SARS-related Perceptions in Hong Kong

To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and ≈70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and ≈40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic

Old Technique -New Evidence: Topical agents for musculo-skeletal injuries

The popular use of topical agents for the treatment of musculoskeletal injuries has persisted for centuries but not much scientific evaluations have been done. Since medicinal herbs are particularly popular in Asia, we started a systematic exploration on their choices, and their pharmacological activities; whether transcutaneous transport of bioactive components occur and above all, whether quality clinical evidences could be generated. We found that a search on the vast literature pool would reveal the favourable choices of herbal agents. Biological screening of those selected herbs showed that they probably follow three major common pathways to help with healing after injury, viz, anti-inflammation, pro-angiogenesis and cellular proliferation. Using a simple formula of selected herbs with the ideal bioactivities, evidence based clinical trials could be organized to further prove the efficacy. We have created two such formulae to be put on clinical trial. Our early pilot clinical trials on two minor injuries on the foot and one chronic inflammatory condition have yielded positive data on the value of such topical agents on pain and oedema control, as well as functional maintenance. There was also suggestion of more rapid bone healing. Although limitations exist clear with the small number of study subjects, the positive data and safe application support more studies

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

N-staging by magnetic resonance imaging for patients with nasopharyngeal carcinoma: Pattern of nodal involvement by radiological levels

Background and purpose: To study the pattern of lymphatic spread for patients with nasopharyngeal carcinoma (NPC), the significance of retropharyngeal node (RP-LN) involvement, and the possibility of replacing the supraclavicular fossa (SCF) by Levels IV and Vb (LL) as a demarcating criterion for N3-category. Patients and methods: The magnetic resonance imagings (MRI) of 202 consecutive patients with NPC treated during 2001-2002 were retrospectively reviewed. Distribution in terms of radiological level (using the same criteria as other head and neck cancers) was mapped, and the size of individual node measured. Prognostic significance of RP-LN and LL was analyzed. Results: Only 4% of patients were node-negative on presentation. The nodal involvement occurred predominately at II (94%), III (85%) and RP-LN (80%). The presence of RP-LN affected the N-category in 3.5% of patients, and had no significant impact on tumor control. Replacing SCF by LL as one of the criteria for defining N3 is predictive for both distant control and overall survival. Conclusions: With sensitive detection by MRI, the incidence of nodal involvement was very high for patients with NPC. It was difficult to isolate the prognostic significance of RP-LN. The current criterion for defining N3-category by extension into SCF or nodal size >6 cm is the recommended standard, however replacing SCF with LL could be potentially useful and further validation is warranted. © 2006 Elsevier Ireland Ltd. All rights reserved.Link_to_subscribed_fulltex

Effect of a twin-herb formula for the Treatment of Chronic Non-healing Ulcers: a Clinical Study

Forty-four patients (27 males and 17 females) with Chronic Non-healing Ulcers that had been refractory to conventional treatment were enrolled in a single arm pre- and post-treatment clinical trial. A twin-herb formula was provided for the treatment for the 6-month study period. All conventional treatment of wound care remained unchanged. Their ulcers were assessed every month. The ulcer sizes greatest length and width was measured at baseline. The target ulcer was assessed at baseline and then every month for 6 months or healed.The mean age of patients was 66.6 (38.0-93.0) years. The mean surface area of ulcers was 28.0±77.1 cm2 and 14.8±55.0 cm2 at baseline and six months of study respectively. Differences in ulcer area between the initial and fi nal visit were signifi cant (p&lt;0.001). The mean healing time was 149 days (median 167 days). Our results showed that the two-herb recipe (NF3) could reduce the wound size about 50% during 6 months period. 36.7% ulcers were healed. No adverse side effects were founded in our patients during study period.The twin-herb formula showed promising results in initiating the healing process in chronic nonhealing ulcers. It was found to be well tolerated and safe to use. However, further clinical trials should be performed involving a control group to verify these data.</p

Genomic and epidemiological evidence of a dominant panton-valentine leucocidin-positive methicillin resistant staphylococcus aureus lineage in Sri Lanka and presence among isolates from the United Kingdom and Australia

Objective: To undertake the first detailed genomic analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolated in Sri Lanka. Methods: A prospective observational study was performed on 94 MRSA isolates collected over a 4 months period from the Anuradhapura Teaching Hospital, Sri Lanka. Screening for mecA, mecC, and the Panton-Valentine leucocidin (PVL)-associated lukS-PV/lukF-PV genes and molecular characterization by spa typing was undertaken. Whole genome sequencing (WGS) and phylogenetic analysis was performed on selected multilocus sequence type (MLST) clonal complex 5 (CC5) isolates from Sri Lanka, England, Australia, and Argentina. Results: All 94 MRSA harbored the mecA gene. Nineteen spa types belonging to nine MLST clonal complexes were identified. Where origin of the sample was recorded, most isolates were from skin and soft tissue infections (70/91; 76.9%), with fewer causing bacteremia (16/91; 17.6%), empyema (3/91; 3.3%) and osteomyelitis (2/91; 2.2%). Sixty two (65.9%) isolates were PVL positive with the majority (56 isolates; 90.3%) belonging to a dominant CC5 lineage. This lineage, PVL-positive ST5-MRSA-IVc, was associated with both community and hospital-onset infections. Based on WGS, representative PVL-positive ST5-MRSA-IVc isolates from Sri Lanka, England and Australia formed a single phylogenetic clade, suggesting wide geographical circulation. Conclusions: We present the most detailed genomic analysis of MRSA isolated in Sri Lanka to date. The analysis identified a PVL-positive ST5-MRSA-IVc that is prevalent among MRSA causing clinical infections in Sri Lanka. Furthermore, this clone was also found among isolates from the United Kingdom and Australia

Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 trial by the Hong Kong Nasopharyngeal Cancer Study Group

Purpose: This randomized study compared the results achieved by concurrent chemoradiotherapy (CRT) versus radiotherapy (RT) alone for nasopharyngeal carcinoma (NPC) with advanced nodal disease. Patients and Methods: Patients with nonkeratinizing/undifferentiated NPC staged T1-4N2-3M0 were randomized to CRT or RT. Both arms were treated with the same RT technique and dose fractionation. The CRT patients were given cisplatin 100 mg/m2 on days 1, 22, and 43, followed by cisplatin 80 mg/m2 and fluorouracil 1,000 mg/m 2/d for 96 hours starting on days 71, 99, and 127. Results: From 1999 to January 2004, 348 eligible patients were randomly assigned; the median follow-up was 2.3 years. The two arms were well-balanced in all prognostic factors and RT parameters. The CRT arm achieved significantly higher failure-free survival (72% v 62% at 3-year, P = .027), mostly as a result of an improvement in locoregional control (92% v 82%, P = .005). However, distant control did not improve significantly (76% v 73%, P = .47), and the overall survival rates were almost identical (78% v 78%, P = .97). In addition, the CRT arm had significantly more acute toxicities (84% v 53%, P < .001) and late toxicities (28% v 13% at 3-year, P = .024). Conclusion: Preliminary results confirmed that CRT could significantly improve tumor control, particularly at locoregional sites. However, there was significant increase in the risk of toxicities and no early gain in overall survival. Longer follow-up is needed to confirm the ultimate therapeutic ratio. © 2005 by American Society of Clinical Oncology.Link_to_subscribed_fulltex