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We report the first case of successful fetal pleurodesis with OK-432 for recurrent severe fetal primary chylothorax after failing repeated pleuroamniotic shunting. Shunting and pleurodesis could be complementary to each other in the treatment of fetal chylothorax.

Objectives: To examine the effect of rapid aneuploidy testing by amnio-PCR on anxiety levels and quality of life measures in women and their partners with positive Down screening result. Methods: In the original design, screen-positive women were to be randomized to have amnio-PCR or not. Of the first 60 women approached to join the study between April 2004 and April 2005, 4 declined amniocentesis, 14 agreed to be randomized, while the other 42 (75%) chose to pay for the amnio-PCR themselves (3 excluded: 2 because of Down syndrome and 1 dropout). The study was thus performed as a prospective observational study on the remaining 39 women of the last group. The longitudinal profile of the state-anxiety and quality of life domain scores for this cohort were studied using the Spielberger State-Trait Anxiety Inventory and WHO Quality of Life Measure – abbreviated version (Hong Kong) Questionnaire at 5 time points: (1) before amniocentesis, (2) 2 days after amniocentesis when amnio-PCR report was disclosed, (3) 3 weeks after amniocentesis when karyotyping report was disclosed, (4) 30–32 weeks’ gestation, (5) 6 weeks after delivery. Results: In the final cohort of 39 women and 27 partners, a significant reduction in their state-anxiety scores was found when they received the normal amnio-PCR report. On the other hand, there was no significant change in their quality of life domain scores. Conclusions: There is a demand from women and their partners who had a positive Down screening result for rapid aneuploidy testing (amnio-PCR) which can effectively alleviate their anxiety. A rapid aneuploidy test should be made available to women in a Down screening programme.

We present an evaluation of the diagnosis, management and outcome of a pair of heterokaryotypic monozygotic dichorionic twins. The heterokaryotype was an incidental finding from an amniocentesis performed for prenatal diagnosis of β-thalassaemia major in a pair of dichorionic twins. Monozygocity was revealed by QF-PCR showing identical short tandem repeat markers on chromosomes 21, 18, 13, X and Y. The twins were heterokaryotypic for duplication chromosome 2q13-q23.3, as shown by array comparative genomic hybridization. Selective foeticide was performed. This case demonstrates that heterokaryotypic monozygotic dichorionic twins are a genetic possibility that does occur.

Objectives To validate the clinical efficacy and practical feasibility of massively parallel maternal plasma DNA sequencing to screen for fetal trisomy 21 among high risk pregnancies clinically indicated for amniocentesis or chorionic villus sampling.Design Diagnostic accuracy validated against full karyotyping, using prospectively collected or archived maternal plasma samples.Setting Prenatal diagnostic units in Hong Kong, United Kingdom, and the Netherlands.Participants 753 pregnant women at high risk for fetal trisomy 21 who underwent definitive diagnosis by full karyotyping, of whom 86 had a fetus with trisomy 21. Intervention Multiplexed massively parallel sequencing of DNA molecules in maternal plasma according to two protocols with different levels of sample throughput: 2-plex and 8-plex sequencing. Main outcome measures Proportion of DNA molecules that originated from chromosome 21. A trisomy 21 fetus was diagnosed when the z score for the proportion of chromosome 21 DNA molecules was >3. Diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were calculated for trisomy 21 detection.Results Results were available from 753 pregnancies with the 8-plex sequencing protocol and from 314 pregnancies with the 2-plex protocol. The performance of the 2-plex protocol was superior to that of the 8-plex protocol. With the 2-plex protocol, trisomy 21 fetuses were detected at 100% sensitivity and 97.9% specificity, which resulted in a positive predictive value of 96.6% and negative predictive value of 100%. The 8-plex protocol detected 79.1% of the trisomy 21 fetuses and 98.9% specificity, giving a positive predictive value of 91.9% and negative predictive value of 96.9%.Conclusion Multiplexed maternal plasma DNA sequencing analysis could be used to rule out fetal trisomy 21 among high risk pregnancies. If referrals for amniocentesis or chorionic villus sampling were based on the sequencing test results, about 98% of the invasive diagnostic procedures could be avoided.

Introduction: Non-prescription slimming products are popular and can be easily purchased from the Internet. However, adulteration of these products with undeclared substances including prescription drugs is not uncommon. We report a case of serotonin syndrome after an overdose of a non-prescription product containing sibutramine. Case report: A 21-year-old woman presented with somnolence, sinus tachycardia, generalised increase in tone, hyper-reflexia and clonus more prominent in the lower limbs after an intentional overdose of a non-prescription slimming product obtained from the Internet. The product was later found to contain sibutramine and other substances such as animal thyroid tissues, caffeine and phenolphthalein. Quantitative analysis of patient’s serum on presentation revealed a sibutramine concentration of 112 ng/mL, which far exceeded the reported peak serum concentration after a single oral dose of 15 mg (the maximum daily recommended dose). No other culpable agent was identified. The overall clinical presentation was compatible with serotonin syndrome associated with sibutramine overdose. The patient made a full recovery after supportive management. Discussion and conclusion: This case highlighted the health threat posed by non-prescription slimming products sold over the Internet. Sibutramine overdose can result in serotonin syndrome, as in overdose of other serotonergic agents. Early recognition and timely supportive treatment are essential to ensure a good clinical outcome.

From 2009 to 2017, we identified only seven instances.2 Subsequently, an additional six cases were recorded between 2018 and 2022 (unpublished data, 2022). Since its identification in toxicology samples in the United States in 2021, the abuse of N,N-dimethylpentylone has become increasingly prevalent.3 This substance has also been detected in New Zealand and Spain through on-site pill testing, analysis of seized materials, and wastewater-based epidemiological investigations.4 The use and abuse of synthetic cathinones can result in a sympathomimetic toxidrome characterised by agitation, tachycardia, hyperthermia, convulsions, rhabdomyolysis, cardiovascular collapse, and ventricular arrhythmias. Author contributions All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity. HS Leung 1,2; Magdalene HY Tang 1,2; HF Tong 1,2; YK Chong 1,2 1 Hospital Authority Toxicology Reference Laboratory, Hong Kong SAR, China 2 Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China

To the Editor—Ketamine analogues are new psychoactive substances that share the arylcyclohexylamine backbone of ketamine and produce dissociative effects through antagonistic activity at the N-methyl-D-aspartate receptor.1Ketamine and its analogues have plagued Hong Kong over the last two decades. Analysis or interpretation of data: TM Han 1,2; Magdalene HY Tang 1,2; HF Tong 1,2; YT Cheung 1,2; Jeremiah SB Tseung 1,2; MK Yip 1,2; CK Ching 1,2; YK Chong 1,2 1 Hospital Authority Toxicology Reference Laboratory, Hong Kong SAR, China 2 Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China

The Hospital Authority Toxicology Reference Laboratory—the only tertiary referral laboratory for toxicological analysis in Hong Kong, established in 2004—did not encounter cases of LSD intoxication until 2015. The patient's blood pressure was 116/80 mm Hg, heart rate was 150 beats per minute, body temperature was 39.2℃, and pupil sizes were 5 mm bilaterally. The patient's blood pressure was 127/50 mm Hg, heart rate was 167 beats per minute, body temperature was 38.7℃, and pupil sizes were 6 mm bilaterally. Ethics approval Ethics approval for this study was granted by the Hong Kong Hospital Authority Kowloon West Cluster Research Ethics Committee (Ref KW/EX-19-003).