Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis.

BACKGROUND Amyloid light-chain (AL) amyloidosis is usually due to deposition of immunoglobulin lambda light chains from plasma cells in patients with multiple myeloma. AL amyloid may involve the salivary glands, gastrointestinal tract, peripheral nerves, and skin. However, musculoskeletal amyloid and amyloid arthropathy are rare. This report is of a woman with bilateral upper limb musculoskeletal amyloid and amyloid arthropathy associated with multiple myeloma, initially diagnosed and managed as a case of rheumatoid arthritis. CASE REPORT A 59-year-old woman who was initially diagnosed with rheumatoid arthritis presented with bilateral polyarthritis in the upper limbs. Despite treatment with corticosteroids, methotrexate, and hydroxychloroquine, her symptoms did not improve. After 4 months, she revisited our hospital with the appearance of swollen soft tissue in the upper right arm and numbness of the right hand. She had an arthroscopic synovectomy of the right shoulder joint, and the mass in the right elbow area was removed. These specimens were positive by Congo red stain and confirmed the deposition of light chain protein as amyloid. She was diagnosed with multiple myeloma according to International Myeloma Working Group criteria, including bone marrow plasma cells more the 10%, lytic lesions in bone, and anemia. CONCLUSIONS This report highlights the importance of imaging, biopsy, and laboratory investigations in patients with arthropathy and musculoskeletal disease. In this case, the patient was seronegative for rheumatoid arthritis, and the presentation with very thick and nodular synovium supported an alternative diagnosis. The identification of musculoskeletal amyloid and amyloid arthropathy confirmed underlying multiple myeloma.

Knowledge and Attitude Related to Hepatitis C among Medical Students in the Oral Direct Acting Antiviral Agents Era in Vietnam.

BACKGROUND: Medical students play important frontline roles in the prevention, early detection, and treatment of hepatitis C. This study investigated knowledge and attitudes toward hepatitis C among 5th- and 6th-year medical students and possible associated factors. METHODS: A cross-sectional survey was conducted among 2000 students from eight medical universities using a self-administered structured questionnaire. RESULTS: The mean knowledge and attitude scores for hepatitis C were 20.1 ± 4.0 (out of 26) and 10.6 ± 2.9 (out of 20), respectively. Approximately, three-quarters (74.4%) of the participants had a good knowledge score, but only a small proportion (3.1%) obtained a good attitude score. Although the participants had fairly high knowledge about the causes, consequences, and transmission routes of hepatitis C, there were important gaps in their knowledge about hepatitis C screening and treatment. In multivariate analysis, female students, 5th-year students, and students from the central provinces had significantly higher knowledge and attitude scores. There was a low positive correlation between knowledge and attitude scores. CONCLUSION: This study points out the need to update the medical training curriculum to improve the knowledge and attitude of students about hepatitis C infection.

Knowledge, Attitudes and Practices toward Hepatitis B Virus Infection among Students of Medicine in Vietnam.

BACKGROUND: Building capacity in hepatitis B virus prevention and management for medical students and health professionals is one of the pillars of the national viral hepatitis control strategy. METHODS: A cross-sectional study was conducted at eight medical universities from the northern, central and southern regions of the country between May and November 2020 using a systematic random sampling technique. RESULTS: Among 2000 participants, 84.2% reported they had been tested for hepatitis B and 83.9% had received the hepatitis B vaccine. The mean knowledge, attitude, practice score was 40.2 out of 54 (74.4%) with only 19.9% of the study participants obtaining a good score. In multivariate analysis, fifth year students, students from central universities, students who had tested positive for hepatitis B and students who had received hepatitis B vaccine or had encountered patients with chronic hepatitis B had significantly higher knowledge score (p < 0.05). The study showed lack of trust in the hepatitis B vaccine safety and lack of confidence in providing counselling, testing and management of patients with chronic hepatitis B. CONCLUSION: Findings from our research emphasized an immediate need to improve the medical schools' training curriculum in Vietnam to enable students' readiness in hepatitis B prevention and management.

Working environment and fetal malformations

During gestation, a fetus may be affected by factors that cause it to develop in anomalous ways. Yet it is not easy to determine what exactly are the causes of a given fetal malformation. Objectives: We investigated pregnant women's perceptions of what could be the causes of the fetal malformations they experienced. Methods: Qualitative interviews with 30 pregnant women and their families after an ultrasound scanning had detected a defect in the fetus. Results: Even though in many cases the working environment of either mother or father might have played a role in causing the malformation, the research showed that the parents themselves hardly ever blamed their working environment for the defect. The research also showed that most couples kept the malformation secret from their family, community and colleagues. This secrecy in combination with parental reluctance to consider the health impact of their working environment may make it difficult to combat possibly toxic working environments in Vietnam. Conclusions: In some cases, fetal malformations may be related to a toxic working environment. Yet in this study, a few pregnant women know that exposure to toxic chemicals at the workplace can play a role in causing a malformation in their fetus.