Introduction:Vascular anomalies, regardless of tumour or malformation, may result in significant morbidity. Thediagnosis of vascular anomalies in the paediatric group is always challenging. We aim to describe thepattern of vascular anomalies referred to the Paediatric Institute Kuala Lumpur Hospital (PIKLH).Methods:This is a 3-year retrospective review on vascular anomalies among children referred to PIKLH between2013 and 2015.Results:There were 289 children; male to female ratio of 1:2.1; aged from birth to 14 years with median age of5 months recruited. The referring diagnoses included haemangioma (71.3%), capillary malformation(13.8%), lymphatic malformation (1.7%), kaposiform hemangioendothelioma (1.0%) and others. Ahundred and sixty-one (55.7%) had lesions located at the head and neck region, followed by trunk(14.2%), lower limbs (9.3%), upper limbs (7.6%), perineum (3.8%) and multiple sites (6.9%). In 197patients (68.2%), there were no further investigations performed, 13.5% had ultrasonography, 7.3%had MRI, 4.8% had both ultrasonography and MRI; 4.1% had skin biopsy, 0.3% had angiogram.The final diagnoses were haemangioma (72.3%) of which 10 were ulcerated; capillary malformations(17.6%), combined vascular malformations (2.4%), kaposiform hemangioendothelioma (2.8%),lymphatic malformations (2.1%); venous malformations (1.4%); tufted angioma (1.0%) andarteriovenous malformations (0.3%). One hundred and nine patients (37.7%) received beta-blockers;71(24.6%) underwent laser, 16(5.5%) received sirolimus, 9(3.1%) received systemic corticosteroidswith vincristine, 4(1.4%) had systemic corticosteroids, 3(1.0%) had excision and 2(0.7%) hadsclerotherapy. The remaining patients were put under observation.Conclusion:Three-quarters of the vascular anomalies referred were hemangioma followed by vascularmalformations. Vascular anomalies have a large variation in clinical presentation. Expertise inthe diagnosis and management modalities are essential to achieve optimum outcomes. Thereforevascular anomalies are best managed in a multidisciplinary setting.

INTRODUCTIONThis study investigated the responses of plasma endotoxin and pro- and antiinflammatory cytokines during a 21-km road race in warm and humid conditions. The influence of carbohydrate-electrolyte (CE)-water (WA) drink mix ingested on leukocyte subset responses and the association between plasma lipopolysaccharide (LPS) concentration and fluid balance, exercise intensity, and body core temperature (Tc) were also studied.

MATERIALS AND METHODSThirty runners provided blood samples before and after the half-marathon for leukocyte, LPS and cytokine analyses. Tc was measured by the ingestible telemetric temperature sensor and fluid intake and split-times were recorded at 3 km intervals. Exercise intensity was determined by matching running speed and heart rate during the race with the corresponding speed-oxygen uptake relationship and heart rate measured in the laboratory 2 to 6 weeks before the race.

RESULTSPlasma LPS concentration increased from 1.9 +/- 1.9 pg/mL before, to 2.5 +/- 1.9 pg/mL after running (P <0.05). Peak plasma LPS concentration was 7.5 pg/mL. Plasma IL-1beta and TNF-concentration did not change significantly, whereas significant increases in IL-10 (50%), IL-1ra (23.2%) and IL-6 (65.2%) were observed after the race. No significant correlation between plasma LPS concentration and exercise intensity, hydration and Tc was observed.

CONCLUSIONLeukocyte subset responses were not related to the ratio of CE and water drink mix ingested. Running a half-marathon can induce mild endotoxaemia, which is not related to exercise intensity, fluid balance, and Tc responses. Mixing CE drink with water did not mitigate postexercise leukocytosis and lymphopenia.

Adult ; Beverages ; Cytokines ; immunology ; Endotoxins ; blood ; immunology ; Fluid Therapy ; Hot Temperature ; Humans ; Humidity ; Leukocytes ; immunology ; Lipopolysaccharides ; immunology ; Male ; Physical Exertion ; physiology ; Running ; physiology

Introduction:Patch test is the gold standard diagnostic test for contact allergy. Periodic analysis of the trend ofcontact allergy provides a valuable guide to clinicians. We aim to study the pattern of contact allergyin adults at Hospital Selayang.Methods:This is a retrospective review of patch test data in adults suspected with allergic contact dermatitisbetween January 2011 and December 2013 at Hospital Selayang.Results:There were 705 subjects with 247 males (35%) and 458 females (65%). At least 1 positive reactionwas detected in 546 (77.4%) subjects patch tested with European Baseline Series (EBS) and additionalseries. The top 5 common allergens in the EBS were nickel sulfate (28.7%), cobalt chloride (13.6%),paraben mix (11.6%), balsam of peru (10.6%), and potassium dichromate (10.5%). Among thosepatch tested with rubber additives series, the top 3 allergens were N,N-Diphenylguanidine (DPG),N-Cyclohexyl-N-phenyl-4-phenylenediamine (CPPD), and N-Cyclohexylthiophthalimide. Of thetop 5 common allergens in the group tested with fragrance series, all except Ylang ylang oil werecomponents of fragrance mix I. Among the subjects tested with fragrance series, the top 5 commonallergens were individual components of fragrance mix I and Ylang ylang oil.Conclusion:A multicentre study would reflect better the pattern of allergen exposure of the nation. Furtherevaluation of the prevalence of contact allergy to DPG, CPPD, N-Cyclohexylthiophthalimide andYlang ylang oil would guide the need to incorporate these allergens in routine testing along with EBS.

Allergic contact dermatitis affects 15 to 20% of the population. The pattern of contact allergy varies across nations. Therefore, many countries utilize their unique individual baseline series for patch testing. In this study, we aimed to assess the outcome of rubber and fragrance allergy detection with the addition of 1,3-Diphenylguanidine. N-Cyclohexyl-N-Phenyl-4-Phenylenediamine, N-Cyclohexylthiophthalimide and Ylang ylang oil.

Summary Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg-Strauss Syndrome (CSS) is a rare granulomatous necrotizing vasculitic disease characterized by the presence of asthma, sinusitis, and hypereosinophilia. We describe a patient who was initially diagnosed with tuberculous lymphadenitis and later diagnosed with EGPA.
Granulomatosis with Polyangiitis ; Tuberculosis, Cutaneous ; Tuberculosis, Lymph Node