MyMedR

Massive paediatric pulmonary haemorrhage in Dieulafoy's disease: Roles of CT angiography, embolisation and bronchoscopy

Woodhull S, Bush A, Tang AL, Padley S

Paediatr Respir Rev, 2020 Nov;36:100-105.

PMID: 32680823 DOI: 10.1016/j.prrv.2020.06.001

Acute, major pulmonary haemorrhage in children, is rare, may be life-threatening and at times presents atypically. Dieulafoy's disease of the bronchus presenting with recurrent or massive hemoptysis was first described in adults. Prior to reviewing the literature, we report an illustrative case of bronchial Dieulafoy's disease (BDD) in a child presenting unusually with massive apparent hematemesis. The source of bleeding is a bronchial artery that fails to taper as it terminates within the bronchial submucosa. A high index of suspicion is required to identify such lesions via radiological imaging and the role of bronchial artery embolisation is highlighted with video images of angiography included.

Pediatric Achalasia

Woodhull S, Raja Segar D

N Engl J Med, 2021 Oct 28;385(18):e64.

PMID: 34677918 DOI: 10.1056/NEJMicm2108193

Severe pediatric oral mucositis

Woodhull S, Chwen CC, Yang TZ

J Fam Pract, 2022 Nov;71(9):413-415.

PMID: 36538779 DOI: 10.12788/jfp.0511

We initially suspected primary herpetic gingivostomatitis. But the patient's lab work, persistent fever, and cough led us in a different direction.

Infantile intracardiac thrombus in severe encephalo-myocarditis

Woodhull S, Choo KK, Terumalay SD, Liew PS, Tan ZY

Med J Malaysia, 2021 Nov;76(6):956-959.

PMID: 34806696

Myocarditis is an uncommon disease in childhood and has a wide range of clinical presentations, from subtle to devastating and thus requires a high index of suspicion. Intracardiac thrombus formation following myocarditis is rare and thus its management remains challenging and not well defined. We report a child whom presented with a viral prodrome, rapidly deteriorated into multi organ failure and developed fulminant viral myocarditis with encephalitis that was complicated with an intracardiac thrombus formation. We describe the challenges faced, the successful medical treatment offered and propose factors that can help guide appropriate treatment.

Pediatric Flexible Bronchoscopy in Singapore: A 10-year Experience

Woodhull S, Goh Eng Neo A, Tang Poh Lin J, Chay OM

J Bronchology Interv Pulmonol, 2010 Apr;17(2):136-41.

PMID: 23168729 DOI: 10.1097/LBR.0b013e3181dc993a

To determine the results of children who underwent flexible bronchoscopy and bronchoalveolar lavage (BAL) in the Respiratory Medicine Service of Kandang Kerbau Women's and Children's Hospital from 1996 to 2005.

Fulltext Economic value of atopic dermatitis prevention via infant formula use in high-risk Malaysian infants

Bhanegaonkar AJ, Horodniceanu EG, Abdul Latiff AH, Woodhull S, Khoo PC, Detzel P, et al.

Asia Pac Allergy, 2015 Apr;5(2):84-97.

PMID: 25938073 DOI: 10.5415/apallergy.2015.5.2.84

BACKGROUND: Breastfeeding is best for infants and the World Health Organization recommends exclusive breastfeeding for at least the first 6 months of life. For those who are unable to be breastfed, previous studies demonstrate that feeding high-risk infants with hydrolyzed formulas instead of cow's milk formula (CMF) may decrease the risk of atopic dermatitis (AD).

OBJECTIVE: To estimate the economic impact of feeding high-risk, not exclusively breastfed, urban Malaysian infants with partiallyhydrolyzed whey-based formula (PHF-W) instead of CMF for the first 17 weeks of life as an AD risk reduction strategy.

METHODS: A cohort Markov model simulated the AD incidence and burden from birth to age 6 years in the target population fed with PHF-W vs. CMF. The model integrated published clinical and epidemiologic data, local cost data, and expert opinion. Modeled outcomes included AD-risk reduction, time spent post AD diagnosis, days without AD flare, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs are expressed in Malaysian Ringgit (MYR; MYR 1,000 = United States dollar [US $]316.50).

RESULTS: Feeding a high-risk infant PHF-W vs. CMF resulted in a 14% point reduction in AD risk (95% confidence interval [CI], 3%-23%), a 0.69-year (95% CI, 0.25-1.10) reduction in time spent post-AD diagnosis, additional 38 (95% CI, 2-94) days without AD flare, and an undiscounted gain of 0.041 (95% CI, 0.007-0.103) QALYs. The discounted AD-related 6-year cost estimates when feeding a high-risk infant with PHF-W were MYR 1,758 (US $556) (95% CI, MYR 917-3,033) and with CMF MYR 2,871 (US $909) (95% CI, MYR 1,697-4,278), resulting in a per-child net saving of MYR 1,113 (US $352) (95% CI, MYR 317-1,884) favoring PHF-W.

CONCLUSION: Using PHF-W instead of CMF in this population is expected to result in AD-related costs savings.

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