Vaccine-induced immune thrombocytopaenia purpura in autologous haematopoietic stem cell transplantation.

Immune Thrombocytopenia Purpura (ITP) secondary to vaccinations is rare, especially after autologous hematopoietic stem cell transplantation (HSCT). A 31-yearold female received autologous HSCT for relapsed Hodgkin Disease, with platelet engraftment at Day+14. One week after receiving second scheduled vaccinations, she developed severe thrombocytopenia (3x109/L) associated with pharyngeal hematoma. Bone marrow (BM) examinations were consistent with ITP, possibly secondary to Influenza vaccine. Platelet increment was poor despite high dose corticosteroids, intravenous immunoglobulin (IVIG), Danazol and Eltrombopag. A repeated BM biopsy was in agreement with ITP. Re-treatment with tapering doses of prednisolone resulted in stable platelet counts at 120x109/L a year later.

Formation of Organic Molecular Nanocrystals under Rigid Confinement with Analysis by Solid State NMR.

Crystallization in rigid confinement is a promising method to obtain organic molecular nanocrystals. However, the crystallization behavior and the related characterization methods are not well studied. Here we present a systematic study of the nucleation of organic molecular nanocrystals in rigid pores. Four different compounds were studied, ibuprofen, fenofibrate, griseofulvin, and indomethacin, which range from simple to complex molecules. Solid-state Nuclear Magnetic Resonance (NMR) was employed to analyse the structure of these compounds inside pores which are difficult to characterize by other analytical methods. We successfully demonstrated the production of nano-crystalline ibuprofen, fenofibrate and griseofulvin in porous silica particles with ~ 40 nm pores. These nanocrystals showed significant enhancement in dissolution rates. These results help advance the fundamental understanding of nucleation under rigid confinement and may lead to potential applications in developing new formulations in the pharmaceutical industry.

Collembola are unlikely to cause human dermatitis.

Abstract There have been several unconfirmed case reports of dermatitis caused by Collembola (springtails). We recently investigated two nurses with dermatitis suspected to be caused by Drepanura Schött (Collembola: Entomobryidae). IgE antibodies to Collembola proteins were not detected in sera from the nurses and skin tests with the Collembola extract and crushed whole Collembola were negative in both the nurses and volunteers. This study suggests that the springtail Drepanura may not cause human dermatitis and that other organisms and organic matter that are also found in the moist environment inhabited by Collembola might instead be responsible.

National Cancer Patient Registry--Haematology Malignancy (NCPR-HM).

Treatment option of Haematological malignancies has expanded over the last decade. The outcome of treatment is expected to be better compare to previously. However, study of treatment outcome for haematological malignancies has not been carried out in Malaysia. The goal of this study is to measure the treatment outcome in patients with haematological malignancy.

Legal issues in the treatment of a violent manic patient in a non-gazetted setting: a case report.

INTRODUCTION: Psychiatrists in non-gazetted treatment settings, like psychiatric wards in restructured general hospitals and private hospitals, face a major problem when psychiatric patients who require admission are either not competent or refuse to consent to admission and treatment, although they are clearly in need of such inpatient management. Admission to the state mental hospital is often refused by their relatives for a number of reasons, like the stigma attached to admission to such a hospital, and the fear that future employment prospects might be affected. CLINICAL PICTURE: Mr X, a manic, violent patient, had no insight into his disorder and refused admission and treatment for his manic episode. He was the head of a large corporation, and his relatives were apprehensive he would make decisions that could jeopardize the company. TREATMENT: He refused oral medication, could not tolerate parenteral haloperidol and had lithium nephrotoxicity. Inpatient electroconvulsive therapy had to be administered, after which he responded satisfactorily. CONCLUSION: The legal implications in this case, like consent for treatment and admission, and ethical issues, are discussed.

A comparative study of the aerobic fitness of 421 healthy adult males in Singapore.

The maximum oxygen consumption (VO2 max) of 421 healthy adult males from three ethnic groups (Chinese, Malay and Indian), aged 25-54 years, was assessed from direct analyses of their expired respiratory gases during all-out runs on a treadmill as a measure of aerobic fitness. The subjects were divided into three age groups: group 1, 25-34 years; group 2, 35-44 years; group 3, 45-54 years. Each group was further subdivided into non-exercisers (NE), non-regular exercisers (NRE) and regular exercisers (RE). Consistently within each age group, regular exercisers produced significantly higher VO2 max values compared to non-regular exercisers and non-exercisers. They also met the VO2 max requirements for heavy physical work and compared favourably with the standards of the National Physical Fitness Award of Singapore and Cooper's aerobic fitness classification standards based on North American males. Non-regular exercisers and non-exercisers only met the VO2 max requirements for moderate physical work and compared poorly in both of the aerobic fitness standards.

A comparative study of the maximum oxygen uptake of regularly exercising and non-exercising health adult men in sedentary occupations.

This study aims to assess and compare the aerobic fitness (max VO2) of 210 healthy adult men in sedentary occupations in Singapore. All the subjects studied were in codes 0 to 2 of the Singapore Standard Occupational Classification, comprising professional, technical, administrative and related workers. Their max VO2 were determined from direct analyses of their expired respiratory gases during an all-out run on a treadmill. Of these 210 men, 71 (33.8 per cent) were recreation-related regular exercisers and their mean max VO2 of 40.9 ml/kg per min STPD (at standard temperature and pressure, dry) and 95 per cent confidence interval of 39.2-42.6 ml/kg per min was significantly higher (p less than 0.001) than that of the remaining 139 men (34.3 ml/kg per min STPD) with 95 per cent confidence intervals of 33.2-35.4 ml/kg per min who were not regular exercisers. The regular exercisers also met the max VO2 requirements for heavy physical work capacity and compared favourably with the recommended standards for aerobic fitness in the National Physical Fitness Award of Singapore as well as Cooper's Standards based on North American men while the non-regular exercisers did not. The study has shown that the recreation-related regular exercise of the study-defined type, intensity, duration and frequency can significantly improve the physical work capacity of healthy adult men in sedentary occupations in Singapore.

Activation of bovine prothrombin as monitored by the clotting assay.

The activation of bovine prothrombin was studied with highly purified clotting factors and using a coagulation assay developed to look at the initial rate of prothrombin conversion as well as the conversion rate over a time course of 75 min. Activation of prothrombin by factor Xa alone was slow. The rate of prothrombin conversion increased markedly with the addition of each of the accessory components Ca2+, phospholipid and bovine factor V, respectively. With the complete prothrombinase complex comprising factor Xa, Ca2+, phospholipid and factor V, the rate increase was about 22,000-fold higher compared to the action of factor Xa and Ca2+ on prothrombin alone. The rates of thrombin formation obtained with activated factor X1 were only about 70% the values obtained with factor X2. The rate of prothrombin activation and the difference between the activities of the activated factors X1 and X2 are discussed.

Distribution of microspheres in plantaris muscles of resting and exercising rats as a function of fiber type.

The purpose of this study was to determine histologically the distribution of microspheres (MSs) (14 micron), and hence the relative distribution of blood flow, in rat plantaris muscle relative to the fiber types (fast-twitch-oxidative-glycolytic [FOG], fast-twitch-glycolytic [FG], and slow-twitch-oxidative [SO]). Three conditions were investigated: 1) preexercise standing; 2) treadmill locomotion at 15 m/min (fast walking); and 3) treadmill locomotion at 60 m/min (moderate galloping). The MS suspension (containing 1 x 10(6) MSs) was infused into the ascending aorta via a catheter in the carotid artery under each of the 3 conditions so that MSs were distributed to the tissues in proportion to their respective blood flows. Sections (20 micron) of the plantaris muscle were cut and assayed for reduced nicotinamide adenine dinucleotide tetrazolium reductase (NADH-TR) and myofibrillar adenosine triphosphatase (ATPase) activities so the fibers could be typed as SO, FOG, or FG. MSs were located in the NADH-TR sections, and the fibers next to the MSs were classified and counted. The observed numbers of fibers of each type in each condition that were adjacent to MSs were compared to the predicted number of adjacent fibers based on the assumption the MSs were randomly distributed in the tissue. This analysis demonstrated that MSs (and blood flows) were preferentially distributed to SO fibers during preexercise, to SO and FOG fibers during slow locomotion, and to FOG fibers during fast locomotion. The data support the contention that blood flow is distributed in muscles of conscious animals as functions of fiber type and exercise intensity.

Prevalence of respiratory illnesses of school children in the industrial, urban and rural areas of Singapore.

An epidemiological survey of 3216 primary school children living in the industrial, urban and rural areas of Singapore revealed a high prevalence of various respiratory symptoms and illnesses, with 13.1% cough, 8.2% wheezy chest, 25.9% blocked/running nose, 4.3% sinusitis, 7.8% asthmatic attacks and 4.1% bronchitis/pneumonia. Differences in the prevalence of respiratory illnesses and lung function tests were observed among children in the three areas, but this could not be accounted for by the varying air pollution levels which have been maintained below the long-term standards set up by WHO. It was probably responsible for the differences noted.

Activation of prothrombin as measured by the conversion of Nalpha-benzoylarginine ethyl ester.

The activation of prothrombin has been studied by using highly purified preparations of activated factor X1 and activated factor X2, factor V and prothrombin. The rate of prothrombin activation was followed using an esterase assay involving the conversion of N alpha-benzoylarginine ethyl ester (BAEE) by thrombin generated in the course of prothrombin activation. The rate of thrombin generation increased by about 26000-fold when factor V and phospholipid were added to prothrombin, factor Xa and calcium. A comparison of the rates of thrombin formation obtained with activated factor X1 and activated factor X2 showed that activated factor X1 had only 70% of the biological activity of activated factor X2. Attempts to explain the rate of prothrombin activation and the difference between the activity of activated factor X1 and activated factor X2 are discussed.

Preparation of bovine blood coagulation factors X1 and X2.

A method is described for the preparation of both Factor X1 and Factor X2 from citrated bovine blood. The proteins from the plasma were first adsorbed on barium citrate by adding barium chloride solution. The precipitate formed was stirred with citrate/NaOH pH 6.9 buffer; barium and other clotting factors were removed by adding ammonium sulphate (up to 30% saturation) to the suspension. The Factor X was then precipitated by 65% ammonium sulphate, after resolution in citrate buffer chromatographed on DEAE-Sephadex and purified by rechromatography on DEAE-Sephadex and DEAE-Sepharose, respectively. This yielded Factor X1 and Factor X2 with respective purifications of about 16 000 and 24 000-fold that of the plasma. The apparent molecular mass of both Factor X1 and Factor X2 was 55 kDa as estimated by the sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Factor X2 had a higher specific biological activity of about 340 000 units/mg compared to that of Factor X1 of about 230 000 units/mg.

Some possible benefits and dangers of non-aerobic exercise in cardiac rehabilitation programmes.

This paper reviews several recent studies on the possible benefits and dangers of non-aerobic exercises in cardiac rehabilitation programmes. It presents the case for including in such programmes, exercises which specifically improve components of overall physical fitness other than aerobic or cardiorespiratory endurance fitness. This is because many of these other components of overall physical fitness are required in the daily lives of patients in cardiac rehabilitation programmes and can best be acquired through non-aerobic exercises. These non-aerobic exercises include judicious callisthenic and isometric exercises to specifically improve on joint flexibility, agility, muscular strength, muscular endurance and coordination.

Y-autosome translocation, gonadal dysgenesis, and gonadoblastoma.

A 5-year-old girl was discovered to have an abnormal karyotype with a translocation involving the Y chromosome. The primary complaint was slight physical growth retardation. Cytogenetic and endocrinologic evaluations were performed. The chromosomal complement exhibited a mosaicism: 45,X,t(Y;18)(q11;p11)/45,X0. The gonads of this patient were typical streaks containing no ova or follicles. A gonadoblastoma was present bilaterally.