We report a case of streptococcal pneumonia associated haemolytic uraemic syndrome (SP-HUS) in a 4-year old child. It is a rare complication of invasive streptococcus pneumonia infection. This article touches on the how the patient's mother was unusually calm after hearing the bad news. Factors that could account for her reaction are explored. Other issues triggered by this case were questions on the pathophysiology, clinical features, treatment and prognosis of this complication. We also discussed "catch-up" vaccination for children immunised with the old 7-valent pneumococcal vaccine, early diagnosis of community acquired pneumonia, recognising antibiotic failure and SP-HUS.

Objective To observe the therapeutic effects of intravenous immunoglobulin (IVIG) between the higher dose (1 g/kg) and the lower dose (400 mg/(kg?d)1~3 d) for severe ABO hemolytic disease of newborn. Methods 48 term infants with severe hyperbilirubinemia receiving IVIG were divided into 2 groups. 24 cases in group A with higher dose, while 24 cases in group B with lower dose, another 20 cases without IVIG in the control group C. Phototherapy were used concomitantly for all infants in these 3 groups. The days of life on admission, the days of jaundice appearance, and the peak of serum bilirubin concentration (TB) in each group were macthed. The theraputic effects in TB reduced between each group were compared. Results The infants admitted on the 1st day of life in group A,B,and C were 11, 11, and 8 cases respectively, the range of TB(MTB) in the 3 groups were 230~237?mol/L (13.5~13.9 mg/dl). After treatment, the MTB declined to 203?mol/L (12 mg/dl) in group A within 24hrs, vs 285~316 ?mol/L (17~18 mg/dl) in group B and C,P

Objective To study the IgG antibodies on red cell surface in ABO and Rh-incompatible infants and to evaluate its predictive value for hemolysis. Methods From Nov. 2001 to Jul. 2002,50 full term newborn babies with ABO and Rh incompatibility hemolysis were admitted .They were divided into two groups according to the direct Coombs test(DCT): 38 cases with positive result and 12 cases were negative. Another 30 normal newborns were chosen as control group. Erythrocyte associated IgG,A and M were measured by a flow cytometry (FCM). Results the mean level of concentration of IgG antibodies in positive DCT group was (12.64?16.83)%,while (4.54?2.54)% in negative DCT group ( P 427.5 ?mol/L,IgG was elevated with the increased TSB level. There was a close relationship between the concentration of TSB and IgG ( r =0.678). Conclusion Measurement of erythrocyte surface antigen IgG assists the diagnosis of maternal-fetal incompatible hemolysis,especially when with a positive direct Coombs test result.

Objective To observe the effect of intravenous immune globulin (IVIG) therapy on newborn infants of Rh hemolytic disease. Methods IVIG group (n=14) received conventional treatments including albumin administration and phototherapy with additional IVIG therapy at a daily dose of 400 mg/kg given for 1～5 consecutive days,and control group (n=16) only received conventional treatments. Effects were compared between the two groups. Result There were 25 patients with hyperbilirubinemia caused by Rh hemolytic disease received exchange transfusions. IVIG was infused in 12 cases,100% of them had the total serum bilirubin level dropped down during the treatment before the exchange transfusions, vs 5 (38%) of 13 cases in control group (P

OBJECTIVE:To observe clinical efficacy and safety of tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treatment of elderly patients with local advance esophageal cancer. METHODS:48 cases of local advance esophageal cancer were divided into group A,B and C according to random number table method,with 16 cases in each group according to random number table method. Group A was given 3D-CRT with total dose of 60-66 Gy totnlly for 6-7 weeks;group B was additionally given tegafur gimeracil oteracil potassium 60 mg/(m2·d),bid,on the basis of group A 3 weeks for a course of treatment,until the end of radvotherapy;group C was additionally given thermotherapy on the basis of group B 3 weeks for a course of treatment,until the end of radvotherapy. Clinical efficacy,1-year survival rate,dysphagia,weight and KPS score were compared among 3 groups,and the occurrence of toxic reactions(radioactive esophagitis,radioactive pneumonia, bone marrow suppression and gastrointestinal reaction) were observed in 3 groups. RESULTS:Total effective rate,1-year survival rate and the remission rate of dysphagia of group C were 93.75%,87.50% and 93.75%,which were significantly higher than those of group A(50.00%,50.00% and 56.25%)and B(68.75%,68.75% and 68.75%),with statistical significance(P<0.05). There was no statistical significance in the rate of weight gain and KPS score gain among 3 groups(P>0.05). The incidence of radioactive esophagitis and radioactive pneumonia in group C were significantly lower than in group A and B,with statistical significance(P<0.05);there was no statistical significance in the incidence of gastrointestinal reaction and bone marrow suppression among 3 groups (P>0.05). CONCLUSIONS:Tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treat-ment of elderly patients with local advance esophageal cancer further improves clinical efficacy and survival rate,but shows low inci-dence of toxic reaction.

Objective To investigate the cellular immune state and pathological mechanism of HBV chronic infection by analyzing the cytokines produced by peripheral blood mononuclear cells(PBMCs) of asymptomatic HBV carriers.Methods PBMCs were prepared from diagnosed chronic asymptomatic HBV individuals and cultured in the presence of different antigens and antibodies.The levels of IFN-?,IL-12,TNF-?,TGF-? and IL-10 in the culture supernatants were respectively detected by ELISA.Results The levels of IFN-?,IL-12 were significantly lower than in the counterparts from healthy controls;meanwhile,those of TGF-? and IL-10 were elevated markedly.Neutralization of TGF-? and IL-10 simultaneously restore the IFN-? production from PBMCs of HBV carriers,and exogenous IL-12 in low dose combined with specific HBV antigens promoted IFN-? production.Conclusion Reduction of IL-12 from PBMCs may be the fundamental reason of viral persistence in HBV chronic carriers,combined IL-12 and specific HBV antigen promoted the celluar immunity of PBMCs from HBV carriers.

Objective:To observe the effect of Shuxuetong Injection on unstable angina pectoris in diabetic pa- tients after coronary stent implantation.Method:40 diabetic patients after coronary stent implantation were randomly divid- ed into two groups.The patients in the two groups were treated with basic drugs.17 patients in the controlled group were venously treated with Danshen injection 6 milliliters dissolved in 250 milliliters 0.9% sodium chloride injection once daily. 23 patients in the treatment group were venously treated with Shuxuetong injection 6 milliliters dissolved in 250 milliliters 0.9% sodium chloride injection once a day.The treatment course was fifteen days in both groups.The clinical effect and the frequency of angina attack were observed in both groups.The concentrations of plasma fibrinogen(FBG)and serum C- reactive protein(CRP)were measured before and after the treatment.Result:Compared with those of the controlled group, the frequency of angina attack and the indication of myocardial ischema in electrocardiogram greatly improved(P

To evaluate the inhibiting effect of Homoharringtonine (HHT) on the corneal haze after excimer laser photorefractive keratectomy (PRK) in rabbits. 18 healthy rabbits which underwent PRK were randomly divided into three groups (A, B and C). The refractive degree of ablation was - 10.0DS in each group. Group A was locally treated with a piece of filter paper soaked with 1 mg/mL HHT for 5 min, and then the entire cornea was repeatedly irrigated with balance solution; Group B was dropped with 0.1 mg/mL HHT after PRK for 3 months; Group C was the control group. Corneal haze, histopathology, response, ect. were investigated. The corneal haze was significantly less in group A, while the difference between group B and group C was insignificant. Keratocytes and fibrocytes in corneal stroma were more active up to 3 months in group B and group C. Intraoperative use of topical HHT can reduce corneal haze after PRK in rabbits.
Corneal Opacity/etiology ; Corneal Opacity/*prevention & control ; Endothelium, Corneal/pathology ; Harringtonines/*administration & dosage ; Myopia/*surgery ; Photorefractive Keratectomy/*adverse effects ; Random Allocation

ObjectiveTo investigate the injury mechanism,clinical characteristics and surgical treatments of Segond fracture combined with anterior cruciate ligament (ACL) injury.MethodsNine patients suffering from Segond fracture combined with ACL injury were treated between January 2008 and December 2010.All the patients revealed ACL and medial collateral ligament (MCL) breakage under arthroscopy.Furthermore,one patient was associated with lateral collateral ligament (LCL) breakage and medial meniscus injury,four with medial meniscus tear and two with lateral meniscus tear.All the patients underwent arthroscopic tendon allotransplantation,ACL reconstruction and MCL repair.Besides,synchronous LCL reconstruction was performed in one patient,meniscus suture in three and meniscus plasty in four.Six patients with large Segond fracture fragments were fixed with two hollow lag crews and three with relatively small fracture fragments fixed with one hollow lag crew.ResultsThe mean followup period was 12 months,which showed average postoperative Lysholm score of 59 points and satisfactory clinical outcome.ConclusionsSegond fracture is often combined with ACL injury and is predictive for ACL injury.In ACL reconstruction,large Segond fracture blocks should be reduced and fixed and the combined injuries also should be treated in the same period.

The “patient-centred medical home” is a model of healthcare delivery first conceived in the United States. It seeks to bring the values and principles of family medicine back into focus in this age of subspecialisation and fragmentation of care. This model is based on the following principles: a personal physician, physician-directed medical practice, whole person orientation, coordinated and integrated care, quality and safety, enhanced access to care and appropriate payment. Locally, should this model of care be implemented, a corresponding change in care delivery and funding model is needed. However, the patient-centred medical home has been associated with positive health outcomes at the primary care level in the United States. It will be interesting to see the potential impact on our healthcare system if such a model were to be implemented in Singapore.