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

BackgroundThe purposes of this study were to assess the usefulness of myocardial 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for evaluating myocardial metabolic status in hypertrophic cardiomyopathy (HCM) and the therapeutic efficacy of alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy (HOCM).MethodsThirty HCM patients (64.4±10.5 years, 14 male, 12 hypertrophic non-obstructive cardiomyopathy [HNCM], 16 HOCM, and 2 dilated phase of HCM) underwent 18F-FDG-PET/CT. 18F-FDG uptake was semi-quantitatively evaluated using an uptake score in each 17 segment and the entire LV or regional standardized uptake value (SUV).Results18F-FDG uptake was observed mostly in a hypertrophied myocardium in HNCM patients, whereas 18F-FDG was extensively accumulated beyond the hypertrophied myocardium in HOCM patients. There was a positive correlation between the summed uptake score of 18F-FDG and high-sensitive troponin T level in HNCM patients (r = 0.603, p = 0.049), whereas the score was positively correlated with brain natriuretic peptide level (r = 0.614, p = 0.011) in HOCM patients. In 10 patients who received ASA, the maximum SUV of the entire LV was significantly reduced from 5.6±2.6 to 3.2±2.1 (p = 0.040) after ASA. Reduction of that maximum SUV was particularly significant in the lateral region (from 5.5±2.6 to 2.9 ±2.2, p = 0.024) but not significant in the anteroseptal region (from 4.5±2.6 to 2.9±1.6, p = 0.12).ConclusionExtensive 18F-FDG uptake beyond the hypertrophied myocardium was observed in HOCM. ASA attenuates 18F-FDG uptake in a remote lateral myocardium.

BPV is related to coronary plaque volume, but not to coronary plaque vulnerability. In addition to conventional coronary risk factors, BPV may be a therapeutic target for coronary atherosclerosis.

Age was independently correlated with LV concentric/functional changes regardless of LV hypertrophy, suggesting that ageing is independently involved in the progression of LV remodelling.

Streptococcus agalactiae (Group B streptococcus, GBS) is the major pathogen encountered in the perinatal period, although the incidence of GBS infection has recently increased among non-pregnant adults. Nevertheless, GBS infective endocarditis (IE) is uncommon and often accompanies aortic embolism. We experienced two cases of GBS IE. In Case 1, mobile vegetation of the aortic valve caused an infective cerebral aneurysm. In Case 2, the patient experienced an acute aortic embolic episode. Generally, early surgery for large mobile sites of vegetation is recommended as a class IIb therapy in the guidelines. GBS IE often exhibits a severe clinical course and specificity of vegetation. Therefore, early surgery should be considered in such cases.