Acute myeloid leukemia (AML) Treatment in Singapore

The prognosis depends on the patient's age, response to treatment, presence of genetic mutations, and whether the leukemia was acute or relapsed. Better treatment results are seen in younger patients with favorable mutations.

Treatment may cause fatigue, nausea and vomiting, loss of hair, infections, low blood counts, and organ toxicity. Long-term side effects primarily include heart, lung, and immune system dysfunction.

Although genetic mutations are a cause of AML, the vast majority of cases are not inherited. However, a family history of leukemia or other genetic syndromes can increase the risk of developing AML.

Singapore has advanced centers performing autologous and allogeneic stem cell transplants.

Yes, many Singaporean hospitals offer specialised services for international AML patients.

MRD testing helps detect tiny traces of leukemia after treatment and is widely used in Singapore.

Hospitals offer translation services, accommodation assistance, and specialised oncology care.

Patients are generally advised to follow a high-protein, high-calorie, balanced diet, maintain good hygiene to prevent infections, and manage stress effectively. Regular follow-up visits are essential to detect complications or relapse early.

Common complications of AML are infections, bleeding, and organ impairment owing to the low blood cell count. The significant complications, which could lead to respiratory or organ failure, are mostly experienced during intensive treatments like chemotherapy.

Stroke in Children : Rare But Real

Childhood stroke is uncommon but can have serious effects on kids, often leading to significant health challenges. The causes vary and differ from those seen in adults. There's still a lot to learn about strokes in children. It's crucial for doctors working with young patients to recognize the signs of a stroke at any age so they can provide appropriate care, helping the brain heal and function better.

Stroke is defined by the World Health Organization (WHO) as “a clinical syndrome consisting of rapidly developing clinical signs of focal (global in case of coma) disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin.”

Type of stroke based on a child's age:

Perinatal stroke: It happens between 28 weeks of pregnancy and the first 28 days after birth. There are two main types within this category. Acute perinatal strokes occur right at or soon after birth and can show up as focal seizures or changes in consciousness. On the other hand, presumed perinatal strokes are chronic problems identified later on, believed to have happened during the earlier period.

Childhood stroke: which occurs from 28 days after birth up until the age of 18. Ischemic stroke in children happens in about 1 to 2 out of every 100,000 kids each year in developed Western countries. The risk is greatest for infants and kids under 5, and it affects boys more often than girls. Also, Black and Asian children tend to experience strokes more frequently than white children.

How common is stroke in children

Studies show there are about 1 to 2 cases of stroke for every 100,000 kids under 18 each year. For newborns, the rate is roughly 1 perinatal stroke for every 3,500 live births. It’s important to note that these figures can be tricky to pinpoint because diagnosing strokes can be quite difficult.

What are the risk factor in children for stroke

Risk factors include both maternal and neonatal factors. Normal activation of coagulation factors in the mother and low levels of factors in the infant just before and after the time of delivery may contribute to the increased stroke risk in neonates

Neonatal Risk Factors

1. Congenital heart diseases
2. Blood clotting disorder
3. Lack of oxygen during birth
4. Infection
5. Trauma
6. Genetic syndrome, e.g., Down syndrome.
7. Cardiac defects
8. Brain or Neck injury

Maternal Risk Factors

1. History of infertility
2. Premature rupture of membranes
3. Emergency cesarean section
4. Gestational or delivery complications
5. Dehydration
6. Traumatic Brain Injury
7. Infection
8. Obesity
9. High blood pressure

Common signs and symptoms of stroke in children

1. Seizure
2. One-side weakness (hemiparesis)
3. Irritability (Ataxia)
4. Sensory loss
5. Changes in behavior and thinking
6. Swallowing difficulty (dysphagia)
7. No neck control in early ages
8. Affects ability to communicate (aphasia)
9. Vision and hearing loss
10. Cognitive changes or problems with memory, judgment, focus and problem solving
11. Learning disabilities, including poor attention skills

Various imaging tests diagnosing a stroke in children

• CT scan (computed tomography scan): It is often the first choice, as it quickly reveals any bleeding in the brain. If more detail is needed, an MRI provides a detailed look at your child’s brain and blood vessels, making it the best test for spotting a stroke.
• MRI (magnetic resonance imaging): To check the blood vessel lesions.
• MRA (magnetic resonance angiogram): which shows how blood flows in the brain. Additionally, to understand the reasons behind.
• Echocardiogram (ECG): To check the heart anatomy.
• Electroencephalogram (EEG): To see if seizures are happening and blood tests to rule out conditions like sickle cell disease or issues that could lead to blood clots.

Management of Stroke in Children:

• Antibiotics
• Corticosteroid
• Blood transfusion
• Opening blocked vessels through drugs or surgeries
• Blood-thinning medication
• Prevent high pressure in brain

Every kid's journey is different. It’s important to have a multidisciplinary team that includes an occupational and physical therapist, a speech therapist, a neuropsychologist, a social worker, school officials, and a nutritionist. Together, they make a customized recovery plan. After a child has a stroke, they might face challenges like weak muscles, tight muscles, difficulty swallowing, issues with thinking, or trouble speaking and balance.

Strokes in children are difficult to diagnose because the symptoms are often subtle, which means they can be easily misdiagnosed. It is really important to thoroughly check a child's neurological health, look at their symptoms, and use radiological tests for an accurate diagnosis. Getting this diagnosis quickly is crucial. When we do, it can lead to better long-term outcomes and reduce the risk of serious neurological issues that could develop if a stroke isn’t treated properly.