal dominant while others are autosomal recessive. The underlying mechanism is a defect in attachment between or within the epidermis and dermis of the skin. There are four main types: epidermolysis bullosa simplex, dystrophic epidermolysis bullosa, junctional epidermolysis bullosa, and Kindler syndrome. The diagnosis is suspected based on symptoms and confirmed by skin biopsy and definitive genetic testing. The severity of EB can range from mild to fatal. Severe complications may arise in some EB types and subtypes within the eye, ear, nose, upper airway, gastrointestinal and genitourinary tracts. There is no cure for the condition to date. Optimal management must be multidisciplinary, and involves wound care, pain control, controlling infections, nutritional support, and prevention and treatment of complications. EB presents in different forms. Treatment is supportive. The prognosis of milder forms is good. Children severely affected with EB and their families live a misery life with impaired quality of life. Health care workers must be aware of the suffering in these families and proactively support them.
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http://dx.doi.org/10.2174/1573396317666210525161252DOI Listing
June 2022

Pachydermodactyly.

J Pediatr 2021 Sep 23;236:316-317. Epub 2021 May 23.

Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

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http://dx.doi.org/10.1016/j.jpeds.2021.05.049DOI Listing
September 2021

Experimental Drugs with the Potential to Treat Atopic Eczema.

J Exp Pharmacol 2021 12;13:487-498. Epub 2021 May 12.

Department of Pediatrics, The University of Calgary, and the Alberta Children's Hospital, Calgary, Alberta, Canada.

Introduction: Eczema or atopic dermatitis (AD) is a chronically relapsing dermatosis characterized by pruritus and a significant impact on the quality of life.

Methods: The authors undertook a structured search of peer-reviewed research articles from PubMed and Google Scholar. Recent and up-to-date studies relevant to the topic were included.

Results: This report overviews current treatment and experimental drug for AD. Topical agents including topical phosphodiesterase E4 (PDE4) inhibitors such as crisaborole are efficacious in the treatment of AD with few side effects. Monoclonal antibodies such as dupilumab given subcutaneously are efficacious for more severe disease. Systemic treatment can ameliorate symptoms in severe and recalcitrant AD. New systemic treatment includes several traditional herbal formulations that have undergone clinical trials using modern research methodology to determine their efficacy and safety. AD is associated with many complicating psychosocial issues. Often suboptimal efficacy is due to unrealistic expectations and poor compliance making treatment difficult in spite of effective treatment and efforts in drug discovery. Randomized trials have shown that novel topical and subcutaneous medications are safe and efficacious. Regarding herbs, a methodology for the investigation of herbal medications is often flawed and scientific evidence is lacking. Experimental drugs include various biologics, PDE4 and JAK inhibitors in topical, oral, subcutaneous or intravenous forms are in various phases of trials.

Conclusion: Many novel medications demonstrate efficacy for AD. Experimental drugs include various biologics, PDE4 and JAK inhibitors are in various phases of trials.
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http://dx.doi.org/10.2147/JEP.S259299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126870PMC
May 2021

A boy with multiple patches of alopecia and an affected cat.

Paediatr Child Health 2021 Jun 9;26(3):135-136. Epub 2020 Apr 9.

Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta.

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http://dx.doi.org/10.1093/pch/pxaa035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077206PMC
June 2021

Visual Diagnosis: High Fever, Maculopapular Rash, Perianal Desquamation, and Conjunctivitis in a 3-year-old Boy.

Pediatr Rev 2021 05;42(5):e17-e22

Division of Cardiology, Department of Pediatrics, University of Southern California, Los Angeles, CA.

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http://dx.doi.org/10.1542/pir.2018-0330DOI Listing
May 2021

Acrodermatite entéropathique chez un garçon de 3 mois.

CMAJ 2021 04;193(17):E627-E628

Université de Calgary (Leung), Hôpital pour enfants de l'Alberta (Leung), Calgary, Alb.; Institut de pédiatrie (Leong), Hôpital général de Kuala Lumpur, Kuala Lumpur, Malaisie; Département de dermatologie et des sciences dermatologiques (Lam), Université de la Colombie-Britannique, Hôpital pour enfants de la Colombie-Britannique (Lam), Vancouver, C.-B.

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http://dx.doi.org/10.1503/cmaj.201181-fDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101976PMC
April 2021

Juvenile Dermatomyositis: Advances in Pathogenesis, Assessment, and Management.

Curr Pediatr Rev 2021 ;17(4):273-287

Department of Family Medicine, The University of Calgary, Calgary, Alberta,Canada.

Background: Juvenile dermatomyositis is the most common inflammatory myopathy in the pediatric age group and a major cause of mortality and morbidity in individuals with childhood rheumatic diseases. Mounting evidence suggests that early diagnosis and timely aggressive treatment are associated with better outcomes.

Objective: The purpose of this article is to provide readers with an update on the evaluation, diagnosis, and the treatment of juvenile dermatomyositis.

Methods: A PubMed search was performed in Clinical Queries using the key term "juvenile dermatomyositis" in the search engine. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. The information retrieved from the above search was used in the compilation of the present article.

Results: Juvenile dermatomyositis is a chronic autoimmune inflammatory condition characterized by systemic capillary vasculopathy that primarily affects the skin and muscles with possible involvement of other organs. In 2017, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) developed diagnostic criteria for juvenile idiopathic inflammatory myopathies and juvenile dermatomyositis. In the absence of muscle biopsies which are infrequently performed in children, scores (in brackets) are assigned to four variables related to muscle weakness, three variables related to skin manifestations, one variable related to other clinical manifestations, and two variables related to laboratory measurements to discriminate idiopathic inflammatory myopathies from non-idiopathic inflammatory myopathies as follows: objective symmetric weakness, usually progressive, of the proximal upper extremities (0.7); objective symmetric weakness, usually progressive, of the proximal lower extremities (0.8); neck flexors relatively weaker than neck extensors (1.9); leg proximal muscles relatively weaker than distal muscles (0.9); heliotrope rash (3.1); Gottron papules (2.1); Gottron sign (3.3); dysphagia or esophageal dysmotility (0.7); the presence of anti-Jo-1 autoantibody (3.9); and elevated serum levels of muscle enzymes (1.3). In the absence of muscle biopsy, a definite diagnosis of idiopathic inflammatory myopathy can be made if the total score is ≥7.5. Patients whose age at onset of symptoms is less than 18 years and who meet the above criteria for idiopathic inflammatory myopathy and have a heliotrope rash, Gottron papules or Gottron sign are deemed to have juvenile dermatomyositis. The mainstay of therapy at the time of diagnosis is a high-dose corticosteroid (oral or intravenous) in combination with methotrexate.

Conclusion: For mild to moderate active muscle disease, early aggressive treatment with high-dose oral prednisone alone or in combination with methotrexate is the cornerstone of management. Pulse intravenous methylprednisolone is often preferred to oral prednisone in more severely affected patients, patients who respond poorly to oral prednisone, and those with gastrointestinal vasculopathy. Other steroid-sparing immunosuppressive agents such as cyclosporine and cyclophosphamide are reserved for patients with contraindications or intolerance to methotrexate and for refractory cases, as the use of these agents is associated with more adverse events. Various biological agents have been used in the treatment of juvenile dermatomyositis. Data on their efficacy are limited, and their use in the treatment of juvenile dermatomyositis is considered investigational.
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http://dx.doi.org/10.2174/1573396317666210426105045DOI Listing
January 2022

Continuous Renal Replacement Therapy (CRRT) for Nonrenal Indications among Critically Ill Children with Malignancy.

Case Rep Pediatr 2021 13;2021:6660466. Epub 2021 Mar 13.

Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong.

The role of continuous renal replacement therapy (CRRT) has been expanding beyond support for acute kidney injury (AKI) in recent years. Children with malignancy are particularly at risk of developing conditions that may require CRRT. We reported three children with malignancy who received CRRT for non-AKI indications. Patient 1 was a 17-year-old teenage girl who developed refractory type B lactic acidosis due to relapse of acute lymphoblastic leukemia (ALL). Her peak lactate level was 18 mmol/L, and the lowest pH and bicarbonate level was 7.13 and 6.0 mmol/L, respectively. She received three sessions of high-volume hemodiafiltration to bring down the lactate level. Patient 2 was a 15-year-old male with T-cell ALL who developed cytokine storm requiring mechanical ventilatory and high-dose inotropic support due to necrotizing enterocolitis complicated by pneumoperitoneum and septicemia. He received two sessions of hemoperfusion using a specific filter capable of endotoxin absorption and cytokine removal and was successfully weaned off all inotropes after the treatment. Patient 3 was an 8-year-old boy who received bone marrow transplantation and developed worsening hyperbilirubinemia and deteriorating liver function. He received a session of single-pass albumin dialysis for bilirubin removal prior to liver biopsy. Except for mild electrolyte disturbances, no major CRRT complication was encountered. Our report demonstrated that CRRT is an effective and safe procedure for a wide spectrum of nonrenal conditions among children with oncological diagnoses in the pediatric intensive care unit. However, the optimal dose, regime, timing of initiation, and monitoring target for these indications remain to be determined.
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http://dx.doi.org/10.1155/2021/6660466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984898PMC
March 2021

An ulcerated giant segmental hemangioma resulting in contracture of the left elbow.

Paediatr Child Health 2021 Apr-May;26(2):e70-e72. Epub 2020 Apr 24.

Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia.

The majority of infantile hemangiomas are benign and will resolve on their own. We report a 4-month-old infant with an ulcerated giant segmental infantile hemangioma involving the left upper limb who developed a contracture of the left elbow despite treatment with oral propranolol, proper wound care, and regular intense physiotherapy. To our knowledge, contracture resulting from an infantile hemangioma has not been reported previously.
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http://dx.doi.org/10.1093/pch/pxaa050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962706PMC
April 2020

Cutaneous Lupus Erythematosus in Children.

Curr Pediatr Rev 2021 ;17(2):103-110

Department of Paediatrics, Associate Member, Department of Dermatology, University of British Columbia, Vancouver, British Columbia, AB, Canada.

Background: The skin is commonly involved in autoimmune diseases, such as lupus erythematous. The cutaneous lupus erythematosus (CLE) can manifest with or without systemic symptoms. It is advantageous from a patient and healthcare system standpoint for early diagnosis and intervention. Prevention of complications is especially important in the pediatric population.

Objective: To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric cutaneous lupus.

Methods: The search term "cutaneous lupus" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. The search was restricted to English literature and children. A descriptive, narrative synthesis of the retrieved articles was provided.

Results: A variety of innate and adaptive immune responses are being investigated to explain the pathogenesis of CLE. There are a number of variations of cutaneous manifestations varying from localized malar rash as in the case of ACLE lesions and papulosquamous psoriasiform lesions as in the case of SCLE to the multiple subtypes within chronic CLE. First-line pharmacological treatments include topicals, such as typical calcineurin inhibitors and corticosteroids, or oral agents, such as glucocorticoids, antimalarial drugs, and hydroxychloroquine.

Conclusion: CLE is inclusive of a number of subtypes that have varying dermatological manifestations in adult and pediatric populations. The current treatment modalities will change based on the newly understood molecular targets. Ongoing research on the mechanisms underlying CLE is necessary to derive new interventions for pediatric patients.
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http://dx.doi.org/10.2174/1573396317666210224144416DOI Listing
October 2021

Adolescent with physiologic striae atrophicae of the thighs.

Pediatr Dermatol 2021 Mar 19;38(2):510-511. Epub 2021 Feb 19.

Department of Dermatology and Skin Sciences, University of British Columbia and BC Children's Hospital Vancouver, Vancouver, BC, Canada.

Physiologic striae atrophicae of adolescence occur mainly in healthy nonobese adolescents in association with the adolescent growth spurt. The striae typically present as erythematous, purple, or violaceous, horizontal linear plaques in the lumbar area. Occurrence of striae elsewhere on the body exclusively is rare. A PubMed search of the English literature using the key terms "physiological striae atrophicae of adolescence" OR "physiological striae atrophicae of puberty" AND "thigh" did not yield any prior report. We report a teenager with physiologic striae atrophicae of adolescence with striae restricted to the thighs.
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http://dx.doi.org/10.1111/pde.14536DOI Listing
March 2021

Acrodermatitis enteropathica in a 3-month-old boy.

CMAJ 2021 Feb;193(7):E243

University of Calgary (Leung); Alberta Children's Hospital (Leung), Calgary, Alta.; Pediatric Institute (Leong), Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia; Department of Dermatology and Skin Sciences (Lam), University of British Columbia; BC Children's Hospital (Lam), Vancouver, BC.

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http://dx.doi.org/10.1503/cmaj.201181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034336PMC
February 2021

Diagnostic Yield of Bronchoalveolar Lavage in Immunocompromised Children.

J Trop Pediatr 2021 01;67(1)

Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, AB, Canada.

Results from early studies in the diagnostic yield of bronchoalveolar lavage (BAL) in immunocompromised adults and children were variable. This prospective study aimed to determine the diagnostic yield of BALs in immunocompromised children over the first 18 months of service at a newly established children's hospital. Relationship between BAL results and changes in antimicrobial management was also studied. Twenty-one bronchoscopic BALs were performed on 18 children; 14 BALs (66.7%) yielded at least 1 pathogen and 7 (33.3%) yielded no pathogen. Two pathogens were found in 2 samples, and 1 pathogen was identified in 12 samples. Bacteria (n = 7 patients), viruses (n = 8 patients) and fungus (Pneumocycstis jirovecii in one patient) were yielded. Of the 21 BALs, 8 (38.1%) were associated with changes in antimicrobial management (Fisher's exact test, p = 0.018). No significant side effects such as pneumothorax or pulmonary hemorrhages were observed in this series. In conclusion, BAL in immunocompromised children is rewarding and has potential to impact on antimicrobial management.
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http://dx.doi.org/10.1093/tropej/fmaa131DOI Listing
January 2021

Vitiligo: An Updated Narrative Review.

Curr Pediatr Rev 2021 ;17(2):76-91

Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong.

Background: Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism.

Objective: This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo.

Methods: A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English language. The information retrieved from the above search was used in the compilation of the present article.

Results: Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment.

Conclusion: The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.
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http://dx.doi.org/10.2174/1573396316666201210125858DOI Listing
October 2021

COVID-19 in Hong Kong - Public health, food safety, and animal vectors perspectives.

J Virol Methods 2021 04 4;290:114036. Epub 2020 Dec 4.

Department of Mechanical Engineering, The University of Hong Kong, Hong Kong Special Administrative Region.

The coronavirus disease 2019 (COVID-19) pandemic, caused by infection with a novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), has led to escalating morbidity and mortality in all nations and cities. SARS-CoV-2 lies within the same coronavirus family as SARS-CoV (2003) and MERS-CoV (2012), though there are genetic and epidemiological differences between the viruses, as well as different clinical presentations in the patients. Despite this, Hong Kong has so far managed to control the pandemic very successfully. Here we offer a Hong Kong perspective on different aspects of the pandemic virus (SARS-CoV-2) and the disease : public health (diagnosis and control), food safety (reducing transmission in the workplace) and animal vectors (controlling potential reservoirs of the virus and their movements).
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http://dx.doi.org/10.1016/j.jviromet.2020.114036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717881PMC
April 2021

An Overview of the Pediatric Toxidromes and Poisoning Management.

Curr Rev Clin Exp Pharmacol 2021 ;16(4):318-329

Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary AB, Canada.

Background: Poisoning is one of the leading causes of childhood morbidity and mortality worldwide. Despite the advancement of poison detection by modern investigation methods, the clinical skill of toxidrome recognition by combining the findings from a detailed history, thorough physical examination, and the results of basic investigations is still indispensable for the management of children with suspected poisoning.

Objective: The aim was to review pediatric toxidromes and poisoning management.

Methods: A literature search was conducted on PubMed (between February 1 and 15, 2020) with keywords "toxidrome" "poisoning" "intoxication" "children" and "pediatric". The search was customized by applying the appropriate filters so as to get the most relevant articles to meet the objective of this review article.

Results: Toxidrome recognition may offer a quick guide to possible toxicology diagnosis so that specific antidote can be administered in a timely manner. This article discusses a few commonly encountered toxidromes in pediatric poisoning, with an emphasis on the symptomatology and source of exposure. The antidote and specific management for each toxidrome are also discussed. Although most patients with intoxication can be managed with close observation, supportive measures and antidote treatment, it is unfortunate that antidotes are only available for a limited number of poisons responsible for intoxication. Extracorporeal toxin removal is being increasingly recognized as a mode of treatment for patients with rapid deterioration who are unresponsive to conventional management. The decision to apply such technique and the choice of modality are frequently individualized due to the paucity of high-level evidence. The various patient and toxin/medication factors involved in the decision- making process are discussed.

Conclusion: Poisoning is a common cause of pediatric accidents and injuries. Physicians should be familiar with common toxidromes and poisoning management.
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http://dx.doi.org/10.2174/1574884715666201201090210DOI Listing
April 2022

Childhood Infectious Encephalitis: An Overview of Clinical Features, Investigations, Treatment, and Recent Patents.

Recent Pat Inflamm Allergy Drug Discov 2020 ;14(2):156-165

Department of Pediatrics, Division of Pediatric Neurology, Pediatric Traumatic Brain Injury Program, Associate Professor of Pediatrics and Neurology, Boston University, School of Medicine, Boston, MA, United States.

Background: Infectious encephalitis is a serious and challenging condition to manage. This overview summarizes the current literature regarding the etiology, clinical manifestations, diagnosis, management, and recent patents of acute childhood infectious encephalitis.

Methods: We used PubMed Clinical Queries as a search engine and used keywords of "encephalitis" AND "childhood" Patents were searched using the key term "encephalitis" in google.patents.- com and patentsonline.com.

Results: Viral encephalitis is the most common cause of acute infectious encephalitis in children. In young children, the clinical manifestations can be non-specific. Provision of empiric antimicrobial therapy until a specific infectious organism has been identified, which in most cases includes acyclovir, is the cornerstone of therapy. Advanced investigation tools, including nucleic acid-based test panel and metagenomic next-generation sequencing, improve the diagnostic yield of identifying an infectious organism. Supportive therapy includes adequate airway and oxygenation, fluid and electrolyte balance, cerebral perfusion pressure support, and seizure control. Recent patents are related to the diagnosis, treatment, and prevention of acute infectious encephalitis.

Conclusion: Viral encephalitis is the most common cause of acute infectious encephalitis in children and is associated with significant morbidity. Recent advances in understanding the genetic basis and immunological correlation of infectious encephalitis may improve treatment. Third-tier diagnostic tests may be incorporated into clinical practice. Treatment is targeted at the infectious process but remains mostly supportive. However, specific antimicrobial agents and vaccines development is ongoing.
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http://dx.doi.org/10.2174/1872213X14999201124195724DOI Listing
September 2021
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