诺卡式菌性角膜炎表现为盘状角膜炎1例

目的:报告诺卡式菌属感染引起的盘状角膜炎病例1例。方法:病例报告。结果:患者,男,13岁,无角膜接触镜使用史,在小溪里游泳后,右眼疼痛伴视力下降2wk。最佳矫正视力:右眼6/30(0.2)。检查发现角膜基质存在形态规则的旁中心盘状浸润伴炎症反应。角膜敏感度下降。最初角膜刮片镜检行革兰氏染色阴性,棘阿米巴角膜刮片和培养阴性。诊断为病毒性盘状角膜炎,给予口服阿昔洛韦和局部使用激素眼药水。2wk后患者视力恶化伴角膜损伤加重,再次角膜取材刮片行革兰氏染色提示诺卡式菌属感染,按经验局部给予3g/L加替沙星眼药水后,临床效果明显。治疗6mo后,视力达到6/6仅在角膜中心留有少量角膜混浊。结论:诺卡式菌属感染延误诊断可以导致病情恶化。如果采用正确的治疗,诺卡式菌属感染引起的角膜炎可以恢复良好,仅留少量瘢痕,获得较好的视力。     

Expression of EGFR and c-kit is associated with the basal-like phenotype in breast carcinomas of African women

Epidermal growth factor receptor (EGFR) and c-kit are tyrosine kinase growth factor receptors which are frequently expressed in basal-like breast carcinomas, and tyrosine kinase inhibition is now a promising strategy in treatment of breast cancer. The aim of this study was to evaluate the expression of EGFR and c-kit in breast cancer with special focus on the basal-like phenotype (BLP) and other prognostic factors in an African population. We analyzed 65 archival tissues immunohistologically. EGFR and/or c-kit were expressed in 55% of basal-like tumors. Expression of EGFR and/or c-kit was strongly associated with high histologic grade (P=0.001), high nuclear grade (P=0.017), high mitotic counts (P=0.002), ER negativity (P=0.003), PR negativity (P=0.007), and HER2 negativity (P=0.014). EGFR and/or c-kit positive tumors were more likely to express the BLP (OR 9.1, CI 2.6-32.0, P<0.0005) than the negative tumors. In conclusion, there is a high expression of EGFR and/or c-kit in basal-like breast carcinoma in this series from Uganda and their expression is associated with features of poor prognosis. More studies are required to assess the clinical significance of EGFR and c-kit in breast cancer patients in Uganda.     

Cathepsin K predicts femoral neck bone mineral density change in nonosteoporotic peri- and early postmenopausal women

OBJECTIVE: Cathepsin K is a cysteine protease that plays an essential role in organic bone matrix degradation. The aim of our study was to seek correlation of serum cathepsin K levels and a change in bone mineral density (BMD) over a 3-year period in a population of healthy nonosteoporotic women. The secondary end points were the correlations of serum cathepsin K with cross-sectional BMD and with other serum bone turnover markers and age. DESIGN: In 43 healthy women aged 42 to 57 years, blood samples for determination of cathepsin K, osteocalcin, bone alkaline phosphatase, C-terminal cross-linking telopeptide of type I collagen, osteoprotegerin, and nuclear factor kappaB ligand were collected at the time of the first BMD measurement. BMD measurements were repeated after 3 years. RESULTS: We found a moderate negative correlation of serum cathepsin K levels with change in femoral neck BMD, but none with change in spinal BMD. There were no significant correlations between cross-sectional BMD of the spine or femoral neck and serum levels of cathepsin K. Serum levels of cathepsin K were not significantly correlated with any bone turnover markers studied or with age. CONCLUSIONS: Serum cathepsin K does not seem to represent a surrogate for bone turnover markers used at present, but it might be useful as a predictor of cortical bone loss.     

The potential of the coelomic fluid in sea cucumber as an antioxidant

In a biological system the product of free-radical induced-lipid peroxidation are conjugated dienes (CDs), lipid peroxides and malondialdehyde (MDA). Its control depends on antioxidant activities. Antioxidant defend the body system by controlling the damage caused by the free radicals. This paper describes lipid peroxidation process and antioxidant activities present in three species of holothuroid obtained from the coastal waters of Terengganu, Malaysia. Among the three species studied, the coelomic fluid of Bohadschia mamorata vitiensis contained the highest level of protein (7.24 + 0.04)g/L. The coelomic fluid of Stichopus badionotus Selenka contained the highest level of superoxide dismutase (SOD) (9.46 + 0.99)X 105 IU/g protein, MDA (16.46 + 1.28)nmol/g protein and total antioxidant activities (AOA) (58.81 + 5.70) %. In Stichopus variegatus Semper the coelomic fluid only demonstrated the highest level of CDs (94.19 + 11.34) RU/g protein compared with the other two species. This preliminary study indicated that some form of antioxidant activities are present in the coelomic fluid of holothuroids.     

The Problem of Routine Circumcision

One hundred male infants were studied at the Kingston General Hospital, Kingston, Ontario, to determine the incidence and complications of routine circumcision. The parents were also interviewed concerning the reason for operation.

In these 100 infants, complications, usually minor, were very common, and included hemorrhage (35), meatal ulcers (31), infection (eight), phimosis (one) and meatal stenosis.

The reasons given for operation were prophylactic—to avoid the psychological trauma of later operations for infection, phimosis and “troubles” (40), cleanliness (11) and phimosis (four). The remaining cases were for social and other non-medical reasons. Attitudes of parents and physicians regarding circumcision varied from firm belief in its value to a casual approach. One-half of the babies had partial circumcisions, confirming previous suspicions that non-Jewish males frequently had partial operations. Partial operations do not always guarantee cleanliness and probably do not eliminate the risk of penile carcinoma in all cases, if smegma is carcinogenic. Routine circumcisions spare a few children psychologically traumatic operations at a later date and relieve parents of anxiety about the future of the uncircumcised child. This should be balanced against the complications which, although usually minor, may occasionally be serious.

Between 1961 and 1962, at the Kingston General Hospital, 349 (48%) of 727 male newborn babies were routinely circumcised.

     

Case Report: Outbreak of Human Brucellosis from Consumption of Raw Goats' Milk in Penang,Malaysia

We report the largest outbreak of brucellosis in Penang, Malaysia. Brucellosis is not endemic in this region. The index case was a 45-year-old goat farm owner presented with 3 weeks of fever, headache, severe lethargy, poor appetite, and excessive sweating. He claimed to have consumed unpasteurized goat''s milk that he had also sold to the public. Tests were negative for tropical diseases (i.e., dengue fever, malaria, leptospirosis and scrub typhus) and blood culture showed no growth. Based on epidemiological clues, Brucella serology was ordered and returned positive. Over a period of 1 year, 79 patients who had consumed milk bought from the same farm were diagnosed with brucellosis. Two of these patients were workers on the farm. Four laboratory staff had also contracted the disease presumably through handling of the blood samples. The mean duration from onset of symptoms to diagnosis was 53 days with a maximum duration of 210 days. A combination treatment of rifampin and doxycycline for 6 weeks was the first line of treatment in 90.5% of patients. One-third of the patients had sequelae after recovering and 21% had a relapse. We highlight the importance of Brucellosis as a differential diagnosis when a patient has unexplained chronic fever.     

Contact Tracing Activities during the Ebola Virus Disease Epidemic in Kindia and Faranah,Guinea, 2014

The largest recorded Ebola virus disease epidemic began in March 2014; as of July 2015, it continued in 3 principally affected countries: Guinea, Liberia, and Sierra Leone. Control efforts include contact tracing to expedite identification of the virus in suspect case-patients. We examined contact tracing activities during September 20–December 31, 2014, in 2 prefectures of Guinea using national and local data about case-patients and their contacts. Results show less than one third of case-patients (28.3% and 31.1%) were registered as contacts before case identification; approximately two thirds (61.1% and 67.7%) had no registered contacts. Time to isolation of suspected case-patients was not immediate (median 5 and 3 days for Kindia and Faranah, respectively), and secondary attack rates varied by relationships of persons who had contact with the source case-patient and the type of case-patient to which a contact was exposed. More complete contact tracing efforts are needed to augment control of this epidemic.