A small but important proportion of patients with epidermolysis bullosa (EB) may develop significant renal and urological complications which can have a major impact on their morbidity and mortality. During the last 10 years, five of a large group of children with EB under our care, with either dystrophic or junctional types of disease, experienced major nephro-urological complications. Two patients with recessive dystrophic EB (REDB) developed macroscopic haematuria - one had renal failure and underwent a renal biopsy showing IgA nephropathy. A third patient with RDEB also developed renal failure and his biopsy demonstrated postinfectious glomerulonephritis/type III membranoproliferative (mesangiocapillary) glomerulonephritis. Both patients with renal failure underwent peritoneal dialysis. Two patients with junctional EB developed obstructive uropathies, which required bladder reconstruction and the fashioning of a Mitrofanoff channel in one.

A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription.

Background On January 30, COVID-19 was declared a Public Health Emergency of International Concern—a week after Singapore’s first imported case and 5 days before local transmission. The National University Hospital (NUH) is Singapore’s third largest hospital with 1200 beds, heavy clinical workloads, and major roles in research and teaching. Main body With memories of SARS still vivid, there was an urgent requirement for the NUH Division of Infectious Diseases to adapt—undergoing major reorganization to face rapidly changing priorities while ensuring usual essential services and standards. Leveraging on individual strengths, our division mobilized to meet the demands of COVID-19 while engaging in high-level coordination, strategy, and advocacy. We present our experience of the 60 days since the nation’s first case. During this time, our hospital has managed 3030 suspect cases, including 1300 inpatients, 37 confirmed cases, and overseen 4384 samples tested for COVID-19. Conclusion Complex hospital adaptations were supported by an unprecedented number of workflows and coordination channels essential to safe and effective operations. The actions we describe, aligned with international recommendations and emerging evidence-based best practices, may serve as a framework for other divisions and institutions facing the spread of COVID-19 globally.

Background Obesity and shorter telomeres increase the risk for diabetes complications and mortality. However, the relationship between obesity and telomere length in diverse Asian populations with type 2 diabetes (T2D) is not well understood. This study examined the association of baseline and changes in obesity indices with telomere length in multiethnic Asian populations with T2D. Methods Leukocyte telomere length (LTL) was measured by quantitative polymerase chain reaction in the SMART2D cohort (n = 1431 at baseline, n = 1039 after 3.2 years median follow‐up). Associations between obesity indices and LTL were assessed by linear regression. Results Compared with Chinese, LTL was longer in Malays (P < 0.0001) and similar in Indians. Cross‐sectionally, body mass index (BMI)‐adjusted (residual) visceral fat area (VFA; β = −0.004, P = 0.006), and waist‐to‐hip ratio (β = −1.95, P = 0.030) were significantly associated with LTL in Chinese but not in Malays and Indians. Changes in BMI (r = −0.080; P = 0.053) and VFA (r = −0.126; P = 0.002) were inversely correlated with changes in LTL only in Chinese. Furthermore, in Chinese, 1‐SD incremental changes in BMI (β = −0.070; P = 0.040) and VFA (β = −0.088, P = 0.028) were significantly associated with larger telomere attrition, independent of age, sex, diabetes condition, baseline LTL, obesity, and inflammation markers. Conclusions Three‐year changes in BMI and VFA were associated with telomere dynamics in Chinese but not in Malays and Indians with T2D. Reducing obesity may reduce the risk of diabetes complications associated with shorter LTL in the Chinese population.

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Immunocompromised patients are susceptible to infections from common and unusual microorganisms. Protothecosis is seldom suspected on clinical grounds, yet it is readily diagnosed once detected in the laboratory. We report the first pediatric liver transplant recipient with pulmonary protothecosis, detected during an episode of Pneumocystis jirovecii pneumonia, and we conducted a review of the available literature.

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LETTER TO THE EDITORDear Editor, Coronavirus disease 2019 arrived in Singapore in January 2020 as imported cases, followed by local transmission predominantly involving dormitories, with later spread within the wider community. Children still represent the minority of cases in Singapore, with around 8,000 paediatric cases as of 6 November 2021 out of a total of over 200,000 cases. Only 0.034% of children younger than 12 years old needed oxygen supplementation, intensive care, or died. 1,2 A few possible reasons have been postulated: firstly, children may have more robust innate responses to viral infections; secondly, angiotensin-converting enzyme 2 receptors may be immature or less expressed in the respiratory tract of a child; and thirdly, children may have increased mucociliary clearance. 3 In 2021, with the emergence of the Delta variant, rising local transmission, and children <12 years old remaining unvaccinated, we started to experience the fuller spectrum of paediatric SARS-CoV-2 infection. We describe the first Singapore cases known to the authors of vertically transmitted COVID-19, and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, in the setting of a tertiary paediatric unit in National University Hospital in Singapore. The unit has about 109 paediatric inpatient beds and an intensive/high dependency care capacity of 18 beds.Vertically transmitted COVID-19 in a newborn. In our centre, mothers with active COVID-19 infection are offered the option of rooming separately from their newborn after delivery, especially if they are deemed highly infectious by being early in illness with a low cycle threshold (CT) value. Active COVID-19 infection is defined as duration of the illness and infectivity is generally taken to be 10 days if the woman is fully vaccinated and 14 days if she is unvaccinated. Breast milk is the preferred feeding option regardless of whether the newborn is separated from the mother or rooming with her. Investigation-wise, cord blood is sent for SARS-CoV-2 serology at birth. Initially, nasopharyngeal swabs for SARS-CoV-2 RNA polymerase chain reaction (PCR) were performed in neonates after birth, and on days 1 and 2 of life, with accompanying stool samples sent for PCR. This has since been rationalised to only on days 1 and 2 of life. If the neonate