Adverse drug reactions induced by hydroxychloroquine in the treatment of oral lichen planus: a report of 13 cases / 口腔疾病防治

Objective @# To analyze the adverse drug reaction（ADR） reports of hydroxychloroquine for clinical medication safety. @* Methods@#The ADR reports of hydroxychloroquine between May 2019 and May 2021 were analyzed. Age, reasons for drug use, time of ADR, combined drug use, and ADR outcomes were statistically analyzed. @*Results@# No severe ADR was reported. Patients over 60 years old accounted for 53.85% of the total cases, and the time of ADR appearance was significantly earlier among those under 60 years old. A total of 61.54% of ADRs were involved in multiple organs, and optic neurotoxicity was reported in 46.15% of cases. @*Conclusion@# In the treatment of oral lichen planus with hydroxychloroquine, adverse drug reactions should be monitored, and increased attention should be given to patients over 60 years old to ensure the safety of this medication.

The etiologies of post-stroke depression: Different between lacunar stroke and non-lacunar stroke

Abstract Objectives: Depression is common after both lacunar stroke and non-lacunar stroke and might be associated with lesion locations as proven by some studies. This study aimed to identify whether lesion location was critical for depression after both lacunar and non-lacunar strokes. Methods: A cohort of ischemic stroke patients was assigned to either a lacunar stroke group or a non-lacunar stroke group after a brain MRI scan. Neurological deficits and treatment response was evaluated during hospitalization. The occurrence of depression was evaluated 3 months later. Logistic regressions were used to identify the independent risk factors for depression after lacunar and non-lacunar stroke respectively. Results: 83 of 246 patients with lacunar stroke and 71 of 185 patients with non-lacunar stroke developed depression. Infarctions in the frontal cortex, severe neurological deficits, and a high degree of handicap were identified as the independent risk factors for depression after non-lacunar stroke, while lesion location was not associated with depression after lacunar stroke. Conclusion: The main determinants for depression after lacunar and non-lacunar stroke were different. Lesion location was critical only for depression after non-lacunar stroke.

Silencing of circular RNA ANRIL attenuates oxygen-glucose deprivation and reoxygenation-induced injury in human brain microvascular endothelial cells by sponging miR-622

BACKGROUND: Circular RNA (circRNA) is highly expressed in the brain tissue, but its molecular mechanism in cerebral ischemia-reperfusion remains unclear. Here, we explored the role and underlying mechanisms of circRNA antisense non-coding RNA in the INK4 locus (circ_ANRIL) in oxygen-glucose deprivation and reoxygenation (OGD/R)-induced cell injury. RESULTS: The expression of circ_ANRIL in OGD/R-induced human brain microvascular endothelial cells (HBMECs) was significantly up-regulated, while that of miR-622 was significantly down-regulated. Overexpression of circ_ANRIL significantly inhibited the proliferation of OGD/R-induced HBMECs and aggravated OGD/R-induced cell apoptosis. Moreover, circ_ANRIL overexpression further increased the secretion of interleukin (IL)-1ß, IL-6, tumor necrosis factor-a, and monocyte chemoattractant protein-1 in OGD/R-treated HBMECs. The results of bioinformatics analysis and luciferase reporter assay indicated that circ_ANRIL served as an miR-622 sponge to negatively regulate the expression of miR-622 in OGD/R-treated HBMECs. Additionally, circ_ANRIL silencing exerted anti-apoptotic and anti-inflammatory effects by positively regulating the expression of miR-622. Furthermore, inhibition of OGD/R-induced activation of the nuclear factor (NF)-kB pathway by circ_ANRIL silencing was significantly reversed by treatment with miR-622 inhibitor. CONCLUSIONS: Knockdown of circ_ANRIL improved OGD/R-induced cell damage, apoptosis, and inflammatory responses by inhibiting the NF-κB pathway through sponging miR-622.

Carotid intima-media thickness and plaques in internal carotid artery as surrogate markers of lower limb arterial lesions in Chinese patients with diabetic foot

Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056-1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450-40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092-7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.

Construction of recombinant plasmids Egr1-XPO4 and its synergic inhibition with 5-FU against hepatocarcinoma SK-Hep1 cells / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To construct recombinant plasmid Egr1-XPO4 and evaluate its synergic inhibition with 5-FU against hepatocarcinoma SK-Hep1 cells. Methods: The XPO4 gene was inserted into vector carrying promoter Egr1 to construct a new recombinant vector, Egr1-XPO4, which was then transfected into human hepatocarcinoma cell line SK-Hep1 and sensitized with chemotherapeutic drug 5-FU. Western blotting was adopted to examine the protein expression of XPO4; CCK assay was used to detect SK-Hep1 cell proliferation after transfection, and Flow Cytometry with Annexin V-FITC/PI staining was used to detect the apoptosis of SK-Hep1 cells. SKHep1 cell xenograft model was constructed on nude mice, and the effect of Egr1-XPO4 in combination with 5-FU on the growth of xenograft was observed. Results: The recombinant plasmid Egr1-XPO4 was successfully constructed.With the sensitization of 5-FU, the expression of XPO4 protein in SK-Hep1 cells was significantly elevated after Egr1-XPO4 transfection, and the evlevation was in a 5FU dose-depend manner.The combined treatment of Egr1-XPO4 and 5-FU produced a significantly stronger inhibition against SKHep1 cell proliferation and greatly promoted apoptosis of SK-Hep1cells compared with 5-FU or pEgr-XPO4 mono-treatment group (all P<0.05). And in vivo antitumor experiment showed that the tumor volume in Egr1-XPO4+5-FU treatment group was significantly smaller than that of Egr1-XPO4 or 5-FU mono-treatment group (P<0.05). Conclusion: The recombinant plasmid Egr1-XPO4 in combination with 5-FU could exertsynergic inhibitionagainst hepatocarcinomaSK-Hep1 cells.

Clinical effect of Caulis decoction on iron deficiency anemia and the hepcidin iron metabolism

Studies have shown that Chinese herb caulis extract can effectively inhibit the expression of the core regulatory hormone hepcidin in iron metabolism and significantly increase the iron level in the body. On this basis, this paper analyzed clinical efficacy and safety of oral niferex [polysaccharide iron complex] combined with caulis Decoction in the treatment of iron deficiency anemia. The results showed that the recovery rate of the Caulis group, Niferex group and the combined treatment group were 41.6%, 46.6% and 58.3% respectively. The difference of recovery rate was statistically significant. The RBC, Hb, Hct, SI, SF, Tf, TIBC and serum Hepcidin in the combined treatment group were

significantly higher than those in the other groups [P<0.05]. Caulis group has 3 cases of gastrointestinal symptoms, and the incidence of adverse reactions was 5%. Chinese medicine caulis can significantly improve erythrocyte count,

hemoglobin, hematocrit and related iron metabolism, but the improvement of the combined treatment group is more obvious. In conclusion, Chinese medicine caulis can significantly improves the clinical symptoms and iron metabolism

in patients with iron deficiency anemia, combined oral niferex therapy has better effect

Effect of rhubarb on extravascular lung water in patients with acute respiratory distress syndrome

Summary Objective: The aim of this study was to evaluate the effect of rhubarb on extravascular lung water (EVLW) in patients with acute respiratory distress syndrome (ARDS). Method: A total of 80 patients with ARDS were randomly divided into a treatment group (40 cases) and control group (40 cases). Patients in the treatment group received rhubarb (30.0 g/d) and patients in the control group received conventional therapy for seven consecutive days. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were determined using pulse contour cardiac output (PiCCO) technology, and the oxygenation index was measured by blood gas analysis at baseline and on days 3, 5 and 7 after treatment. Results: The oxygenation index was higher and the levels of EVLWI and PVPI were lower after treatment in the two groups; however, these indexes showed significant differences on the 5th and 7th days after rhubarb treatment compared with the results in the control group (p<0.05). Conclusion: Rhubarb can decrease EVLWI and PVPI, and improve oxygenation in patients with ARDS.

Research of microwave sterilization of dentures / 口腔疾病防治

@#The lack of proper denture cleaning can put patients who wearing dentures at higher risk from opportunistic oral infections, particularly fungal. The methods for cleaning dentures can be divided into mechanical and chemical. Although the aforementioned methods seem to be effective, however, underused long-term and inappropriately care might not sufficient to control the growth of fungi and other microorganisms that easily adhere to the inner structure of acrylic resin. Denture cleaning should be quickly and easily to perform, especially in long-term care facilities. The use of a microwave oven has been suggested for cleaning and disinfecting dentures. There was no standardization for microwave use for denture cleaning. This review paper aims to synthesize and discuss the advantages and disadvantages of using a conventional microwave oven to clean and disinfect complete dentures and its potential risk for causing structural damage.

Clinical features of adult and pediatric anaphylaxis in Taiwan.

Background: Most epidemiologic studies of anaphylaxis have been on Western populations, leaving the clinical and demographic pattern of this acute allergic condition in Asia unclear. Objective: To investigate the clinical characteristics of patients with anaphylaxis in Chang Gung Memorial Hospital, the largest medical center in Taiwan. Methods: We conducted a retrospective analysis of 201 patients who visited the emergency department or were admitted to the hospital for anaphylaxis from 2000 to 2010. We analyzed the causes, clinical presentation, and management, and also compared adult and pediatric cases. Results: The average patient age was 43.3 years. Mortality from anaphylaxis was 0.5% (1/201). The annual number of cases presenting with anaphylaxis increased throughout the decade we studied. Seven types of etiology were identified: medication (53%), contrast medium (24%), idiopathic condition (8%), food (5%), blood transfusion (4%), insect sting (3%), and others (3%). Skin and respiratory presentations are more common in children than in adults (skin presentation, 81% vs. 51%, p =0.002); respiratory presentation, 74% vs. 49%, p =0.011), and cardio-vascular presentation is more frequent in adults than in children (83% vs. 61%, p =0.006). Clinical presentations with angioedema, gastro-intestinal and neurological system involvement, and management were not significantly different between adults and children. Conclusions: We conclude that anaphylaxis in Taiwan appears to be increasing, just as in the West, but shows a different clinical picture; medication rather than food was the most common cause of anaphylaxis in our population. Moreover, food-induced anaphylaxis in children is not so prevalent in Taiwan.

Prevalence and risk factors for early presentation of asthma among preschool children in Taiwan.

Background: Traditional asthma prevalence surveys were based on the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, which focuses on children aged 6-7 and 13-14. However, asthma-like symptoms usually commence in preschool aged children, in whom it is difficult to make a definite diagnosis of asthma. It is worth determining the prevalence rate of asthma or asthma-like symptoms and analyzing the risk factors for this phenomenon among preschool aged children. Materials and Methods: Children aged 3-6 years were recruited from kindergartens in Keelung City, northern Taiwan. The questionnaire used was based on the ISAAC phase III core and environmental questionnaires and included questions on asthma, rhino-conjunctivitis, and eczema, along with questions to elicit common and early presentations of asthma, as well as other demographic and environmental data. The questionnaires were delivered and completed by parents. Results: 2,395 questionnaires were delivered to parents with children at 50 kindergartens, of which 2,170 questionnaires were returned (return rate 90.6%). 9.9% of these preschool children had physician-diagnosed asthma. However, 20.4% of them experienced asthma-like symptoms while attending kindergarten. Both the physician-diagnosed asthma and asthma-like symptoms groups had more clinical symptoms in all seasons except summer, compared to children without asthma. It was significant that the asthma-like symptoms commenced after joining a kindergarten (P< 0.001), and 66.5% of the children started to experience the symptoms within one month of beginning kindergarten. Using antibiotics or antipyretics in young infancy and mothers having asthma were the risk factors for developing asthma and asthma-like symptoms (P< 0.001), but parental smoking was not contributory to asthma development in preschool children. More frequent use of antipyretics in a year had a higher risk for the development of asthma and asthma-like symptoms. Conclusions: Asthma and asthma-like symptoms were common in preschool children. Early infection of the respiratory tract and use of antibiotics were associated with presentation of symptoms. Attending a kindergarten is also a risk factor for early presentation of asthma among preschool children.

The association of seasonal variations of asthma hospitalization with air pollution among children in Taiwan.

Background: The impact of air pollution on asthma in children in different age group has not been well defined. Objective: This study aimed to evaluate the association between seasonal variations in air pollution and asthma hospitalization of children within a two-year period. Methods: Using the National Health Insurance database, seasonal variations in hospitalization trends in children with a primary diagnosis of asthma (International Classification of Disease 9th revision, code 493) for patients aged < 18 years from 2001 to 2002 were investigated. Data on the average concentration of nitrogen dioxide (NO2), carbon monoxide (CO), ozone(O3), sulphur dioxide (SO2), and particles with aerodynamic diameter < 10 μm (PM10) for each month were obtained from the Environmental Protection Department through 71 stations of air quality monitor distributed nationwide. PSI value (pollutants standard index) > 100 was considered poor air quality. Seasonal variations in asthma admissions were compared to the air pollution quality data using Spearman’s rank correlation. Results: Asthma hospitalization was not related to the number of days when the PSI was > 100 during the 24-months period (r = -0.361; p = 0.083). However, it was significantly associated with seasonal changes in the concentration of each pollutant. The most strongly related air pollutant variable was PM10 (standardized coefficients 0.384), followed by O3 (standardized coefficients 0.255) and SO2 (standardized coefficients 0.162) concentrations. The association of seasonal changes in asthma hospitalization with these pollutants was greater in pre-school and school age children. Temperature and rainfall in all seasons were not related to asthma hospitalization. None of the pollutants were associated with seasonal variations in admission rate for adolescents. Conclusion: Seasonal variations of asthma hospitalization among preschool children are associated with concentration of air pollutants.

Development of rabbit meniscus acellular matrix / 中国医学科学院学报

<p><b>OBJECTIVE</b>To prepare a rabbit meniscus acellular matrix scaffold and explore the histomorphological and biomechanical properties of the scaffold.</p><p><b>METHODS</b>Rabbit meniscuses were collected and acellularized using a modified eight-step detergent process with hydrogen peroxide, distilled water, Triton X-100, and sodium deoxycholate. Its color and texture were observed. Histomorphological assessment was performed using routine hematoxylin-eosin stain, toluidine blue stain, Saffron stain, Hoechst-33258 stain, and immunohistochemical staining of collagen I. The ultrastructure of the specimens was observed with inverted phase contrast microscopy. Transient recovery rate of deformation, maximal recovery rate of deformation, and maximal compressive strength were tested to determine the biomechanical properties of the scaffold.</p><p><b>RESULTS</b>The processed meniscus was milk-white in color with loose structure. It histologically appeared cell-free, stained positively for collagen I, and had abundant micropores according to phase-contrast microscopy. The transient recovery rate of deformation was (76.65∓4.61)%, the maximal recovery rate of deformation was 100%, and the maximal compressive strength was (4.51∓0.69) N when the specimens were compressed 40%.</p><p><b>CONCLUSIONS</b>The rabbit meniscus acellular matrix scaffold, with numerous micropores, is easy to be recovered from deformation and suitable for the adhesiveness and growth of breeding cells. This scaffold can be used as an ideal implant for future tissue engineering of the meniscus.</p>

The Effect of Brain-derived Neurotrophic Factor on Angiogenesis / 华中科技大学学报（医学）（英德文版）

To investigate the in vitro and in vivo proangiogenic effects of brain-derived ncurotrophic factor (BDNF),human umbilical vein endothelial cells (HUVECs) were isolated and cultured in primary culture.The effect of BDNF on the proliferation of HUVECs was examined by MTT assay.The effects of BDNF on HUVEC migration and tube formation were studied by modified Boyden chamber assay and tube formation assay,respectively.Matrigel plug assay and chorioaUantoic membrane assay were used to evaluate the effects of BDNF on angiogencsis in vivo.Our results showed that BDNF substantially stimulated the migration and tube formation of HUVECs in vitro,although it did not induce HUVEC proliferation.BDNF also induced angiogenesis both in matrigcl plug of mouse model and in chick chorioallantoic membrane.In conclusion,BDNF can promote angiogenesis both in vitro and in vivo,and may be a proangiogenic factor.

Epidemiology and current status of asthma and associated allergic diseases in Taiwan- ARIA Asia-Pacific Workshop report.

The prevalence of allergic diseases appears to have been increasing in recent years. The hospitalization rate of asthma in children showed an increasing trend. House dust mites and cockroaches are the two most common indoor aeroallergens in Taiwan. Various kinds of inhaled corticosteroids or combination medications are available, but in clinical practice these have not been used as much as oral beta-2 agonists. Generally 68% of the physicians would follow the asthma treatment guidelines. Because of the comprehensive health care insurance system, the majority of the population in Taiwan can afford the medical expense of diseases. The country's expenditure of asthma care is around USD 83.1 millions per year which is increasing by the year as well. In clinical aspects, asthma education should still be included as part of its treatment.

Risk factors and bacterial profiles of urinary tract infections in patients with systemic lupus erythematosus.

Bacteremic urinary tract infection (UTI) is known to carry a high mortality rate, especially in immunocompromised patients. Patients with systemic lupus erythematosus (SLE) have an immunocompromised status, and thus an increased risk of infection. To evaluate the risk factors for UTI in SLE patients and to identify factors associated with bacteremic UTI, we reviewed SLE patients hospitalized for UTI over a 20-year study period. Based on our results we conclude that lupus nephritis is a risk factor for UTI in SLE patients. Clinical symptoms do not significantly distinguish bacteremic from non-bacteremic UTI in hospitalized SLE patients. Although Escherichia coli remain the most common bacteria in UTI, Salmonella spp. might need particular attention because of their high likelihood for causing bacteremia.

Prevalence and severity of symptoms of asthma, allergic rhinitis, and eczema in 10- to 15-year-old schoolchildren in central Taiwan.

The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was distributed through 14 schools and was completed by 11,874 students out of which are parents of 4,167 children aged between 10 and 12 years old and 7,677 older children aged between 13 and 15 years in central Taiwan. The overall cumulative and 12-month prevalence of wheezing, rhinitis, and eczema were 7.4%, 43.0%, and 7.2%, respectively. It was shown that boys had significantly higher prevalence of wheezing and rhinitis (p < 0.001 and p = 0.001) when compared to girls in central Taiwan. The study also found that prevalence rates among younger children with symptoms of wheezing, rhinitis, and recurrent itchy rash in the past 12-month (8.2%, 44.4%, and 8.8%) were higher than that among older children (6.9%, 42.2%, and 6.3%, respectively). In conclusion, boys had significantly higher prevalence of wheezing and rhinitis than girls while younger children tend to have higher prevalence of the disorders than those that are older in age.

Increasing asthma care knowledge and competence of public health nurses after a national asthma education program in Taiwan.

One of the responsibilities of a public health nurse is to provide asthma education to local residents. However, there have been no comprehensive education programs for public health nurses on asthma care in the past. This study aimed to determine level of competence of public health nurses on asthma care in order to improve their capability through a one-day national asthma education course. In addition to lectures on updated asthma management information, data was obtained through demonstrations and practice on inhalation techniques of various kinds of inhaled devices, including the ability to use and interpret the data of a peak flow meter. Two written examinations with the same questions were given to participants before and right after the lectures. All of the 560 public health nurses in the 392 public health bureaus were invited to join the program and 522 (93.2%) participated. Five hundred and six completed both the pre- and post-tests. Before the national education program, only 10.9% of the participants knew the purpose of the peak flow meter, while 62.6% had never heard of it. Initially, they showed less confidence on teaching patients on the use of inhaled devices (2.36 and 2.59 in 5 scales). Comparing the two tests, there was a significant increase in the public nurses' knowledge as regards: 1) the general concept of asthma, 2) prevention of trigger factors and environmental control, 3) proper medication knowledge, 4) peak flow meter (PEF) monitoring, and 5) intervention after acute exacerbation of asthma (p < 0.001). A well-designed course on asthma management is an efficient scheme to improve public health nurses' knowledge and confidence on asthma care.

Survey of the clinical practice of physicians in the management of asthma in Taiwan.

Asthma is a common problem with a prevalence rate increasing every year. However, not all asthmatic patients receive appropriate treatment, partly due to the disease entity or patients' compliance, and partly due to physicians' knowledge and disposition in terms of treatment. This study was designed to investigate the current status of asthma treatment among clinicians in different practice settings, particularly regarding the acceptance of and adherence to asthma treatment guidelines and asthma patient education. Questionnaires were distributed by randomized sampling to doctors throughout the entire country. The questionnaire had six parts, measuring the following: 1) the use of different kinds of medication in the treatment of asthma; 2) adherence to asthma treatment guidelines; 3) the use of inhaled corticosteroids as part of management; 4) the use of peak flow meters in monitoring asthma; 5) relative efficiency in treating asthma; and 6) the use of a referral system, from general practitioners to specialists. There were 531 respondents out of 1,000 questionnaires distributed. The results revealed the following: 1) 20.2% of physicians use oral corticosteroids for maintenance therapy; 2) 31.8% of physicians do not follow asthma treatment guidelines; 3) 77.2% of physicians use inhaled corticosteroids for maintenance therapy (physicians in medical centers and regional hospitals use inhaled corticosteroids more frequently than private practitioners); 4) 51% of doctors do not use peak flow meters to monitor asthma symptoms because of prohibitive costs; 5) approximately 80% of clinicians have confidence in dealing with asthma problems; and 6) 29.2% of general practitioners do not refer patients to asthma specialists unless there is poor control or a need for further evaluation. Adherence to asthma treatment guidelines is poor, and such guidelines need to be popularized or simplified. There are still many discrepancies among doctors at different levels of hospitals. Re-education and review of asthma knowledge is necessary to keep clinical practitioners at the forefront of standard practice.

Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children.

The aim of this study was to analyze the clinical spectrum and seek potential curable causes of spontaneous pneumomediastinum (SPM) in children in order to minimize respiratory morbidity. Medical records from 1986 to 2003 were retrospectively reviewed at a tertiary pediatric facility in northern Taiwan. Sixteen cases of SPM were identified. There were eleven boys and five girls (M:F = 2.2:1) and ages ranged from 2 to 17 years (average, 10 years). Cough (81%), dyspnea (75%) and chest pain (56%) were the predominant symptoms and expiratory wheezing (63%) and neck crepitus (50%) were the most common physical findings. The specific sign of Hamman's crunch was noted in only one child initially. A coughing-related Valsalva maneuver (13 patients/81%) was the most common cause of pneumomediastinum in these children. The most common underlying medical causes were asthma (8 patients/50%) and idiopathic origin (5 patients/31%). Acute gastroenteritis, foreign body aspiration and mycoplasmal pneumonia were each found in one patient respectively. All patients had subcutaneous emphysema on initial chest radiographs. Two patients were complicated by pneumothorax and required intensive respiratory therapy. The average hospital stay was 4 days (range 1-9 days). Rapid resolution of symptoms without long-term sequelae was common except for one patient who had hypoxic-ischemic encephalopathy with epilepsy after foreign body removal. We conclude that in young teenagers, who suffer from cough, dyspnea, chest pain and associated discomfort of throat or neck, the diagnosis of SPM should be considered and chest radiography including posterior-anterior and lateral projections should be performed to verify the diagnosis. Because of the high prevalence of asthma related SPM, children of idiopathic SPM should undergo diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma. Targeted investigations of the underlying causes of SPM might decrease respiratory morbidity and avoid further complications.

Juvenile ankylosing spondylitis with uveitis.

A 17-year-old boy had suffered from right ankle arthralgia when he was 13 years old. He also had bilaterally congested conjunctivas and were erythematous around his right ankle joint. A soft tissue echo showed swelling of the right ankle joint. A Ga 67 scan revealed a focal elevated uptake in the right ankle, but a bone scan was negative. Reactive arthritis was suspected due to conjunctivitis, arthritis and a previous episode of watery diarrhea. An ophthalmologic examination showed no evidence of uveitis. Laboratory data were negative for rheumatoid factor, antinuclear antibody and anti-ds DNA. Erythrocyte sedimentation rate (ESR) was 40 mm/hr and a histocompatibility test was positive for antigen B27. Based on the diagnosis of cellulitis and reactive arthritis, oxacillin and naproxen were given for 14 days. During follow-up at the OPD, bilateral arthralgia of the ankle joints was noted and a sonography showed bilateral edematous ankle joints. Juvenile ankylosing spondylitis (JAS) was suspected. Two years later, he had lower back pain and arthralgia of the knee joints with uveitis of the right eye. He was treated with naproxen and prednisolone. Because few JAS cases initially present as axial arthropathy or enthesopathy and uveitis is uncommon in children, we presented the case with a review of literature and conclusion that the possibility of JAS should be considered in young adolescent boys with arthritis of the lower limbs, enthesitis, a family history of related diseases and positive HLA-B27, as well as negative rheumatoid factor (RF) and anti-nuclear antibody (ANA) results.