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@#Abstract： Thimerosal is commonly used as a preservative in biological products，especially in vaccines. Although it has been removed from single ⁃ dose vaccines in most countries，thimerosal is still widely used in multi ⁃ dose vaccines at present. Thimerosal，as a component in vaccine preparation，should be compatible with other components，especially should not damage the activity of antigen. However，in recent years，many studies have reported that thiomersal can reduce the antigenicity and immunogenicity of vaccine antigens，especially protein antigens containing or rich in cysteine（Cys）， suggesting that the effect of thimerosal on vaccine antigen activity should be fully evaluated when it is used as a vaccine preservative. In this paper，the effects of thimerosal on antigenicity and immunogenicity of two inactivated vaccines and three recombinant protein vaccines and the possible mechanisms were reviewed，in order to provide reference for rational selection of vaccine preservatives.
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@#Among the three subtypes of neurofibromatosis are type 1 and 2 neurofibromatosis and schwannomatosis, von Recklinghausen disease also known as type 1 neurofibromatosis has an autosomal dominant inheritance. It is the commonest form as and presents with numerous café-au-lait macules and neurofibromas. Giant congenital melanocytic nevus (CGMN) on the other hand is characterized by a melanocytic proliferation that present at birth. CGMN develops due to a defective embryonic pigment cell (melanocyte) precursors development and are often present at birth. Giant congenital melanocytic nevus (CGMN) and type 1 neurofibromatosis may occur together rarely. Clinicians should be aware of the rare presentation of both CGMN and type 1 neurofibromatosis in a patient.
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@#Hodgkin lymphoma is a form of malignant lymphoid neoplasm. It can have various clinical presentations such as prolonged fever, night sweats, weight loss and asymptomatic lymphadenopathy. It has a distinct fever pattern known as Pel Ebstein fever. However, in some instances, its clinical presentation can mimic some tropical infections. Here, we present a case of primary splenic lymphoma masquerading as splenic abscess in a 53-yearold man with underlying dyslipidemia.
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@#Dengue fever is one of the commonest tropical disease in the tropics. It can present with mild acute febrile illness to severe organ failure. Reported neurological complications of dengue include dengue encephalopathy, encephalitis, transverse myelitis and intracranial haemorrhage. Intracranial haemorrhage in dengue can present as subdural haematoma, extradural haematoma, intracerebral haemorrhage and subarachnoid haemorrhage. We report here a case of subarachnoid haemorrhage in a patient with severe dengue. Our patient was a 30-year-old man who presented with acute febrile illness. He subsequently developed plasma leakage and upper gastrointestinal bleeding. He then had reduced conscious level. Computed tomography of his brain showed subarachnoid haemorrhage. He eventually succumbed to his illness.
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Objective:To observe the clinical efficacy of modified Chushi Juanbitang combined with pedicle vertebrotomy on kyphosis of ankylosing spondylitis due to syndrome of dampness-heat obstruction. Method:The 90 cases were randomly divided into control group and observation group， 45 cases in each group. The patients in control group received pedicle vertebrotomy + <italic>Tripterygium</italic> glycosides， and the patients in observation group received pedicle vertebrotomy + modified Chushi Juanbitang. The treatment course was 6 months in both groups. Their bath ankylosing spondylitis disease activity index （BASDAI）， bath ankylosing spondylitis measure index （BASMI）， imaging index， traditional Chinese medicine syndromes， serum proinflammatory factor， anti-inflammatory factor， bone metabolism index ［bone-specific alkaline phosphatase （BALP）， tartrate resistant acid phosphatase isomer-5b （TRACP-5 b）， bone morphogenetic protein-2 （BMP-2）， osteocalcin （BGP）］， ossification related proteins ［bone morphogenetic protein-7 （BMP-7）， dickkopf-related protein-1 （DKK-1）， and tissue inhibitor matrix metalloproteinase-2 （TIMP-2）， sclerostin（SOST）］ were observed and detected. The clinical efficacy， recurrence rate and safety indexes were followed up for 12 months and compared. Result:The total effective rate was 97.73% （43/44） in the observation group， higher than 80.95% （34/42） in the control group （<italic>χ</italic><sup>2</sup>=5.172， <italic>P</italic><0.05）. In the comparison with control group after treatment， the BASDAI， BASMI， imaging index， traditional Chinese medicine syndromes， proinflammatory factors， TRACP-5b， BMP-7 and TIMP-2 were lower in observation group （<italic>P</italic><0.05）， and the anti-inflammatory factors， BALP， BMP-2， BGP， DKK-1 and SOST were higher in observation group （<italic>P</italic><0.05）. During the follow-up for at least 12 months， the recurrence rate was 4.65% （2/43） in observation group， lower than 26.47% （9/34） in control group （<italic>χ</italic><sup>2</sup>=4.261， <italic>P</italic><0.05）. There was no significant difference in the incidence of postoperative complications between the two groups. The incidence of adverse reactions was 2.27% （1/44） in observation group， lower than 38.64% （17/44） in control group （<italic>χ</italic><sup>2</sup>=5.763， <italic>P</italic><0.05）. Conclusion:Modified Chushi Juanbitang combined with pedicle vertebrotomy is effective in the treatment of kyphosis of ankylosing spondylitis due to syndrome of dampness-heat obstruction.
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@#Skin conditions are a common reason for consulting primary health care. The public frequently expects their primary health care providers to be able to recognise and treat common skin conditions with confidence. Primary care providers must be able to identify ‘red flag’ skin conditions that require dermatology referral. However, diagnosis is often delayed due to the non-specific clinical presentation, low incidence, slow evolution and long-term history of such lesions. We report the case of a patient with extramammary Paget’s disease that presented to her primary care provider and subsequently underwent a wide local excision.
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@#Chest radiograph is one of the most commonly employed imaging modalities in primary care. It may be done for symptomatic patients or routine health screening. Hence, it is important for a primary care physician to be able to interpret chest radiograph systematically in relation to patient’s clinical history. Here, we would like to illustrate a case of abnormal chest radiograph detected during health screening.
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@#Atrial septal defect (ASD) is a congenital heart disease often encountered in the adult population, as it is frequently asymptomatic in childhood. In untreated patients with ASD, some may go on to develop complications such as atrial arrythmias, pulmonary hypertension and Eisenmenger syndrome. Pulmonary hypertension is seen in 6 – 35% of this group of untreated patients in adulthood as a result of left-to-right shunting. Symptoms of pulmonary hypertension include progressive dyspnoea, ascites and syncope. Here, we would like to illustrate a case of ASD presenting with recurrent syncopal attack.
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@#Introduction: Excessive ultraviolet light (UV) can cause premature skin aging and potentially skin cancer. Currently there is a lack of awareness among health care professionals and the public on sun protection. The objectives of this study were to determine knowledge on sunscreen and skin cancer among health care professionals, to evaluate the knowledge, attitude, practice and perception of doctors and pharmacists toward the usage of sunscreen as protection against UV radiation. Materials And Methods: This is a cross-sectional study conducted among doctors and pharmacists in Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia. Questionnaires were used in this study. Results: A total of 384 participants completed the questionnaires. The participants consisted of 323 doctors (84.1%) and 61 pharmacists (15.9%). The age group of the participants ranged between 25 till 55 years old. Ninety doctors (27.9%) and thirty-one pharmacists (51.0%) reported used sunscreen daily (p<0.001). This finding showed that there was a deficit in the practice of sun protection. Pharmacists scored a higher knowledge score of median 12 (IQR=3.0) while the doctors scored 11 (IQR=2.0). This study showed a significant association between ethnicity and skin cancer knowledge (p<0.05). Conclusion: This study demonstrated a lack of knowledge of sunscreen and skin cancer prevention among health care practitioners. This finding supports better medical education program on this topic.
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@#A 49-year-old gentleman presented with epigastric pain for one day associated with one episode of vomiting and dyspnoea. Respiratory examination showed reduced breath sound over his left lower zone. He was treated as left spontaneous pneumothorax and left lung empyema requiring left chest tube insertion and intravenous antibiotics. His left pleural fluid biochemistry result was exudative while its centrifuge showed empyema. In ward, we noticed food material draining from his left chest tube during feeding. An urgent contrast enhanced computed tomography (CECT) thorax showed a left oesophageal-pleural fistula with possible broncho-oesophageal fistula. During oesophagogastroduodenoscopy (OGDS), air bubbles were seen in his left under-water chest drainage during air-insufflation of the oesophagus. The revised diagnosis was Boerhaave syndrome. He was treated with an esophageal stent to cover the perforation and a left lung decortication via video assisted thoracoscopic surgery (VATS) for his left empyema. He improved and was discharged well.
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@#Primary care providers should be alert to travel-related infections. Around 10-40% of returning travelers from all destinations and 15-70% of travelers from tropical settings experience ill health, either overseas or upon returning home.1 A systematic approach concentrating on possible infections should be undertaken based on the patient’s travel location, immunization history, presence of malaria chemoprophylaxis at the destination, other potential exposures, incubation period, and clinical presentation.2-3 The World Health Organization (WHO) website is constantly being updated on specific travel-related infections and recent geographical outbreaks. In this paper, we report a case of severe falciparum malaria in a returned traveler.
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@#Mesenchymal chondrosarcoma is a malignant neoplasm arising from cartilaginous bone or soft tissue. It is uncommon yet devastating. Our patient was a 21-year-old man who presented with pleuritic chest pain and weight loss. His chest radiograph showed left pleural effusion. His pleural effusion analysis was consistent with exudative pleural effusion. Tuberculosis workup was negative. Pleural fluid cytology did not yield malignant cells. Subsequently, his computed tomography of thorax showed left rib sclerotic lesion with soft tissue component. Biopsy of the soft tissue eventually confirmed the diagnosis of mesenchymal chondrosarcoma. He succumbed to his illness before the diagnosis was confirmed. We hope that through this case report, we are able to provide some insight into this rare condition.
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@#Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited cardiomyopathy characterised by right ventricular dysfunction, ventricular arrhythmias and increased risk of sudden cardiac death. Due to the replacement of myocardium with fibro-fatty and fibrous tissue, patients with ARVC are prone to develop ventricular tachycardia. Histologically, it is often reported as the ‘triangle of dysplasia’ involving the inflow tract, outflow tract and apex of the right ventricle.2 We describe a 20-years-old patient who collapsed during a futsal match and was subsequently diagnosed to have ARVC with a right ventricular thrombus from cardiac magnetic resonance imaging.
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@#Malaria is a parasitic disease that is caused by the Plasmodium parasite. Worldwide, it remains a significant public health problem especially in the Africa region where it contributes to more than 90% of cases and malaria death. However, zoonotic (simian) Plasmodium knowlesi parasite is a widely prevalent cause of malaria in the South East Asian countries. It is known to cause severe human disease due to its 24hour erythrocytic cycles. Thus far, cases of severe falciparum malaria have been reported in asplenic patients. Here, we report a case of severe P.knowlesi malaria in a 51-year-old man who is a postsplenectomy patient.
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@#There are increasing reports of methanol poisoning (MP) incidence worldwide. In Malaysia, the largest first methanol poisoning was reported in Selangor in 2013 with a total of 41 patients and cluster of cases been reported from the country since then. Often MP involved adulterated alcohol containing more than the legal permissible concentration of methanol. Methanol is rapidly absorbed and metabolised into formic acid which causes variable symptoms of the central nervous system such as blindness, seizure, coma and gastrointestinal disturbances. Mortality could reach up to 83% as reported using the coma state, pH and pCO2 level in the worst-case scenario.
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@#Primary care providers should be alert to travel-related infections. Around 10-40% of returning travelers from all destinations and 15-70% of travelers from tropical settings experience ill health, either overseas or upon returning home.1 A systematic approach concentrating on possible infections should be undertaken based on the patient’s travel location, immunization history, presence of malaria chemoprophylaxis at the destination, other potential exposures, incubation period, and clinical presentation.2-3 The World Health Organization (WHO) website is constantly being updated on specific travel-related infections and recent geographical outbreaks. In this paper, we report a case of severe falciparum malaria in a returned traveler.
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Objective:To investigate the clinical efficacy of acupuncture combined with modified Shengyutang in treatment of cervical spondylotic radiculopathy with Qi-blood deficiency and its effect on T-lymphocyte subsets. Method:Totally 201 cases of cervical spondylotic radiculopathy with blood deficiency were randomly divided into 3 groups, with 67 cases in each group. Group A was treated with modified Shengyutang. Group B was treated with acupuncture. Group C was treated with modified Shengyutang combined with acupuncture. The effective rate of each group and the therapeutic effect of deficiency of Qi and blood were observed. Neck disabilitv index（NDI）, visual analogue score（VAS）, SF-36 mental component summary（SF-36MCS）and SF-36 physical component summary（SF-36PCS） were compared before and after treatment. Serum levels of interleukin-1β (IL-1β), interleukin-6 (IL-6) and calcitonin related peptide (CGRP) were measured before and after treatment. The levels of CD3+, CD4+, CD8+ and the ratio of CD4+/CD8+ were compared before and after treatment. The therapeutic safety indexes of each group were observed. Result:After treatment, the total clinical effective rate of group C was significantly higher than that of group A and B (P<0.05). NDI and VAS scores were significantly reduced (P<0.05). The scores of SF-36MCS and SF-36PCS were significantly increased (P<0.05). The score of Qi-blood deficiency syndrome was significantly lower (P<0.05). Serum levels of IL-1β, IL-6 and CGRP were significantly lower (P<0.05). The levels of CD3+, CD4+ and CD4+/CD8+ were significantly increased (P<0.05, P<0.01), whereas CD8+ was significantly decreased (P<0.05, P<0.01). No significant adverse reactions occurred in each group during the treatment. Conclusion:acupuncture combined with Shengyutang has a significant clinical effect on cervical spondylosis with Qi-blood deficiency, and is worth popularizing.
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Objective:To observe the efficacy and safety of warm acupuncture combined with Congrong Duhuosan in treating ankylosing spondylitis （AS） with deficiency of kidney-Yang. Method:Totally 186 patients with AS of deficiency of kidney Yang type were randomly divided into observation group and control group, with 93 patients in each group. The control group was treated with meloxicam dispersive tablets combined with Sulfasalazine enteric-coated tablets, while the observation group was treated with warm acupuncture combined with Congrong Duhuosan, with a course of treatment of 63 d. Bath ankylosing spondylitis patient global score (BAS-G), visual analogue score (VAS), bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), physicians global assessment (PGA) and syndrome differentiation of kidney-Yang deficiency syndrome in traditional Chinese medicine （TCM） were observed before and after treatment. Interleukin-17 (IL-17)，interleukin-23 (IL-23) mRNA expression levels, T helper cell 17（Th17） and regulatory cells（Treg）levels and Th17/Treg ratio were detected before and after treatment. Efficacy and incidence of adverse reactions were compared between two groups. Result:There were 7 cases falling off in control group and 1 case in observation group. After treatment, the total effective rate of observation group was 85.87%（79/92）, which was better than 60.47%（52/86）of control group (χ2=6.08，P<0.01). The scores of BAS-G, VAS, BASDAI, BASFI, PGA and TCM kidney-Yang deficiency syndrome in observation group were significantly improved than those in control group (P<0.05, P< 0.01). IL-17 and IL-23 mRNA expression levels, Th17 and Treg levels and Th17/Treg ratio in observation group were significantly improved compared with control group (P<0.01). The incidence of adverse reactions in observation group was significantly lower than that in control group (P<0.01). Conclusion:Warm acupuncture combined with Congrong Duhuosan can effectively relieve pain, inflammatory reaction and other clinical symptoms of patients with kidney-Yang deficiency AS, and restore the activity function of patients with small adverse reactions. Therefore, it is a safe and effective clinical therapy.
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Objective:To observe the efficacy of modified Chushi Huqianwan combined with core decompression on Ⅰ， Ⅱ stage osteonecrosis of femoral head due to hot and humid syndrome， and the effect on bone metabolism index ［osteocalcin （BGP）， bone morphogenetic protein-2 （BMP-2）， bone isoenzyme alkaline phosphatase （BALP）］， blood lipid ［apolipoprotein A （ApoA）， apolipoprotein B （ApoB）， apolipoprotein C3 （ApoC3）］， protein expression ［matrix metalloproteinase-2 （MMP-2）， matrix metalloproteinase-9 （MMP-9）， tissue inhibitor of matrix metalloproteinase-2 （TIMP-2）］. Method:A total of 90 cases were divided into control group and observation group， with 45 cases in each group. The control group was given core decompression + Xianling Gubao， while the observation group was given core decompression + modified Chushi Huqianwan for 6 months. The hip harris score （HHS）， lateral head index （LHI） and traditional Chinese medicine （TCM） syndrome were observed between two groups. The serum bone metabolic indices （BGP， BMP-2， BALP）， blood lipid （ApoA， ApoB， ApoC3）， protein expressions （MMP-2， MMP-9， TIMP-2） were detected between two groups. The clinical efficacy， adverse reaction and recurrence in 36-month follow-up were compared between two groups. Result:The total effective rate was 97.73% （43/44） in observation group， which was higher than 80.95% （34/42） in control group （χ2=5.915， P<0.05）. The recurrence rate was 4.65% （2/43） in observation group， which was lower than 35.29% （12/34） in control group （χ2=5.317， P<0.05） during the 36-month follow-up. HHS and LHI in observation group were significantly higher than those in control group （P<0.05）， and TCM syndrome score was significantly lower than that in control group （P<0.05）. Compared with control group after treatment， BGP， BMP-2， BALP， MMP-2 and MMP-9 in observation group were significantly increased （P<0.05）， whereas ApoA， ApoB， ApoC3， TIMP-2 were significantly decreased （P<0.05）. No obvious adverse reactions were observed during the treatment. Conclusion:Modified Chushi Huqianwan combined with core decompression can significantly improve clinical symptoms， bone metabolism indexes， blood lipid and protein expressions of patients with Ⅰ， Ⅱ stage osteonecrosis of femoral head due to hot and humid syndrome.