Clinicopathological effects of pepper (oleoresin capsicum) spray.

OBJECTIVES: Pepper (oleoresin capsicum) spray is one of the most common riot-control measures used today. Although not lethal, exposure of pepper spray can cause injury to different organ systems. This review aimed to summarise the major clinicopathological effects of pepper spray in humans. DATA SOURCES: MEDLINE, EMBASE database, and Cochrane Database of Systematic Reviews were used to search for terms associated with the clinicopathological effects of pepper spray in humans and those describing the pathophysiology of capsaicin. A phone interview with two individuals recently exposed to pepper spray was also conducted to establish clinical symptoms. STUDY SELECTION: Major key words used for the MEDLINE search were "pepper spray", "OC spray", "oleoresin capsicum"; and other key words as "riot control agents", "capsaicin", and "capsaicinoid". We then combined the key words "capsaicin" and "capsaicinoid" with the major key words to narrow down the number of articles. A search with other databases including EMBASE and Cochrane Database of Systematic Reviews was also conducted with the above phrases to identify any additional related articles. DATA EXTRACTION: All article searches were confined to human study. The bibliography of articles was screened for additional relevant studies including non-indexed reports, and information from these was also recorded. Non-English articles were included in the search. DATA SYNTHESIS: Fifteen articles were considered relevant. Oleoresin capsicum causes almost instantaneous irritative symptoms to the skin, eyes, and respiratory system. Dermatological effects include a burning sensation, erythema, and hyperalgesia. Ophthalmic effects involve blepharospasm, conjunctivitis, peri-orbital oedema, and corneal pathology. Following inhalation, a stinging or burning sensation can be felt in the nose with sore throat, chest tightness, or dyspnoea. The major pathophysiology is neurogenic inflammation caused by capsaicinoid in the pepper spray. There is no antidote for oleoresin capsicum. Treatment consists of thorough decontamination, symptom-directed supportive measures, and early detection and treatment of systemic toxicity. Decontamination should be carefully carried out to avoid contamination of the surrounding skin and clothing. CONCLUSION: Pepper (oleoresin capsicum) spray is an effective riot-control agent and does not cause life-threatening clinical effects in the majority of exposed individuals. Early decontamination minimises the irritant effects.

Clinical characteristics and treatment outcomes of patients undergoing nail avulsion surgery for dystrophic nails.

OBJECTIVE: To evaluate the clinical characteristics and treatment outcomes of patients undergoing surgical nail avulsion. DESIGN: Retrospective study. SETTING: Two dermatology centres in Hong Kong. PATIENTS: A total of 32 patients with nail diseases who underwent 33 nail avulsion procedures were reviewed from case records. MAIN OUTCOME MEASURES: Age, gender, co-morbidities, disease duration, clinical features, histopathology and fungal culture of nail plate, nail bed specimen for fungal culture in appropriate cases, and postoperative outcome. RESULTS: The mean age of the patients at the time of nail avulsion was 54 (range, 27-86) years. The most frequent preoperative findings were thickened nails (23 specimens, 70%) and discolouration (20 specimens, 61%). Onychomycosis was the most common pre-consultative diagnosis (20 specimens, 61%). Prior to nail avulsion, topical or systemic treatment had been tried in more than half of the cases. Histopathology of the avulsed nails confirmed onychomycosis in 24 (73%) of specimens. The clinical cure rate was 88% and the mycologic cure rate was 100%. The procedure was well tolerated without significant complications. Relapse was only noted in three (9%) of the patients having nail avulsions. The time for full re-growth ranged from 5 to 10 months. CONCLUSIONS: Total nail avulsion is an effective management option for patients whose diagnosis of onychomycosis was doubtful, and constitutes a treatment armamentarium especially for patients with single or oligo-onychomycosis.

Clinical significance of Trichomonas vaginalis detected in Papanicolaou smear: a survey in female Social Hygiene Clinic.

OBJECTIVES: To evaluate the clinical significance of Trichomonas vaginalis detected in Papanicolaou (Pap) smears in our local population. DESIGN: Retrospective study. SETTING: A sexually transmitted disease clinic in Hong Kong. PATIENTS: All patients having Pap smear, wet mount microscopy, and high vaginal swab culture performed in Tuen Mun Social Hygiene Clinic from April 2005 to December 2006 were recruited. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values of the Pap smear for the diagnosis of Trichomonas vaginalis. RESULTS: A total of 209 patients had the diagnosis of Trichomonas vaginalis in the study period. From among these, the results of 149 patients who had Pap smears, wet mount microscopy, and high vaginal swab culture performed were used in the analysis. Sixty cases were excluded because treatments were initiated before the consultation or because the Pap smear had not been done. Among the Trichomonas vaginalis cases with positive Pap smears, 58% (85/146) were symptomatic and 41% (60/146) had concomitant sexually transmitted disease. The respective sensitivity and specificity of the Pap smear in our study were: 98% (128/131; 95% confidence interval, 94-100%) and 96% (440/458; 94-98%). In total, 128 patients were defined as true positives by wet mount microscopy or culture, while 18 were defined as false positives. In our study population, the positive predictive value was 88% (128/146; 95% confidence interval, 82-93%). On comparing the clinical features of patients with true-positive and false-positive Pap smears, the odds ratio for the presence of symptoms and concomitant sexually transmitted disease was 1.9 (95% confidence interval, 0.7-5.1) and 2.0 (0.7-5.8), respectively. There were no statistically significant differences in the univariate analysis by Chi squared testing. CONCLUSION: Treatment for vaginal trichomoniasis is recommended if Trichomonas vaginalis is detected in a Pap smear.

A cluster of chilblains in Hong Kong.

OBJECTIVE: To report a recent clustering of chilblain cases in Hong Kong. DESIGN: Case series. SETTING: A regional hospital and a social hygiene clinic in the New Territories West, Hong Kong. PATIENTS: Patients with a clinical diagnosis of chilblains in February 2008. RESULTS: Eleven patients with chilblains were identified; seven (64%) gave an antecedent history of prolonged exposure to cold. They all presented with erythematous or dusky erythematous skin lesions affecting the distal extremities, especially fingers and toes. Laboratory tests revealed elevated antinuclear antibodies titres in two, positive rheumatoid factor in two, presence of cold agglutinins in one, and a raised anti-DNA titre (>300 IU/mL) in one. Skin biopsies were performed in six patients, four of them showed typical histopathological features of chilblains. In the patient with systemic lupus erythematosus, features of vasculitis were suspected, and in the one with pre-existing juvenile rheumatoid arthritis, there were features of livedo vasculitis. In 10 (91%) of the patients, the skin lesions had resolved when they were last assessed (at the end of March 2008), but had persisted in the patient who had pre-existing systemic lupus erythematosus. CONCLUSION: The recent clustering of chilblains was possibly related temporally to the prolonged cold weather at the end of January to mid-February. In our series, most of the patients developed chilblains as an isolated condition and resolved spontaneously within a few weeks. Laboratory tests and skin biopsies for chilblains are not necessary, unless the condition persists, the diagnosis in doubt or an underlying systemic disease is suspected.

Role of Mycoplasma genitalium and Ureaplasma urealyticum in non-gonococcal urethritis in Hong Kong.

OBJECTIVE: To determine the association of Mycoplasma genitalium and Ureaplasma urealyticum in symptomatic male patients presenting with non-gonococcal urethritis in a sexually transmitted infection clinic in Hong Kong. DESIGN: Cross-sectional study. SETTING: A sexually transmitted infection clinic, Department of Health, Centre for Health Protection, Hong Kong. PATIENTS: A cohort of consecutive new male patients attending the government sexually transmitted infection clinic. MAIN OUTCOME MEASURES: Prevalence of Mycoplasma genitalium and Ureaplasma urealyticum among symptomatic male patients with non-gonococcal urethritis and asymptomatic patients without non-gonococcal urethritis. RESULTS: Specimens of 22 and 10 patients tested positive by polymerase chain reaction for Ureaplasma urealyticum and Mycoplasma genitalium respectively, among the symptomatic non-gonococcal urethritis group (n=98). In the asymptomatic control group (n=236), corresponding patient numbers whose specimens tested positive were 47 and 5. There was no statistically significant difference between the two groups, in terms of the proportion of patients infected with Mycoplasma genitalium (P=0.799) or Ureaplasma urealyticum (P=0.535). CONCLUSIONS: In our study, demonstration of Mycoplasma genitalium and Ureaplasma urealyticum by polymerase chain reaction was not associated with symptomatic non-gonococcal urethritis in male patients attending a Hong Kong government clinic for sexually transmitted infections.