Extended medial sural artery perforator free flap for groin and scrotal reconstruction

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearmbased flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

Molecular detection of Haemophilus parasuis serotypes 4, 5 or 12 and 13 in Peninsular Malaysia

@#Although the economic importance of Haemophilus parasuis infection causing Glasser’s disease is prevalent throughout pig farms in Peninsular Malaysia, there is a dearth of knowledge on its actual nature. In this study, a multiplex PCR was performed to screen for three major predominant virulent strains of H. parasuis, which are serotypes 4, 5 or 12 and 13. A total of 175 tissues or bodily fluid samples of various parts were collected from diseased animals from October, 2016 to February, 2018; with total of 62.9% positive detection of H. parasuis. The highest detection was found to be in the pericardial sac fibrin (90.9%) followed by pleural fibrin, lung, pleural fluid, tonsil, pericardial sac, peritoneal fluid, abdominal fibrin, joint fluid, brain and pericardium. Serotype 13 was the highest (40/110) followed by serotype 4(37/110), serotype 5(31/110) and 12 samples were nontypable (12/110). The presence of untypable serotype also drives to further identification of other serotypes in Malaysia.

Diabetic macular edema: Evidence-based management

Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetic retinopathy with an increasing prevalence tied to the global epidemic in type 2 diabetes mellitus. Its pathophysiology starts with decreased retinal oxygen tension that manifests as retinal capillary hyperpermeability and increased intravascular pressure mediated by vascular endothelial growth factor (VEGF) upregulation and retinal vascular autoregulation, respectively. Spectral domain optical coherence tomography (SD-OCT) is the cornerstone of clinical assessment of DME. The foundation of treatment is metabolic control of hyperglycemia and blood pressure. Specific ophthalmic treatments include intravitreal anti-VEGF drug injections, intravitreal corticosteroid injections, focal laser photocoagulation, and vitrectomy, but a substantial fraction of eyes respond incompletely to all of these modalities resulting in visual loss and disordered retinal structure and vasculature visible on SD-OCT and OCT angiography. Efforts to close the gap between the results of interventions within randomized clinical trials and in real-world contexts, and to reduce the cost of care increasingly occupy innovation in the social organization of ophthalmic care of DME. Pharmacologic research is exploring other biochemical pathways involved in retinal vascular homeostasis that may provide new points of intervention effective in those cases unresponsive to current treatments.

Interregional correlations of glucose metabolism between the basal ganglia and different cortical areas: an ultra-high resolution PET/MRI fusion study using 18F-FDG

Basal ganglia have complex functional connections with the cerebral cortex and are involved in motor control, executive functions of the forebrain, such as the planning of movement, and cognitive behaviors based on their connections. The aim of this study was to provide detailed functional correlation patterns between the basal ganglia and cerebral cortex by conducting an interregional correlation analysis of the 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) data based on precise structural information. Fifteen participants were scanned with 7-Tesla magnetic resonance imaging (MRI) and high resolution research tomography (HRRT)-PET fusion system using 18F-FDG. For detailed interregional correlation analysis, 24 subregions of the basal ganglia including pre-commissural dorsal caudate, post-commissural caudate, pre-commissural dorsal putamen, post-commissural putamen, internal globus pallidus, and external globus pallidus and 80 cerebral regions were selected as regions of interest on the MRI image and their glucose metabolism were calculated from the PET images. Pearson's product-moment correlation analysis was conducted for the interregional correlation analysis of the basal ganglia. Functional correlation patterns between the basal ganglia and cerebral cortex were not only consistent with the findings of previous studies, but also showed new functional correlation between the dorsal striatum (i.e., caudate nucleus and putamen) and insula. In this study, we established the detailed basal ganglia subregional functional correlation patterns using 18F-FDG PET/MRI fusion imaging. Our methods and results could potentially be an important resource for investigating basal ganglia dysfunction as well as for conducting functional studies in the context of movement and psychiatric disorders.

Effects of a juvenile hormone analogue pyriproxyfen on monogynous and polygynous colonies of the Pharaoh ant Monomorium pharaonis (Hymenoptera: Formicidae)

To evaluate the effects of the juvenile hormone analogue pyriproxyfen on colonies of the Pharaoh ant Monomorium pharaonis (L.), peanut oil containing different concentrations (0.3, 0.6, or 0.9%) of pyriproxyfen was fed to monogynous (1 queen, 500 workers, and 0.1 g of brood) and polygynous (8 queens, 50 workers, and 0.1 g of brood) laboratory colonies of M. pharaonis. Due to its delayed activity, pyriproxyfen at all concentrations resulted in colony elimination. Significant reductions in brood volume were recorded at weeks 3 – 6, and complete brood mortality was observed at week 8 in all treated colonies. Brood mortality was attributed to the disruption of brood development and cessation of egg production by queens. All polygynous colonies exhibited significant reduction in the number of queens present at week 10 compared to week 1. Number of workers was significantly lower in all treated colonies compared to control colonies at week 8 due to old-age attrition of the workers without replacement. At least 98.67 ± 1.33% of workers were dead at week 10 in all treated colonies. Thus, treatment with slow acting pyriproxyfen at concentrations of 0.3 – 0.9% is an effective strategy for eliminating Pharaoh ant colonies.

Tissue transfer techniques in reconstructive urology

Tissue transfer techniques are an essential part of the reconstructive urologist's armamentarium. Flaps and graft techniques are widely used in genital and urethral reconstruction. A graft is tissue that is moved from a donor site to a recipient site without its native blood supply. The main types of grafts used in urology are full thickness grafts, split thickness skin grafts and buccal mucosa grafts. Flaps are transferred from the donor site to the recipient site on a pedicle containing its native blood supply. Flaps can be classified based on blood supply, elevation methods or the method of transfer. The most used flaps in urology include penile, preputial, and scrotal skin. We review the various techniques used in reconstructive urology and the outcomes of these techniques.

Randomized, controlled trial comparing the effects of anesthesia with propofol, isoflurane, desflurane and sevoflurane on pain after laparoscopic cholecystectomy / Estudo randômico controlado que compara os efeitos da anestesia com propofol, isoflurano, desflurano e sevoflurano sobre a dor pós-colecistectomia videolaparoscópica / Estudio aleatorizado controlado comparando los efectos de la anestesia con propofol, isoflurano, desflurano y sevoflurano sobre el dolor poscolecistectomía videolaparoscópica

Background: Pain is the primary complaint and the main reason for prolonged recovery after laparoscopic cholecystectomy. The authors hypothesized that patients undergoing laparoscopic cholecystectomy will have less pain four hours after surgery when receiving maintenance of anesthesia with propofol when compared to isoflurane, desflurane, or sevoflurane. Methods: In this prospective, randomized trial, 80 patients scheduled for laparoscopic cholecystectomy were assigned to propofol, isoflurane, desflurane, or sevoflurane for the maintenance of anesthesia. Our primary outcome was pain measured on the numeric analog scale four hours after surgery. We also recorded intraoperative use of opioids as well as analgesic consumption during the first 24 h after surgery. Results: There was no statistically significant difference in pain scores four hours after surgery (p = 0.72). There were also no statistically significant differences in pain scores between treatment groups during the 24 h after surgery (p = 0.45). Intraoperative use of fentanyl and morphine did not vary significantly among the groups (p = 0.21 and 0.24, respectively). There were no differences in total morphine and hydrocodone/APAP use during the first 24 h (p = 0.61 and 0.53, respectively). Conclusion: Patients receiving maintenance of general anesthesia with propofol do not have less pain after laparoscopic cholecystectomy when compared to isoflurane, desflurane, or sevoflurane. .

Justificativa e objetivo: a dor é a principal queixa e também o motivo principal de recuperação prolongada pós-colecistectomia laparoscópica. A nossa hipótese foi que os pacientes submetidos à colecistectomia laparoscópica apresentariam menos dor quatro horas após a cirurgia se recebessem manutenção anestésica com propofol em comparação com isoflurano, desflurano ou sevoflurano. Métodos: neste estudo prospectivo e randômico, 80 pacientes agendados para colecistectomia laparoscópica foram designados para receber propofol, isoflurano, desflurano ou sevoflurano para manutenção da anestesia. Nosso desfecho primário foi dor mensurada em escala analógica numérica quatro horas após a cirurgia. Também registramos o uso intraoperatório de opiáceos, bem como o consumo de analgésicos durante as primeiras 24 horas pós-cirúrgicas. Resultados: não houve diferença estatisticamente significante nos escores de dor quatro horas após a cirurgia (p = 0,72). Também não houve diferença estatisticamente significativa nos escores de dor entre os grupos de tratamento durante as 24 horas pós-cirúrgicas (p = 0,45). O uso intraoperatório de fentanil e morfina não variou significativamente entre os grupos (p = 0,21 e 0,24, respectivamente). Não houve diferença no consumo total de morfina e hidrocodona/APAP durante as primeiras 24 horas (p = 0,61 e 0,53, respectivamente). Conclusão: os pacientes que receberam propofol para manutenção da anestesia geral não apresentaram menos dor pós-colecistectomia videolaparoscópica em comparação com os que receberam isoflurano, desflurano ou sevoflurano. .

Justificación y objetivo: el dolor es el principal motivo de queja y también la principal razón de una prolongada recuperación tras una colecistectomía laparoscópica. Nuestra hipótesis fue que los pacientes sometidos a colecistectomía laparoscópica tenían menos dolor 4 h después de la cirugía cuando recibían propofol para la anestesia en comparación con isoflurano, desflurano o sevoflurano. Métodos: en este estudio prospectivo y aleatorizado, 80 pacientes programados para colecistectomía laparoscópica fueron designados para recibir propofol, isoflurano, desflurano o sevoflurano para el mantenimiento de la anestesia. Nuestro primer resultado fue el dolor medido en escala analógica numérica 4 h después de la cirugía. También registramos el uso intraoperatorio de opiáceos y el consumo de analgésicos durante las primeras 24 h del postoperatorio. Resultados: no hubo diferencias estadísticamente significativas en las puntuaciones del dolor 4 h después de la cirugía (p = 0,72). Tampoco hubo diferencias estadísticamente significativas en las puntuaciones del dolor entre los grupos de tratamiento durante las 24 h del postoperatorio (p = 0,45). El uso intraoperatorio de fentanilo y morfina no varió significativamente entre los grupos (p = 0,21 y 0,24 respectivamente). No hubo una diferencia en el consumo total de morfina e hidrocodona/APAP durante las primeras 24 h (p = 0,61 y 0,53 respectivamente). Conclusiones: los pacientes que recibieron propofol para el mantenimiento de la anestesia general no tenían menos dolor poscolecistectomía videolaparoscópica en comparación con los que recibieron isoflurano, desflurano o sevoflurano. .

Indicadores de calidad en cáncer de mama / Quality indicators in breast cancer surgery

Introduction: although clear guidelines for breast cancer management have been developed and widespread, there are many variations between centers and even among breast cancer surgeons, with impact in clinical outcomes. Use of quality indicators to assess surgical care allows comparison with standards and with other centers and monitoring changes post intervention. Objective: to apply quality indicators to breast cancer surgery and evaluate usefulness. Material and Methods: selected indicators obtained from EUSOMA 2008 workshop were applied to 213 consecutive surgical treatment breast cancer patients from Hospital Militar de Santiago de Chile between 2006 and 2011, comparing results with previously defined standards. Results: benign/malignant index in surgical biopsies: 1: 2.27 (minimum standard: 1/2; Optimum: 1/4), patients with complete pathologic report percentage: 99,2 percent (minimum: 95 percent, optimum: 98 percent), breast conserving surgery percentage: 80.20 percent (minimum: 70 percent, optimum: 80 percent), patients with sufficient axillary sampling percentage: 92.4 percent (minimum: 95 percent, optimum: 98 percent), correct axillary dissection indication percentage: 100 percent (minimum: 95 percent, optimum: 98 percent) and patients who underwent single surgery percentage: 90.40 percent (minimum: 80 percent, optimum: 90 percent), most of them ranged between established standards. Conclusion: the use of quality indicators allows breast cancer surgery result evaluation, enabling comparison between centers and established standards, giving objective and reproducible information, helpful to plan process optimization. These or similar indicators are useful in all breast cancer treatment steps and for breast cancer unit accreditation processes. Our indicator values that are under the standard reveal that some specific local indicators are required.

Introducción: aunque existen guías clínicas ampliamente difundidas para el manejo del cáncer de mama, las variaciones entre centros impactan en los resultados. El uso de indicadores de calidad, permite compararse con estándares, con otros centros y evaluar los cambios posteriores a una intervención. Objetivos: aplicar indicadores de calidad al tratamiento quirúrgico del cáncer de mama evaluando su utilidad. Material y Métodos: se aplicó indicadores de calidad a 213 pacientes consecutivos sometidos a cirugía por cáncer de mama en el Hospital Militar de Santiago entre mayo/2006 y abril/2011, comparando los resultados con estándares. Resultados: se calculó: índice benignidad/malignidad en biopsias quirúrgicas: 1:2,27 (mínimo 1:2; óptimo 1:4), porcentaje pacientes con informe patológico completo 99,2 por ciento (mínimo: 95 por ciento, óptimo: 98 por ciento), porcentaje cirugía conservadora 68,42 por ciento (mínimo: 70 por ciento, óptimo: 80 por ciento), porcentaje pacientes con muestreo axilar suficiente 92,40 por ciento (mínimo: 95 por ciento, óptimo: 98 por ciento), porcentaje pacientes con indicación adecuada de disección axilar 100 por ciento y porcentaje pacientes que requirió una sola cirugía 90,40 por ciento (mínimo: 80 por ciento, óptimo: 90 por ciento). La mayoría cumplió los estándares establecidos. Conclusión: la utilización de indicadores de calidad permite evaluar resultados a través del tiempo, compararse con otros centros, y con los estándares establecidos. Proporciona información objetiva y reproducible que permite evidenciar los puntos críticos en los procesos y focalizarse en ellos. El uso de indicadores de calidad puede ampliarse a todas las etapas del tratamiento del cáncer de mama y servir para unificar criterios en acreditación. El análisis de los valores que resultaron bajo el estándar reveló la necesidad de proponer nuevos indicadores útiles a nivel local.

Prognosticators and the relationship of depression and quality of life in head and neck cancer.

Background and Purpose: To evaluate the relationship of emotional status and health-related quality of life (HRQOL) in disease-free head and neck cancer (HNC) patients post treatment and to explore their predictive factors. Materials and Methods: Seventy-three HNC patients, post treatment at least 1 year, were recruited to complete three questionnaires, EORTC QLQ-C30, EORTC-H&N35 cancer module, and the Beck Depression Inventory-II (BDI-II). Results: Patients with depression demonstrated significantly poor global health status/QoL (score 41.7 vs. 71.9, P<0.001) and almost all functioning, except for role functioning. Besides, depressive patients presented statistically significant worse symptoms in all QLQ-C30 items, except constipation and financial problems, and in all QLQ-H&N35 symptoms except for teeth and coughing problems. Depression was significantly negative correlated with all functional scales and global health status/QoL (r = -0.341 to -0.750, all P<0.05), and was significantly positive correlated with symptom scales (r = 0.348 to 0.793, all P<0.05), except for constipation. Stepwise multiple linear regression analyses showed that physical functioning and physical distressful symptoms play an important role in the perception of HRQOL (total 46% explained). Global health status and impaired social functioning could explain depression in addition to emotional functioning (total 64% explained). Conclusions: HNC patients with depression were noted to have poorer HRQOL in almost every functioning symptom. HNC patients may get benefit from early interventions to improve HRQOL, emotional status, or both by a more rapid and friendly questionnaire to earlier identify patients with poor HRQOL or depressive status.

Complications following urethral reconstructive surgery: a six year experience

PURPOSE: We present a single institutional experience over 6 years of intra and postoperative complications following urethral reconstructive surgery, and the impact of these complications on overall results. MATERIALS AND METHODS: From June 2000 through May 2006, 153 consecutive urethral reconstructive procedures were performed on 128 patients by one surgeon (CMG). Complication rates were determined, and subgroups were categorized based on stricture etiology, patient age, length of stricture, location of stricture, type of repair, and presence of various co-morbid conditions. RESULTS: Overall, 23 of 153 cases (15 percent) had an intra or postoperative complication with a mean follow-up time of 28.3 months (range 3 to 74). The most common complications were related to infection (n = 9). Other complications included repair breakdown (n = 4), bleeding (n = 4), fistulae (n = 3), thromboembolic (n = 2), positioning-related (n = 2), and Foley catheter malfunction (n = 1). Complication rates for anastomotic and substitution urethroplasty were 9.1 percent (4/44) and 17 percent (19/109), respectively. The number of patients with at least one year of follow-up who had a complication and eventual stricture recurrence was 20 percent (4/20), while only 7.4 percent (7/95) of those who did not have a complication recurred (p = 0.08). CONCLUSIONS: Complications following reconstructive surgery for urethral stricture disease were mostly related to infection or repair breakdown in the immediate postoperative period. It does not appear that an intra or postoperative complication following urethral reconstructive surgery impacts the chance of eventual stricture recurrence at intermediate follow-up.

Prevalência de talassemias e hemoglobinas variantes em pacientes portadores de lúpus eritematoso sistêmico / Prevalence of thalassemias and variant hemoglobins in patients with systemic lupus erythematosus

O lúpus eritematoso sistêmico (LES) é uma doença tipicamente multigênica e multifatorial, com grande complexidade clínica e fisiopatológica. As causas do LES não são totalmente conhecidas, mas sabe-se que fatores ambientais e genéticos estão envolvidos. Dentre as várias manifestações clínicas observadas em pacientes com LES, as anemias chamam a atenção principalmente quando se observa nesse estudo uma prevalência de 52,5 por cento dos pacientes com índices hematimétricos sugestivos de anemias. Embora a anemia geralmente já seja observada em pacientes com LES, estudos sobre a prevalência de anemias hereditárias, especialmente as hemoglobinopatias na população com LES, não têm sido conduzidos. O objetivo desse trabalho foi o de avaliar a prevalência das hemoglobinopatias e talassemia em pacientes portadores de LES. Para isso, foram estudadas 80 amostras de sangue de pacientes portadores de lúpus atendidos no ambulatório do Hospital das Clínicas de Goiânia. Foram utilizados testes laboratoriais não moleculares para a detecção das hemoglobinopatias. A freqüência das alterações da hemoglobina foi de 10,0 por cento, encontradas em oito pacientes. Dessas alterações, a mais prevalente foi a talassemia alfa, encontrada em quatro pacientes, correspondendo a uma freqüência de 5,0 por cento da população estudada. Depois, foi o heterozigoto para a hemoglobina S, encontrada em dois pacientes, correspondendo a 2,5 por cento da população, e também outro heterozigoto para a hemoglobina C, encontrada em um paciente, correspondendo a 1,25 por cento, e um paciente com beta talassemia menor, correspondendo a 1,25 por cento. Nenhum caso de homozigose foi encontrado no presente estudo. Este trabalho demonstrou que não houve diferença na prevalência dos distúrbios da hemoglobina entre a população em geral e os portadores de LES.

Systemic lupus erythematosus (SLE) is a typically multigenic and multifatorial disease with remarkable clinical and pathogenic complexities. The causes of SLE are not totally known, but It is known that environmental and genetic factors are involved. Among various clinical manifestations observed in lupus patients, anemia calls the attention because of a prevalence of 52.5 percent of the patients with RBC indices suggestive of anemia identified in this study. Although anemia is usually seen in patients with SLE, studies of the prevalence of hereditary anemias, particularly hemoglobinopathies, have not been carried out in populations. The objective of this work was to evaluate the prevalence of hemoglobinophaties in patients with SLE. We studied 80 blood samples of patients with SLE in Hospital das Clínicas in Goiania, Brazil. The frequency of alterations of the hemoglobin was 10.0 percent (8 patients). Among these alterations, the most prevalent was alpha thalassemia in 4 patients (5.0 percent of the studied population). The heterozygosity for hemoglobin S was seen in 2 patients (2.5 percent), hemoglobin C in one patient (1.25 percent) and one patient was identified with beta thalassemia minor. No homozygous cases were found in the present study. According to this work no difference in the prevalence of hemoglobin disorders was observed between general population and patients with SLE.

Cancer de mama oculto: dos casos clínicos analizados según el concepto actual / Occult breast cancer: Report of two cases

Occult breast cancer is expressed as a metastatic axillary lymph node without clinical or imaging evidence of a primary tumor in the breast. The old concept involved non palpable tumors. Its incidence is low, representing only 0.3 to 1 percent of all breast cancer cases. The search for the primary tumors is performed with mammography, whose sensitivity is low, ranging from 0 to 56 percent. Several studies have shown a higher sensitivity of magnetic resonance imaging, ranging from 85 to 100 percent, to detect occult lesions. The treatment of isolated axillary metastases of breast cancer is controversial. An axillary dissection is recommended. If there is a suspicious image, a radiosurgical or stereotaxic biopsy should be done. However, in patients without radiological lesions in the breast, the tendency is not to perform a radical mastectomy as previously recommended, since the primary tumor will not be found in the surgical specimen in two thirds of cases. A superior and external quadrantectomy or exclusive radiotherapy should suffice. An expecting behavior is not recommended as a therapeutic alternative. Treatment should be complemented with hormonal therapy or chemotherapy. The literature suggests that prognosis is better than stage II, with a ten years survival ranging from 50 to 71 percent. We report two patients with a well defined occult breast cancer and based on them, a review of the subject is attempted. Considering its prognosis, physicians should be aware of this uncommon and difficult to diagnose disease.

Chopstick splinter: A rare cause of bilateral frozen orbits

OBJECTIVE: To report an unusual case of frozen orbit caused by an unsuspected intraorbital foreign body. METHOD: This is a case report. RESULTS: A 31-year old Chinese man presented with a 6-month history of painless progressive right caruncular growth with mucoid discharge. He also had bilateral progressive reduction in ocular movements. His best-corrected vision was 6/9 bilaterally. A conjunctival granuloma arising from the right caruncle and extending to the cornea and associate with ophthalmoplegia was also present. Orbital computed tomography showed a dense rod-like structure traversing the nasal area, extending from the superomedial wall of the right orbit to the apex of the left orbit with surrounding inflammatory reaction but sparing the optic nerve. The intraorbital foreign body, a 6 cm chopstick splinter, was successfully removed via right lateral rhinotomy. CONCLUSION: Intraorbital foreign bodies are not uncommonly seen and, generally, the diagnosis is straightforward. Nevertheless, diagnosis, could be missed if it is not suspected.

Spectrum of opportunistic infections among HIV-infected patients in Malaysia.

We retrospectively reviewed 205 HIV-infected patients, who came at first entry from January 2001 to December 2002 to the Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. The aged range was 21-69 years [mean 37.25 years (+/- SD) 8.1]. Subjects were mainly in the age group 35-44 years. The majority of patients were male (82%), Chinese (55.1%), single (55.6%), resided in Kuala Lumpur (55.1%), and were unemployed (57.1%). The most frequent routes of transmission were sexual contact (78.5%), followed by IDUs (30%), blood transfusion (5%), and unknown (0.5%). Oral candidiasis was the most common mucocutaneous disease and significant co-existence was found with the main opportunistic systemic diseases, such as TB, PCP, toxoplasmic encephalitis, penicillosis, and CMV retinitis (p < 0.05). In this study, the range of CD4 counts was 0-910, with a median of 35 cells/mm3. Significant associations between a CD4 level less than 100 cells/mm3 at the time of diagnosis, and the occurrence of major opportunistic diseases, such as candidiasis, TB, PCP, TE, herpes simplex infection, CMV retinitis, penicillosis, and histoplasmosis were found (p < 0.05) in this study.

Toxoplasmosis in HIV/AIDS patients in Malaysia.

Three hundred and one sera of HIV/AIDS patients were tested for anti-Toxoplasma IgG antibody by ELISA technique. The seroprevalence of toxoplasmosis was 41.2% (95% CI: 35.5-46.9) in HIV/AIDS patients. The seroprevalence was significantly higher in the Malay (57.9%) than the Chinese (38.7%), followed by the Indian patients (29.6%) (p<0.05). No possible risk factor, such as contact with cats, consumption of uncooked meat, and history of blood transfusions was found to have any significant association with the presence of anti-Toxoplasma antibody in the study sample (p>0.05). Multivariate analysis was employed to find any association between Toxoplasma seroprevalence and a single subject having single or multiple risk factors. It was found that the association was not statistically significant (p>0.05). Among the HIV/AIDS study samples, 124 (41.2%) samples were found to have positive anti-Toxoplasma antibody, the association between the presence of anti-Toxoplasma antibody and CD4 cell count was determined but no statistically significant association was found (p>0.05). During the study period, only one case of active CNS toxoplasmosis was registered and the diagnostic criteria included: clinical presentations, CT scan finding, serological evidence of anti-Toxoplasma IgG antibody, and respose to anti-Toxoplasma therapy.

Posterior reversible encephalopathy syndrome:diagnosis with CT and MRI / 中华放射学杂志

Objective To evaluate the role of CT and MR/in the diagnosis of posterior reversible encephalopathy syndrome(PRES).Methods Eight women with PRES(6 pregnant women,1 case after chemotherapy,and 1 patient with hypertension)were enrolled in our study.All of them had MR imaging (T_1WI,T_2WI,FLAIR,DWI),and five cases underwent post-contrast T_1WI and three dimensional contrast enhanced MR angiography(3D CEMRA).Two cases also had CT scan.Results MRV in all 8 patients showed no evidence of stenosis,dilation,or thrombosis in cranial veins and sinuses.MRI demonstrated multiple lesions located in bilateral parieto-occipital lobes(8 cases),bilateral basal ganglia(2 cases),and bilateral frontal lobes(4 cases).The lesions were prominent within white matter,some of them involved gray matter(3 cases).Lesions appeared as hyperintense signals on FLAIR and T_2-weighted images, isointense or mildly hypointense signals on T_1-weighted images,normal or decreased intensity on DWI,and isointensity or hyperintensity on apparent diffusion coefficient(ADC)maps.Post-contrast T_1WI showed mild reversible enhancement and 3D CEMFdisplayed numerous reversible“grape-like”enhancements in terminal arterial branches along the middle cerebral artery(MCA),anterior cerebral artery(ACA)and posterior cerebral artery(PCA).Follow-up scan showed decreased abnormal signals.Conclusion Lesions of PRES are usually located in parieto-occipital lobes,especially in white matter,but they can also be seen in frontal lobes and basal ganglia bilaterally.Post-contrast T_1WI and 3D enhanced MRA can provide useful information in the manifestation of reversible enhancement.MRI has advantages to display lesion in PRES,

Immunogenicity and safety of an inactivated hepatitis A vaccine in Taiwanese adults and children.

The safety and immunogenicity of an inactivated hepatitis A vaccine (AVAXIM, 160 antigen units) was evaluated in 190 subjects: 50 children aged from 2 to 5 years, 70 children aged from 6 to 17 years and 70 adults aged from 18 to 30 years in a monocentric, open, non-controlled, phase III trial conducted in Taipei, Taiwan from December 1996 to October 1997. The vaccine was administered intramuscularly, with a two-dose schedule 6 months apart. Clinical adverse events were monitored during the seven days following each injection. Hepatitis A virus (HAV) antibody titers were measured by modified radioimmunoassay on the day of inclusion and four weeks after both the first dose and booster injection. Among the 190 subjects who received the first dose, 174 (91.6%) were initially HAV seronegative and 16 (8.4%) were HAV seropositive at inclusion. One hundred and seventy-four subjects (91.6%) received the booster dose and completed the study. One month after the first dose, all the subjects, whatever the age, presented HAV antibody titers over 20 mIU/ml. In children (2 to 17 years), the GMT was 136 mIU/ml at week 4 and 7,906 mIU/ml four weeks after the booster dose. In adults (> or = 18 years), GMT values were 93 mIU/ml at week 4 and 3,655 mIU/ml four weeks after the booster. These results show a strong anamnestic response to the second dose of vaccine and are compatible with long-term antibody persistence in each age group. The vaccine was safe and well tolerated. No vaccine-related serious adverse event occurred. No immediate reaction occurred. The majority of the reactions were reported by adults after the primary injection. Local reactions (pain and redness) were reported by 9.0% and 4.0% of the subjects after the primary and the booster doses, respectively. Systemic reactions (mainly myalgia/arthralgia or asthenia) affected less than 10% of the subjects after the first dose and less than 3% after the booster. Results from this study in a Taiwanese population are consistent with those obtained with the same vaccine in previous European studies in children and adults, and suggest that AVAXIM (160 AU) is suitable for use in all subjects aged over 2 years.

Field-simulated residual efficacy of betacyfluthrin against Anopheles sinensis Wiedemann.

The residual efficacy of a relatively new pyrethroid, betacyfluthrin was compared with DDT against Anopheles sinensis Wiedemann in some village houses in Penang, Malaysia, for a period of 30 weeks. Efficacy was determined by exposing laboratory-cultured An. sinensis mosquitos to treated wall surfaces with either betacyfluthrin at 15 and 25 mg/m2 or DDT at 2,000 mg/m2 for one hour. Betacyfluthrin provided a longer residual effect (up to 210 days with > 70% mortality) compared with DDT. The potential of betacyfluthrin as a candidate for residual spraying for malaria control is discussed.

Study of young women vaccinated against rubella virus for 10 years in Taiwan.

Since the licensing of the rubella virus vaccine (RA 27/3 strain) in 1979, clinical studies on the RA 27/3 strain vaccine, which gives rise to high titer antibody, have been reported. In the present study, this vaccine was used to examine the immune response in young women. Volunteers without the previous immunity to rubella virus screened by hemagglutination inhibition (HAI), latex agglutination (LA), fluorescence immunoassay (FIA) and solid-phase immunoassay (SPIA) tests were injected with Rudivax vaccine or Meruvax II vaccine. Adverse reactions occurred between 10 and 20 days after vaccination in 30% of the volunteers. After 28-35 days, vaccinees developed antibodies against rubella virus. The titer of rubella antibody reached it's peak from the 40th day through the 100th day. One year after vaccination, the geometric mean titer (GMT) of rubella virus antibody still remained over 1 : 64 (HAI) and 1 : 38.2 (FIA), and SPIA IgG RI mean was 2.80. Two years later, the antibody titers were 1 : 52 by HAI and 1 : 32.1 by FIA, and SPIA IgG RI mean was 2.75. After 5 years, the antibody titers were 1 : 48.6 (HAI) and 1 : 28.2 (FIA), and SPIA IgG RI mean was 2.74. After 10 years, the anti-rubella virus antibody titers were 1 : 38.9 (HAI) and 1 : 25.1 (FIA), and SPIA IgG RI mean was 2.42. LA antibody still remained seropositive. In conclusion, the rubella vaccine RA 27/3 is safe and efficient, and it is applicable for the control of the rubella in Taiwan.

Cellular inactivation induced by H2O2 and active oxygen species generated by environmental stresses in bacteria

Oxyygen free radicals are highly reactive species that damage several cellular macromolecules and organelles, including membrane lipid peroxidation and produce DNA lesions. We have discussed here; i) The mechanism of radiation-induced cellular damage in bacteria through the intermediation of active oxygen species; ii) the cellular inactivation and the role of bacterial SOS and OxyR systems in the repair of lesions induced by H2O2 under low iron condition; iii) the lethal interaction between H2O2 and o-phenanthroline in E. coli; iv) the biological response induced by near-UV radiation mediated by active oxygen species and finally v) the mutagenic potential of popular plant extracts like guaraná (Paullinia cupana), mate (Ilex paraguariensis) and saiao (Kalanchoe brasiliensis), whose effects are eventually mediated by active oxygen species.