關於 prevent hpv ，我們在網路上蒐集到這些相關的討論、資訊與評價

Novavax 的防護力報告出爐！

PREVENT-19 trial
Novavax

美國Novavax宣佈，經過第 3 期臨床實驗，證明所研發的新冠疫苗安全及總體效力達 90.4%，並在注射兩劑 Novavax 疫苗後，可以 100% 預防新冠肺炎中度和重症，而且對抗某些變種病毒效力高達 93%，

疫苗名：NVX-CoV2372
Age > 18, 排除懷孕及使用免疫抑制者

為評估效力、安全性和免疫原性（Immunogenicity），第 3 期臨床實驗從美國、墨西哥 119 個地點招募 29,960 名受試者，總計有 77 名確診患者對疫苗有反應，其中 63 名患者接種的是安慰劑，而其餘 14 名患者接種兩劑 Novavax 疫苗，因此估計疫苗效力約為 90.4%。

#整體防護力: 90.4% (95% CI: 82.9-94.6)
#中重症防護力: 100% (95% CI: 87-100)

#針對VoC/VoI的防護力為93.2% (95% CI 83.9-97.1)

#針對65歲以上或65歲以下有共病者，防護力為91.0% (95% CI 83.6-95.0)

Novavax 採用的蛋白質次單位技術，與高端、聯亞疫苗相同，因為沒有活病毒進入人體，安全性較高，包含 B 肝疫苗、人類乳突病毒（HPV）疫苗都屬於該類型疫苗。

VoC, VoI的定義，在此⬇️⬇️
https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html

資料來源：

https://ir.novavax.com/news-releases/news-release-details/novavax-covid-19-vaccine-demonstrates-90-overall-efficacy-and

https://www.nih.gov/news-events/news-releases/us-clinical-trial-results-show-novavax-vaccine-safe-prevents-covid-19

講CUHK單嘢都講到口臭，今日想講下現代醫學急速發展，科學醫學基因學一日千里後對醫學院學生同初級醫生嘅影響

拿，頭盔，我唔係故意要同senior們作對，而係有d好重要嘅概念我覺得一路都無人address過。而醫學界仍然有股好重嘅「當年都係咁捱咁讀，點解你咁多意見」嘅風氣

的確，當年前輩們嘅非人on call生活、要去library睇文獻睇書而唔係方便地用Microsoft surface神速打筆記、開uptodate、開pubmed/medline等等。

無可否認，上個年前代嘅醫生們要增進知識要靠嘅自動波去睇論文去溫書，甚至要自己去R導師做臨床教學等等。無人否認當年環境無咁豐富，上堂無精美PowerPoint、臨床教學今時今日已經好structured，分哂history session, examination session, skills session，有像真度極高嘅假人俾你練習，呢d係上代無嘅luxuries

No one is denying this fact

但上一代都一樣無嘅係咩，大家有無諗過？

就係千千萬萬種過去20年發展出來嘅科學醫學理論同治療方法。

O&G 幾十年前都未知道preeclampsia嘅實際原因係乜，原來可以early pregnancy low dose aspirin prevent or delay onset of preeclampsia。廿年前都無HPV疫苗, 都無話原來screen HPV virology比Pap smears更有效發現子宮頸病變，廿年前無人需要知道呢d

Rheumatology幾十年都無一堆biologics, TNFa, IL inhibitor 。原來autoimmune inflammatory arthritis failed NSAID/MTX可以轉infliximab, adalimumab。psoriatic可以用secukinumab但如果有IBD/enteropathic features要小心IL-17 inhibitor，廿前年無人需要知道呢d

Immunology/ID，幾十年前HIV邊有咁多種antiretroviral？今時今日ART多到就算你de novo resistance都可以換藥換到U=U，廿年前都係得舊式治療，無人需要知種種嘅新式療法。immunology仲多咗幾十種唔同嘅complement, complement inhibitor etc etc嘅investigation

Respiratory醫ILD或pulmonary HTN幾十年前個療法來來去去都係得幾種。今時今日IPF有nintedanib，Pul HTN有成堆endothelin antagonist、PDE5 inhibitor同prostacyclin類嘅藥要知。asthma當年來來去去都係ventolin+inhaled/oral steroid，今時今日分埋IgE asthma, eosinophilic asthma，有成堆唔同嘅SABA-LABA, SAMA-LAMA, IgE monoclonal antibodies, IL-5, IL-4 and IL-13，到底eosinophil要幾多先會大機會有response，用緊steroid嘅eosinophil個cutoff係幾多。

Hematology/oncology幾十年前都未有monoclonal antibodies，無rituximab、nivolumab、targeted therapy等等，幾十年來個發現多咗好多唔同gene mutation同targeted site，EGFR, VEGFR, CTLA-4, PD-1，PD-L1、BRAF，HER-2, you name it you got it。以前癌症病人你大多只要beware of neutropenic fever/infection，今時今日你要screen埋immune checkpoint inhibitor autoimmune hepatitis, pneumonitis, thyroditis, colitis，你要知埋有個病人用緊nivolumab時突然變黃，你要screen咩autoimmune，落咩藥，high dose steroid定點，之後仲可唔可以rechallenge。乳癌病人HER-2依加唔止用herceptin，仲有埋pertuzumab，你仲要screen埋cardiomyopathy，echo drop幾多可以接受，係唔係reversible，可唔可以rechallenge

Endocrine幾十年前糖尿病來來去去都係metformin, gliclazide, insulin今時今日T2DM有GLP-1, SGLT-2, gliptin等等，有埋continuous glucose monitoring device又有bump又有唔同林林總總嘅治療。唔止T1/T2DM，今時今日仲有埋LADA，你要知埋個autoimmune panel screen咩。骨質疏鬆當年玩來玩去都係bisphosphonate，今時今日有denusumab有teriparatide，仲有更多新藥。

Gastroenterology幾十年前IBD來來去去都係steroid/steroid sparing agent 5-ASA/aza，今時今日有TNFa blocker有a4b7 inhibitor vedolizumab。當年hepC得幾種antiviral今時今日有sofosbuvir, velpatasvir, glecaprevir等等，仲變成curative。

Neurology MS幾十年前邊有natalizumab，今時今日如果MS on natalizumab with rapid neurological decline，你要諗埋會唔會可能係JC virus reactivation。GBM以前都係只靠surgical resection，今時今日可以用avastin, temozolomide仲要screen埋MGMT hypermethylation去決定有無得用chemo

呢啲改變同發展只係佔各system嘅一小部分，只係我細小嘅腦袋突然諗到嘅小部分內容。世界不斷發展，學海無涯，我們有愈來愈多嘅知識要學，呢一點無人懷疑過。

醫生擁有比一般人更多嘅權力同地位，就自然需要更大嘅責任。

但係，值得大家反思嘅係，當個knowledge base不斷擴大嘅時候，考試仍然要期望你記埋某張slide嘅角落嘅minute details時，呢個係唔係一個合理嘅期望？

當一個basic trainee去考PACES/long case嘅時候，到底係唔係同以前一樣要知得咁深入？當深度一樣，而個base不斷widen broaden時，新世代嘅醫生應該如何應對？

而考試嘅範圍似乎未有被address過，呢點好值得我地一齊諗諗

As it's cervical cancer awareness month, it's time for me to remind all you ladies to go for your pap smears or HPV screening. I've just tried this HPV self-sampling test called to test for the presence of HPV which is an important way to prevent cervical cancer other than pap smears and should be done once every 5 years

My thoughts after using it - convenient, painless and easy to sample. So, for those of you who find it a hassle to book an appointment to see a gynaecologist or are afraid of pap smears, this is a good alternative and it is recommended by MOH as a primary screening tool.

#womenshealth #cervicalcancerawareness #cervicalcancer #hpv #endcervicalcancer #womenswellness #DOCxevalynbrush