Antibiotic-resistant P. acnes is prevalent in Hong Kong. Dermatologists should be more vigilant in prescribing antibiotics for acne patients.

The attribution of individual human papillomavirus (HPV) types to cervical neoplasia, especially intraepithelial lesions, varies ethnogeographically. Population-specific data are required for vaccine cost-effectiveness assessment and type replacement monitoring. HPV was detected from 2,790 Chinese women (444 invasive cervical cancers [ICC], 772 cervical intraepithelial neoplasia [CIN] grade 3, 805 CIN2 and 769 CIN1. The attribution of each HPV type found in multiple-type infections was approximated by the fractional contribution approach. Multiple-type infection was common and correlated inversely with lesion severity (54.7% for CIN1, 48.7% for CIN2, 46.2% for CIN3, 27.5% for ICC). Vaccine-covered high-risk types (HPV16/18) attributed to 59.5% of squamous cell carcinoma, 78.6% of adenocarcinoma, 35.9% of CIN3, 18.4% of CIN2 and 7.4% of CIN1. Distinct features compared to worldwide were a higher attribution of HPV52 and HPV58, and a much lower attribution of HPV45. Inclusion of HPV52 and HPV58 in future vaccines would provide the highest marginal increase in coverage with 11.7% for squamous cell carcinoma, 14.4% for CIN3, 22.6% for CIN2 and 17.7% for CIN1. The attribution of HPV types in southern China is different from elsewhere, which should be considered in prioritizing HPV types for vaccine and screening assay development.Cervical cancer is the third most common cancer in women worldwide. 1 Infection with human papillomavirus (HPV) is a necessary, though insufficient, cause of cervical cancer. [2][3][4][5] More than 40 different types of HPV have been detected from the female genital tract, and 15 of them (HPV16,18,31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82) are classified as high-risk based on the epidemiological association with development of cervical cancer. [6][7][8] Two prophylactic vaccines (Cervarix TM by GlaxoSmithKline, United Kingdom; and Gardasil TM by Merck Sharp and Dohme, NJ USA) are currently available for prevention of HPV infection and the subsequent development of cervical neoplasia. Worldwide, about 70-80% of invasive cervical cancers are caused by HPV16 and HPV18, which are covered by both vaccines. 9-12 However, the distribution of non-16/18 HPV types especially among cervical intraepithelial neoplasia varies markedly by geographic region. [13][14][15][16] A population-specific assessment on the prevalence, more importantly the attribution, of each HPV type is essential for policy makers to evaluate the population benefits and cost-effectiveness of the current and next generation vaccines. Such data is also necessary for formulating an HPV-based screening strategy, especially for deciding the spectrum of HPV types to be covered. Furthermore, data acquired before the widespread administration of HPV vaccine is a crucial baseline for monitoring the effectiveness of vaccination at the population level and for detecting HPV type replacement if it ever occurs.

No abstract

Various types of dressings have been used successfully in the treatment of atopic dermatitis. In this study we looked at the efficacy of two of the newer topical steroids when applied under wet wrap dressings for the treatment of refractory atopic dermatitis in children. Forty children with moderate to severe disease were randomized to receive either one‐tenth‐strength diluted 0.1% mometasone furoate ointment or one‐tenth‐strength diluted 0.005% fluticasone proprionate ointment. These were applied once a day over a 4‐week period without wet wraps, or for 2 weeks without wet wraps followed by 2 weeks of application under wet wraps. There was a 2‐week period for all patients when the topical treatment was standardized. At weekly follow‐ups, patients were assessed by a single, blinded observer and objectively scored for disease extent and severity. A subjective score was also given for the impact of eczema on daily living. There was significant improvement in the disease severity from baseline during the first 2 weeks of the open application arm (p=0.043), however, additional beneficial effects were limited after week 2. Wet wraps further improved the disease severity and extent after week 2 (p < 0.05), and were well tolerated. We concluded that both 0.1% mometasone furoate and 0.005% fluticasone proprionate ointments are effective in the treatment of atopic dermatitis, and that wet wraps are useful in further improving refractory disease in children.

Neisseria gonorrhoeae infections have been empirically treated in Hong Kong with a single oral 400-mg dose of ceftibuten since 1997. Following anecdotal reports of the treatment failure of gonorrhea with oral extended-spectrum cephalosporins, the current study was undertaken to determine the antimicrobial susceptibility pattern and molecular characteristics of isolates of N. gonorrhoeae among patients with putative treatment failure in a sexually transmitted disease clinic setting. Between October 2006 and August 2007, 44 isolates of N. gonorrhoeae were studied from patients identified clinically to have treatment failure with empirical ceftibuten. The ceftibuten MICs for three strains were found to have been 8 mg/liter. These strains were determined by N. gonorrhoeae multiantigen sequence typing to belong to sequence type 835 (ST835) or the closely related ST2469. The testing of an additional eight archived ST835 strains revealed similarly elevated ceftibuten MICs. The penA gene sequences of these 11 isolates all had the mosaic pattern previously described as pattern X. Of note is that the ceftriaxone susceptibility results of these strains all fell within the susceptible range. It is concluded that ceftibuten resistance may contribute to the empirical treatment failure of gonorrhea caused by strains harboring the mosaic penA gene, which confers reduced susceptibility to oral extended-spectrum cephalosporins. Screening for such resistance in the routine clinical laboratory may be undertaken by the disk diffusion test. The continued monitoring of antimicrobial resistance and molecular characteristics of N. gonorrhoeae isolates is important to ensure that control and prevention strategies remain effective.