Facing the threat of influenza pandemic - roles of and implications to general practitioners

The 2009 pandemic of H1N1 influenza, compounded with seasonal influenza, posed a global challenge. Despite the announcement of post-pandemic period on 10 August 2010 by theWHO, H1N1 (2009) virus would continue to circulate as a seasonal virus for some years and national health authorities should remain vigilant due to unpredictable behaviour of the virus. Majority of the world population is living in countries with inadequate resources to purchase vaccines and stockpile antiviral drugs. Basic hygienic measures such as wearing face masks and the hygienic practice of hand washing could reduce the spread of the respiratory viruses. However, the imminent issue is translating these measures into day-to-day practice. The experience from Severe Acute Respiratory Syndrome (SARS) in Hong Kong has shown that general practitioners (GPs) were willing to discharge their duties despite risks of getting infected themselves. SARS event has highlighted the inadequate interface between primary and secondary care and valuable health care resources were thus inappropriately matched to community needs

Nomenclature of drug-induced pityriasis rosea-like rashes

Antonio AT Chuh1Prince of Wales Hospital, Hospital Authority, 2The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong KongI read with admiration an article published in your prestigious journal on the rare adverse effects of clozapine (CLZ).1I write to address a specific issue in this article. In the second paragraph of the section “Dermatological adverse effects”, it was stated that a 54-year-old patient with schizophrenia treated for 28 days with CLZ developed a generalized rash compatible with pityriasis rosea (skin rash that usually begins as one large circular or oval spot on your chest, abdomen, or back).I wish to point out certain problems for coining pityriasis rosea (PR) as the diagnostic label in the patient concerned.View original paper by De Fazio and colleagues

Lack of evidence of active human herpesvirus 7 (HHV-7) infection in three cases of pityriasis rosea in children

Three cases of pityriasis rosea in Chinese children are presented. Using polymerase chain reaction for detection of human herpesvirus 7 (HHV-7) DNA in plasma and peripheral blood lymphocytes, we find no evidence of active HHV-7 infection.link_to_subscribed_fulltex

Case Clustering in Pityriasis Rosea: A Multicenter Epidemiologic Study in Primary Care Settings in Hong Kong

OBJECTIVES: To investigate the epidemiology of pityriasis rosea in primary care settings in Hong Kong and to analyze for temporal clustering. DESIGN: Retrospective epidemiologic study. SETTING: Six primary care teaching practices affiliated with a university. Patients Forty-one patients with pityriasis rosea, 564 patients with atopic dermatitis (negative control condition), and 35 patients with scabies (positive control condition). METHODS: We retrieved all records of patients with pityriasis rosea, atopic dermatitis, or scabies diagnosed in 3 years. We analyzed temporal clustering by a method based on a regression model. RESULTS: The monthly incidence of pityriasis rosea is negatively but insignificantly correlated with mean air temperature (gamma s = -0.41, P =.19) and mean total rainfall (gamma s = -0.34, P =.27). Three statistically significant clusters with 7, 6, and 7 cases were identified (P =.03), occurring in the second coldest month in the year (February), the second hottest month (July), and a temperate month (April), respectively. For atopic dermatitis (negative control condition), the nonclustering regression model was selected by Akaike information criteria. For scabies (positive control condition), 1 cluster of 20 cases was detected (P =.03). CONCLUSIONS: Significant temporal clustering independent of seasonal variation occurred in our series of patients with pityriasis rosea. This may be indicative of an infectious cause

Human herpesvirus 6 and 7 DNA in peripheral blood leucocytes and plasma in patients with pityriasis rosea by polymerase chain reaction: A prospective case control study

An association between pityriasis rosea and human herpesvirus 7 (HHV-7) has been reported but remains controversial. The purpose of the present study was to investigate the association between HHV-6 and HHV-7 with pityriasis rosea. Fifteen patients aged 6-54 years with a diagnosis of pityriasis rosea and 15 age-matched controls were recruited. None of the patients had HHV-6 or HHV-7 DNA detected by polymerase chain reaction in the acute or convalescent plasma specimen. In the acute peripheral blood leucocytes specimen, 3 patients and one control had HHV-6 DNA detected (p=0.299; NS), while 7 patients and 5 controls had HHV-7 DNA (p=0.355; NS). Antibody to HHV-6 was detected in the acute specimen of 13 patients and 13 controls, while antibody to HHV-7 was found in all 15 of patients and controls. We thus found no evidence of recent HHV-6 or HHV-7 infection in patients with a diagnosis of pityriasis rosea.link_to_subscribed_fulltex

The association of smoking and acne in men in Hong Kong and in India: A retrospective case-control study in primary care settings

Previous studies on the association of smoking with acne vulgaris have reported conflicting results. The objective of this study was to investigate such an association. Our setting was three primary care practices in Hong Kong and one primary care practice in India. Patient characteristics in all four practices are similar. All medical records in these practices incorporate a section in which the smoking habits of each patient is routinely documented. We searched our database and retrieved 632 records of patients with acne seen in the previous 5 years. We also retrieved 632 records of age- and sex-matched controls. Fifty-three out of 379 male patients with acne and 25 out of 379 male controls were smokers (P = 0.001; OR, 2.3; 95% CI, 1.4-3.8). Six out of 253 female patients with acne and three out of 253 female controls were smokers (OR, 2.0; 95% CI, 0.5-9.4). We conclude that smoking is likely to bear a positive correlation with acne for men. Our numbers are too small for a definite conclusion to be drawn for females.link_to_subscribed_fulltex

A prospective case control study of the association of Gianotti-Crosti syndrome with human herpesvirus 6 and human herpesvirus 7 infections

Gianotti-Crosti syndrome (GCS) is known to be associated with hepatitis B and Epstein-Barr virus (EBV) infections. Apart from a single case report based on serology alone, there are no published data on an association between GCS and human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) primary infections or reactivations. Our aim was to investigate the association between GCS and HHV-6 and HHV-7 infections. Ten patients diagnosed with GCS at a primary care practice over an 18-month period were recruited. Controls were age- and sex-matched patients with unrelated symptoms requiring venepuncture for other indications. Blood specimens were collected from patients and controls at presentation, and from patients 4 weeks later. Virologic evidence of HHV-6 and HHV-7 infection was sought in peripheral blood leukocytes and plasma using polymerase chain reaction (PCR) for viral DNA, reverse transcriptase polymerase chain reaction (RT-PCR) for HHV-6 U91 mRNA transcripts, and serology. Serology for EBV and hepatitis B virus was done. In contrast to the 10 controls, 2 patients (both infants) with clinically diagnosed GCS had evidence of active HHV-6 infection. This was demonstrated by detection of viral DNA in the absence of antibody in the acute plasma specimens and HHV-6 DNA viral loads of more than 5.3 log10 genome copies/5 μl in the whole blood specimens, a profile previously shown to be diagnostic of recent primary HHV-6 infection. None of the patients had evidence of recent EBV or hepatitis B infection. We conclude that primary HHV-6 infection may be associated with GCS in some infants.link_to_subscribed_fulltex

Developing high quality family medicine practice to safeguard the health of our population and towards a healthy development of our health care system

The recent discussion paper on the future service delivery model for our health care system has highlighted the importance of family physicians. It is important to highlight the unique skills of family physicians and explore how best to build up the basic competencies from undergraduate to postgraduate level. A system of certification for family physicians is needed but we must take into account the historical development of Family Medicine in Hong Kong. The certification system must be reasonable in assuring basic standards. It should also be possible for all practicing primary care physicians to achieve without great difficulty. One should use the concept of professional development for doctors already in practice to achieve the basic competencies in Family Medicine. The family physicians must be well positioned in the health care delivery system and the future system should enable them to be more directly involved in chronic disease management, preventive health services and health promotion activities. All these initiatives need to be put in action as soon as possible.link_to_subscribed_fulltex