1.Delay and misdiagnosis in adult myasthenia gravis: A case report
Siew Kim Kwa ; Zainab Abdul Majeed ; Kah Nian Tan
International e-Journal of Science, Medicine and Education 2016;10(3):37-39
Myasthenia gravis (MG) is a rare autoimmune disorder
characterised by fluctuating and variable combination
of muscle weakness and fatigue. Most cases are due to
T-cell mediated autoantibodies against post-synaptic
acetylcholine receptors (AChR-Ab), thus preventing
acetylcholine from binding and signalling skeletal
muscle to contract.
1
The annual incidence is 7-23 new cases per million.
1
It can occur at any age but with two peaks; an early-
onset (20-40 years) female-predominant and a late-onset
(60-80 years) male-predominant peak. MG is classified
into ocular and generalised (80%). More than half the
patients initially present with ptosis and diplopia but half
will progress to generalised disease with involvement of
bulbar, limb and respiratory weakness. Those presenting
as generalised MG can also develop eye signs later.
1
It is important to recognise MG early because it is
highly treatable. Untreated disease leads to permanent
weakness.
2
Treatment reduces mortality from life-
threatening myasthenic crisis.
1,3
Misdiagnosis leads to
potentially harmful interventions and inappropriate
management.
4,5
Diagnosis in late-onset MG is easily
missed
2,3,4,5
because of overlapping symptoms with
other diseases common in the elderly. We report a case
of delay and misdiagnosis in an elderly patient with
co-morbidities.
Myasthenia Gravis
2.Association between human leukocyte antigen DQB1 gene polymorphisms and bronchial asthma among Mongolia and Han nationalities
Liying CUI ; Ying NIAN ; Jie TAN ; Hong SUO ; Xiuyun Lü ; Tianji ZHU ; Hui REN
Chinese Journal of General Practitioners 2010;09(9):619-623
Objective To investigate association between human leukocyte antigen DQB1 (HLADQB1 ) gene polymorphisms and bronchial asthma among Mongolian and Han nationalities. Methods Sequence-specific primer polymerase chain reaction (PCR-SSP) was used to detect frequencies of HLA DQB1 genotypes and alleles in 50 cases of Han and 68 Mongolian asthmatic patients, and 50 Han and 54 Mongolian healthy controls, respectively. Difference in gene frequencies between the two nationalities was estimated by odds ratio (OR) and chi-square test. Results Frequency of the HLA-DQB1 0602 allele was significantly higher in Han patients with bronchial asthma than that in healthy Han nationality (OR = 6.163,P <0.01 ). Frequency of the HLA-DQB1 0603/0608 allele decreased in Mongolian asthmatic patients, as compared to that in healthy Mongolians ( OR = 0.199, P < 0.05 ). Frequency of the HLA-DQB1 0301/4 allele was significantly higher in Mongolian asthmatic patients as compared to that in healthy Mongolians ( OR =2.074,P <0.05). Frequency of the HLA-DQB1 0301/4 allele was significantly higher in Mongolian than that in Han asthmatic patients ( OR = 2.482 ,P =0.05). Frequency of the HLA- DQB1 0602 allele was significantly higher in healthy Mongolians than that in healthy Han nationality ( OR = 3.341, P < 0.05 ), in contrast, frequency of the HLA-DQB1 0402 allele was significantly lower in healthy Mongolians than that in healthy Han nationality ( OR = 0.209, P < 0.05 ). Conclusions The HLA-DQB1 0603/0608 allele is possibly a protective gene and the HLA-DQB1 0301/4 allele a susceptible gene for bronchial asthma in Mongolians, and the HLA-DQB1 0602 allele is possibly a susceptible gene for bronchial asthma in Han nationlity.
3.Total intravenous anesthesia for liver resections: anesthetic implications and safety
Selene Yan Ling TAN ; Nian Chih HWANG
Korean Journal of Anesthesiology 2022;75(5):363-370
Inhalational anesthetics have been the default agents for general anesthesia maintenance for several decades. However, with advances in total intravenous anesthesia (TIVA) and a growing body of evidence on the potential benefits of TIVA, anesthesiologists need to question this paradigm. Some of the benefits of propofol-based TIVA, such as its antiemetic properties and patients’ smooth emergence, are widely acknowledged. A growing body of evidence suggests that TIVA may potentially benefit the immune system and cancer outcomes. From an existential health perspective, there is evidence that inhalational agents have a materially higher global warming potential than propofol-based TIVA. Despite the compelling potential benefits of propofol-based TIVA, there are barriers to its widespread adoption. To examine the applicability of TIVA as a mainstay agent more rigorously, we discuss the safety and applicability of propofol-based TIVA in the context of complex major abdominal surgery, specifically, liver resection surgery. We also discuss the use of propofol-based TIVA in liver resection surgery with a broad, integrated approach, addressing general and specific clinical considerations, economic factors, and operating room turnover.
4.Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein
Wen Nian TAN ; Arvin RAJADURAI ; Dhayal BALAKRISHNAN
Neurointervention 2021;16(2):194-198
Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an arteriovenous shunt where there is fistulous blood flow from the dural arteries from the internal or external carotid artery into the cavernous sinus. The current mainstay of therapy is endovascular treatment. We present a case of restrictive type of CS-DAVF in a 75-year-old male who presented with right eye symptoms. He was treated with embolisation using trans-radial artery access for angiographic runs and a median cubital vein access navigating into the cavernous sinus for coil deployment. This technique completely avoids the conventional technique of a femoral approach and confines all access to the arm. Therefore, there are less risks and complications associated with an arm access, improves patients’ comfort and mobility post procedure. Transradial artery and cubital vein access allows for a safe and convenient alternative technique using the arm as compared with conventional transfemoral approach for treatment of CS-DAVF.
5.The Association Between Bullous Pemphigoid and Neurological Disorders in A Selected Malaysian Population
Zhenli Kwan ; Yit Nian Lai ; Chin Chwen Ch’ng ; Ai Huey Tan ; Leng Leng
The Medical Journal of Malaysia 2015;70(2):81-85
Background: An association of bullous pemphigoid with
neurological disorders has been reported. The objectives of
this study were to review the clinical characteristics of
patients with bullous pemphigoid and compare the
association between bullous pemphigoid and various
neurological disorders and comorbidities.
Methods: This was a retrospective case-control study
involving 43 patients with bullous pemphigoid and 43 age-,
sex- and ethnicity-matched controls.
Results: There was a statistically significant association
between bullous pemphigoid and neurological disorders
[Odds Ratio (OR) = 3.5, 95% Confidence Interval (CI) 1.3 to
9.2, p=0.011 and adjusted OR=3.5, 95% CI 1.2-10.3, p=0.026],
in particular for dementia (p=0.002). Although stroke was
more common among patients with bullous pemphigoid,
this association was not statistically significant with OR of
1.9 (95% CI 0.7 to 5.2) and adjusted OR of 2.1 (95% CI 0.6 to
7.2). Similarly both ischaemic stroke (OR 1.5, 95% CI 0.5 to
4.2) and haemorrhagic stroke (OR 1.5, 95% CI 0.2 to 9.7) were
more common. Other neurological disorders more common
among patients with bullous pemphigoid were Parkinson’s
disease and epilepsy. Dyslipidaemia was significantly less
common among patients with bullous pemphigoid (OR 0.4,
95% CI 0.1 to 0.9, p=0.033).
Conclusion: A combination of an inflammatory process,
prothrombotic state and endothelial activation leads to an
increased frequency of neurological disorders among
patients with bullous pemphigoid. Thus, a holistic approach
to patient care, including screening for dementia and control
of comorbidities, should be practised as bullous
pemphigoid affects more than just the skin.
Pemphigoid, Bullous
6.Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein
Wen Nian TAN ; Arvin RAJADURAI ; Dhayal BALAKRISHNAN
Neurointervention 2021;16(2):194-198
Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an arteriovenous shunt where there is fistulous blood flow from the dural arteries from the internal or external carotid artery into the cavernous sinus. The current mainstay of therapy is endovascular treatment. We present a case of restrictive type of CS-DAVF in a 75-year-old male who presented with right eye symptoms. He was treated with embolisation using trans-radial artery access for angiographic runs and a median cubital vein access navigating into the cavernous sinus for coil deployment. This technique completely avoids the conventional technique of a femoral approach and confines all access to the arm. Therefore, there are less risks and complications associated with an arm access, improves patients’ comfort and mobility post procedure. Transradial artery and cubital vein access allows for a safe and convenient alternative technique using the arm as compared with conventional transfemoral approach for treatment of CS-DAVF.
7.Characteristics and the estimated size of men who have sex with men in different venues of one city
Hao CHEN ; Yan-Hui ZHANG ; Hong-Zhuan TAN ; Yu-Gang BAO ; Meng-Shi CHEN ; Dan LIN ; Nian-Nian CHEN
Chinese Journal of Epidemiology 2011;32(7):664-668
Objective To study the features,safe Sex behavior and the size of men who have sex with men(MSM)population in actuaI and virtual venues in one city.Methods We carried out a cross-sectional study in actual and virtual venues,using the Estimated Size of Population from a Single Sample(LMS method)to estimate the size of MSM population.Results Most MSM in actual venues were 24-43 year olds and had received high school education,whereas in virtual venues,the majority of this population were younger than 29 years old and had higher education,including some college students.The awareness of AIDS of the two groups from different venues showed no statistically significant difierence,neither the safe sex behaviors.Proportions of the MSM population in actual and virtuaI venues were 21.22%(16 383,95%CI:11514-21252)and 78.78%(60830,95%CI:57327-64329),respectively.After adjusting the overlapping part of the MSM from both venues,the total number was between 60 830 and 77213,constituting a proportion of 5.03%-6.38%in the sexually active male population(15-64 year olds)in this city.Conclusion The size of the MSM population was large but the characteristics were different in the actual or virtual venues.As most MSM preferred going to the virtual venues,intervention program on AIDS-specific strategy in this area,in particular dealing with the Internet,should be strenthened.
8.Role of hepatitis B virus infection in pathogenesis of IgA nephropathy.
Nian-song WANG ; Zhao-long WU ; Yue-e ZHANG ; Mu-yi GUO ; Lü-tan LIAO
Chinese Journal of Preventive Medicine 2003;37(1):37-40
OBJECTIVETo clarify the relationship between hepatitis B virus (HBV) infection and IgA nephropathy (IgAN).
METHODSHBV antigen (HBAg) in renal tissues of the patients with IgAN was detected by immunohistochemical technique, the carrier status and localization of HBV DNA in renal tissues were determined by Southern blot analysis and in situ hybridization.
RESULTSSerum HBsAg was detected in 18 of the 100 patients with IgAN (18%), HBAg was detected in 31 of 100 patients (31%) in their renal tissue and in 20 of 31 patients (65%) in their glomeruli, and both HBsAg and HBcAg were detected in 10 of 31 patients (32%), respectively. HBcAg was also found in tubular epithelia (45%, 14/31) and renal interstitium (6%, 2/31), respectively. Five of six cases were proved to be positive of integrated-form HBV DNA in their renal tissue by Southern blot analysis. In situ hybridization demonstrated that HBV DNA was 8/8 and 6/8 positive in their renal tubules and glomeruli of all eight specimens, localized in the nucleus of tubular epithelial cells, glomerular mesangial cells, as well as infiltrated interstitial lymphocytes.
CONCLUSIONHBV infection closely related with IgAN and HBV infection might be involved in pathogenesis of IgAN.
Adolescent ; Adult ; Female ; Glomerulonephritis, IGA ; complications ; virology ; Hepatitis B ; complications ; Hepatitis B Antigens ; analysis ; Hepatitis B virus ; isolation & purification ; Humans ; Male ; Middle Aged
9.Experimental study on the survival of venous flap with different pedicle styles.
Shan-zhang TAN ; Ji ZHANG ; Hui WANG ; Nian CHEN ; Yan FU ; Da-li ZHANG
Chinese Journal of Plastic Surgery 2006;22(3):196-199
OBJECTIVETo study a new method of venous flap that is improved on its persistence and quality.
METHODSNew Zealand white rabbits were subdivided randomly into 4 groups. All rabbits were operated by harvesting a flap from the latero-abdominal wall and then sutured it in the original position. Group A: the superficial epigastric vein in the pedicle was left open (only one inflow vein remained). Group B: the pedicle vein of the proximal and distant end were left open (keeping an inflow vein and a principal out). Group C: the pedicle vein and a tributary vein were left open (keeping an inflow vein and a tributary outflow vein). Group D: the pedicle vein and two tributary veins were left open (keeping an inflow vein and two tributary outflow veins). Survival rate, MDA of the tissue, histology and ultra-microstructure were examined.
RESULTSSurvival rate of A, B, C, D were improved in order. Statistic difference is significant (P < 0.05) between group and group other than C and D. The content of MDA was heightened with statistically significant differences (A > B > C > D) among the four groups 8 hours postoperatively, but fell back to the normal level in group D and C and kept a high level in group A and B at 72 hour postoperatively. Histology and ultra-microstructure exam showed that degeneration of collagen fiber and karyopyknosis of cell is more obvious in Group A and Group B than Group C and Group D.
CONCLUSIONSThe higher survival rate of venous flap is possible by designing the more reasonable venous flap outputs pedicles which can alleviate the high tension dropsy and maintain the valid equilibrium of pour with flow in the venous flap.
Animals ; Graft Survival ; Rabbits ; Surgical Flaps ; blood supply ; Veins ; transplantation
10.Expression features of P-glycoprotein, glutathione S transferase-pi and inhibitor of apoptosis proteins in lymph node metastases of gastrointestinal carcinomas.
Jie HAN ; Bi-bo TAN ; An-feng WANG ; Bing-rong LÜ ; Wei GENG ; Jian-hui ZHAO ; Chun-nian HE
Chinese Journal of Surgery 2009;47(2):106-108
OBJECTIVETo investigate the expression features of P-glycoprotein (P-gp), glutathione S transferase-pi (GST-pi) and inhibitor of apoptosis proteins like p53, survivin and bcl-2 in lymph node metastases of gastrointestinal carcinomas.
METHODSThe expression of P-gp, GST-pi, p53, survivin and bcl-2 were determined by using immunohistochemistry technique in surgical specimens of primary tumor (PT) and lymph node metastases (LNMs) from 54 gastrointestinal cancer patients with metastasis of lymph nodes. The expression difference of 5 multi-drug resistance (MDR)-related factors between LNMs and PT were compared.
RESULTSSignificant difference was found in the expression of P-gp and GST-pi between the two groups (both P < 0.05), and expression of p53 and bcl-2 showed positive correlation between LNMs and PT (r = 0.7248, 0.5524; both P < 0.05), respectively. In LNMs, P-gp expression was positively correlated with GST-pi (r = 0.4062, P < 0.05) and survivin (r = 0.6169, P < 0.05), and also GST-pi expression was related positively with survivin (r = 0.4027, P < 0.05). Statistically positive correlations were noted between bcl-2 and P-gp (r = 0.3986, P < 0.05), bcl-2 and survivin (r = 0.2937, P < 0.05), as well as GST-pi and survivin (r = 0.4481, P < 0.01) in PT. Only a positive correlation between GST-pi and survivin expression was simultaneously shown in both LNMs and PT.
CONCLUSIONSThere is significant heterogeneity of MDR-related factors expression in LNMs of gastrointestinal carcinomas. Effective adjuvant chemotherapy after operation should target on the metastatic loci of the disease.
ATP-Binding Cassette, Sub-Family B, Member 1 ; metabolism ; Adult ; Aged ; Aged, 80 and over ; Digestive System Neoplasms ; metabolism ; pathology ; Female ; Glutathione S-Transferase pi ; metabolism ; Humans ; Inhibitor of Apoptosis Proteins ; Lymph Nodes ; metabolism ; pathology ; Lymphatic Metastasis ; Male ; Microtubule-Associated Proteins ; metabolism ; Middle Aged ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Tumor Suppressor Protein p53 ; metabolism